Visarpa Chikitsa acc to Acharya Charaka with modern correlation – a review article

/ Academic Research Vol.01, Issue-06, December 2024 / Leave a Comment

Vol.01, Issue-06, December 2024

Author: Dr. Manish Singh Tomar, MD, PhD Ayurveda

Abstract

Visarpa, often translated as erysipelas, cellulitis or herpes zoster in modern medicine, is a severe skin disorder characterized by rapid spreading and inflammation. The ancient Ayurvedic text Charaka Samhita, attributed to Acharya Charaka, provides an extensive account of Visarpa, including its etiology, pathogenesis, classification, clinical features, prognosis, and therapeutic approaches. This article delves into Visarpa Chikitsa (treatment of Visarpa) as outlined in the Charaka Samhita, correlating traditional Ayurvedic concepts with contemporary medical understanding. By examining the Ayurvedic perspective alongside modern dermatological insights, we aim to enhance comprehension and foster integrative management strategies for this complex condition.

Table Of Contents
  1. Abstract
  2. Introduction
  3. Understanding Visarpa in Ayurveda
  4. Pathogenesis (Samprapti) of Visarpa
  5. Clinical Features (Lakshana) of Visarpa
  6. Diagnosis
  7. Prognosis (Sadhya-Asadhya) of Visarpa
  8. Treatment (Chikitsa) of Visarpa
  9. Modern Medical Management
  10. Discussion
  11. Conclusion
  12. References

Introduction

Skin diseases are prevalent worldwide and can significantly impact an individual’s quality of life. Among these, acute inflammatory skin conditions with rapid progression pose substantial challenges in diagnosis and management. In Ayurveda, Visarpa is one such condition described extensively in classical texts like the Charaka Samhita.

Visarpa is characterized by sudden onset, rapid spread, and severe symptoms, often compared to the movement of a serpent due to its swift progression. It is considered a serious condition requiring prompt and appropriate treatment to prevent complications.

Modern medicine identifies conditions like erysipelas, cellulitis, and herpes zoster that share similarities with Visarpa. These conditions involve bacterial or viral infections leading to acute skin inflammation.

This article explores Visarpa Chikitsa as presented by Acharya Charaka, correlating it with modern medical concepts. By integrating classical Ayurvedic wisdom with contemporary dermatological knowledge, we aim to provide a comprehensive understanding of Visarpa and its management.

Understanding Visarpa in Ayurveda

Definition

The term Visarpa is derived from two Sanskrit words: ‘Vi’ meaning ‘spreading’ and ‘Sarpa’ meaning ‘snake’. It signifies a disease that spreads rapidly across the skin, resembling the swift movement of a serpent. Visarpa involves the vitiation of Doshas (Vata, Pitta, Kapha), Rakta Dhatu (blood tissue), and sometimes all the seven Dhatus (body tissues), leading to severe skin manifestations.

Etiology (Nidana)

Ayurvedic Perspective

Visarpa is caused by the vitiation of Doshas due to various etiological factors, including improper diet, lifestyle, environmental exposures, and psychological factors.

General Causes
  1. Dietary Factors:
    • Excessive Intake of Specific Tastes:
      • Overconsumption of salty, sour, pungent, and hot foods.
    • Ingestion of Unwholesome Foods:
      • Eating incompatible food combinations (Viruddhahara).
    • Consumption of Fermented and Spoiled Foods:
      • Intake of sour gruels, stale foods, and contaminated substances.
    • Excessive Alcohol Consumption:
      • Particularly unwholesome or improperly prepared alcoholic beverages.
  2. Lifestyle Factors:
    • Daytime Sleeping:
      • Leading to Kapha accumulation.
    • Overexertion:
      • Physical strain causing Vata aggravation.
    • Suppression of Natural Urges:
      • Disrupting normal physiological functions.
  3. Environmental Factors:
    • Exposure to Toxins:
      • Contact with poisonous substances or chemicals.
    • Seasonal Variations:
      • Changes in climate affecting Dosha balance.
  4. Trauma and Injuries:
    • Wounds and Bruises:
      • Physical injuries leading to skin damage.
    • Burns:
      • Exposure to fire or heat causing skin lesions.
  5. Psychological Factors:
    • Emotional Stress:
      • Mental disturbances affecting Dosha equilibrium.
  6. Infections:
    • Exposure to Pathogens:
      • Bacterial, viral, or parasitic infections affecting the skin.

Sanskrit Reference:

  • “Lavaṇāmlakaṭūṣṇānāṁ rasānām ati-sevanāt…” (Verses 15-21)

Modern Correlation

  1. Bacterial Infections:
    • Streptococcus and Staphylococcus:
      • Leading to erysipelas and cellulitis.
    • Necrotizing Fasciitis:
      • Severe bacterial infection causing rapid tissue destruction.
  2. Viral Infections:
    • Herpes Zoster (Shingles):
      • Reactivation of the varicella-zoster virus.
  3. Immunocompromised States:
    • Diabetes Mellitus:
      • Predisposing to skin infections.
    • HIV/AIDS:
      • Reduced immunity increasing infection risk.
  4. Trauma:
    • Skin Breaks and Wounds:
      • Entry points for pathogens.
  5. Lifestyle Factors:
    • Poor Hygiene:
      • Facilitating bacterial growth.
    • Obesity:
      • Increased skin folds and moisture.

Pathogenesis (Samprapti) of Visarpa

Ayurvedic Perspective

Visarpa occurs due to the vitiation of Doshas, primarily involving Rakta Dhatu (blood tissue), along with the skin (Twak), muscles (Mamsa), and lymph (Lasika).

General Pathogenesis

  1. Aggravation of Doshas:
    • Due to etiological factors, Doshas become vitiated and accumulate in the body.
  2. Vitiation of Rakta Dhatu:
    • The aggravated Doshas impair Rakta Dhatu, leading to inflammation.
  3. Involvement of Skin and Muscles:
    • The vitiated Doshas and Rakta spread through the skin and muscle tissues.
  4. Rapid Spreading of Lesions:
    • The disease progresses swiftly across the body, resembling a serpent’s movement.

Types of Visarpa

Acharya Charaka classifies Visarpa into seven types based on the predominant Dosha involvement:

  1. Vataja Visarpa:
    • Caused by aggravated Vata Dosha.
  2. Pittaja Visarpa:
    • Resulting from aggravated Pitta Dosha.
  3. Kaphaja Visarpa:
    • Due to aggravated Kapha Dosha.
  4. Agnivisarpa (Sannipataja Visarpa):
    • Involves all three Doshas with predominance of Pitta and Vata.
  5. Kardama Visarpa:
    • Caused by aggravated Kapha and Pitta Doshas.
  6. Granthi Visarpa:
    • Resulting from aggravated Vata and Kapha Doshas.
  7. Sannipataja Visarpa:
    • Involvement of all three Doshas equally.

Sanskrit References:

  • “Sa ca saptavidhō dōṣair vijñēyaḥ saptadhātukaḥ…” (Verses 12-14)
  • “Rak­taṁ lasīkā tvaṅmāṁsaṁ dūṣyaṁ dōṣās trayō malāḥ…” (Verse 15)

Modern Correlation

  1. Erysipelas and Cellulitis:
    • Acute bacterial infections of the skin and subcutaneous tissues.
    • Rapid spread due to bacterial toxins and enzymes.
  2. Herpes Zoster (Shingles):
    • Viral infection causing painful, vesicular rashes following nerve pathways.
  3. Necrotizing Fasciitis:
    • Severe infection leading to rapid tissue necrosis.
  4. Autoimmune Skin Disorders:
    • Conditions like bullous pemphigoid involving immune-mediated skin damage.

Clinical Features (Lakshana) of Visarpa

General Symptoms

  • Sudden Onset:
    • Rapid development of symptoms.
  • Fever:
    • Accompanied by high temperature.
  • Pain and Burning Sensation:
    • Severe discomfort in the affected area.
  • Skin Lesions:
    • Redness, swelling, and blisters.
  • Rapid Spread:
    • Lesions spreading quickly across the skin.

Specific Symptoms for Each Type

Vataja Visarpa:

  • Skin Color:
    • Dark, bluish or blackish discoloration.
  • Pain Characteristics:
    • Pricking, throbbing pain, and numbness.
  • Other Symptoms:
    • Dryness, stiffness, and tingling sensation.
  • Systemic Features:
    • Constipation, flatulence, and emaciation.

Sanskrit Reference:

  • “Bhrama-da-va-thu-pipāsā-nistōda-śūlāṅga-marda-udvēṣṭana-kampa-jvara-tamaka-kāsa…” (Verse 30)

Pittaja Visarpa:

  • Skin Color:
    • Reddish, yellowish, or bluish lesions.
  • Pain Characteristics:
    • Burning sensation, severe heat in the affected area.
  • Other Symptoms:
    • Fever, thirst, delirium, and sweating.
  • Systemic Features:
    • Dizziness, nausea, and irritability.

Sanskrit Reference:

  • “Jvara-str̥ṣṇā mūrcchā mōhaś-chardiḥ arōcakaḥ aṅga-bhēdaḥ svēdaḥ atimātram antardāhaḥ…” (Verse 32)

Kaphaja Visarpa:

  • Skin Color:
    • Pale, whitish, or light-colored lesions.
  • Pain Characteristics:
    • Mild pain, heaviness, and numbness.
  • Other Symptoms:
    • Swelling, itching, and excessive sleep.
  • Systemic Features:
    • Lethargy, loss of appetite, and coldness.

Sanskrit Reference:

  • “Śītakaḥ śīta-jvarō gauravaṁ nidrā tandrā arōcakaḥ…” (Verse 34)

Agnivisarpa (Sannipataja Visarpa):

  • Skin Color:
    • Dark red or black lesions resembling burn injuries.
  • Pain Characteristics:
    • Intense burning and severe pain.
  • Other Symptoms:
    • Delirium, unconsciousness, convulsions.
  • Systemic Features:
    • High fever, restlessness, and insomnia.

Sanskrit Reference:

  • “Tat upatāpād āturaḥ sarva-śarīraṁ aṅgārair iva ākīryamāṇaṁ manyatē…” (Verse 36)

Kardama Visarpa:

  • Skin Features:
    • Thick, sticky discharge resembling mud.
  • Pain Characteristics:
    • Mild pain with heaviness.
  • Other Symptoms:
    • Swelling, lethargy, and numbness.
  • Systemic Features:
    • Fever, loss of appetite, and malaise.

Sanskrit Reference:

  • “Kaphapittaṁ prakupittaṁ balavat svēna hētunā, Visarpaty ēka-dēśē tu praklēdayati dēhinam.” (Verses 37-38)

Granthi Visarpa:

  • Skin Features:
    • Formation of nodules or lumps (granthi).
  • Pain Characteristics:
    • Severe pain in the affected areas.
  • Other Symptoms:
    • Swelling, stiffness, and difficulty in movement.
  • Systemic Features:
    • Fever, joint pain, and weakness.

Sanskrit Reference:

  • “Vāyuḥ ślēṣmaṇā vibaddha-mārgaḥ tam eva ślēṣmāṇaṁ anēka-dhā bhindan kramēṇa granthi-mālāṁ kr̥cchra-pāka-sādhyāṁ…” (Verse 39)

Diagnosis

Ayurvedic Approach

  1. Rogi Pariksha (Examination of the Patient):
    • Darshana (Inspection):
      • Observing skin lesions, color, spread, and associated features.
    • Sparshana (Palpation):
      • Feeling for warmth, tenderness, swelling, and nodules.
    • Prashna (Questioning):
      • Inquiring about dietary habits, lifestyle, onset of symptoms.
  2. Assessment of Dosha Predominance:
    • Determining which Dosha is primarily involved based on symptoms.
  3. Evaluation of Dhatu Involvement:
    • Assessing the extent of tissue involvement, especially Rakta Dhatu.

Modern Diagnostic Methods

  1. Clinical Examination:
    • Visual Assessment:
      • Examining skin lesions, distribution, and progression.
    • Vital Signs:
      • Monitoring fever, heart rate, and blood pressure.
  2. Laboratory Investigations:
    • Complete Blood Count (CBC):
      • Detecting infection, elevated white blood cells.
    • Blood Culture:
      • Identifying causative organisms.
    • Serological Tests:
      • For viral infections like herpes zoster.
  3. Imaging Studies:
    • Ultrasound or MRI:
      • Assessing deeper tissue involvement in severe cases.
  4. Microbiological Examination:
    • Skin Swab Culture:
      • Identifying bacteria or fungi.

Prognosis (Sadhya-Asadhya) of Visarpa

Ayurvedic Perspective

  • Sadhya (Curable):
    • Visarpa involving single Dosha, early stages.
    • Located superficially (Bahya Marga).
  • Krichra Sadhya (Difficult to Cure):
    • Visarpa involving two Doshas or deeper tissues.
    • Located in internal pathways (Antar Marga).
  • Asadhya (Incurable):
    • Visarpa involving all three Doshas (Sannipataja).
    • Rapid progression, affecting vital organs (Marma).
    • Associated with severe complications.

Sanskrit References:

  • “Bahirmārgāśritaṁ sādhyam asādhyam ubhayāśritam…” (Verse 24)
  • “Sarvāyatanasamutthaṁ sarvaliṅgavyāpinaṁ sarvadhātvanusāriṇam āśukāriṇam… sannipātavisarpam acikitsyaṁ vidyāt.” (Verse 41)

Modern Correlation

  • Good Prognosis:
    • Superficial skin infections responding to antibiotics.
    • Early-stage herpes zoster.
  • Guarded Prognosis:
    • Infections with systemic involvement.
    • Immunocompromised patients.
  • Poor Prognosis:
    • Necrotizing fasciitis.
    • Severe infections with multi-organ failure.

Treatment (Chikitsa) of Visarpa

Ayurvedic Principles

  1. Nidana Parivarjana (Avoidance of Causative Factors):
    • Eliminating the causative dietary and lifestyle factors.
  2. Shodhana (Purification Therapies):
    • Vamana (Emesis):
      • Indicated in Kaphaja Visarpa to expel excess Kapha.
    • Virechana (Purgation):
      • Used in Pittaja Visarpa to eliminate excess Pitta.
    • Raktamokshana (Bloodletting):
      • Removing vitiated blood in Rakta Dushti.
  3. Shamana (Palliative Therapies):
    • Herbal Medications:
      • Using specific herbs to balance Doshas and reduce symptoms.
    • External Applications:
      • Lepa (pastes), Pradeha (plasters), and Seka (pouring of liquids).
    • Dietary Management:
      • Adjusting diet according to the type of Visarpa.
    • Lifestyle Modifications:
      • Rest, avoiding aggravating factors.

Specific Treatments According to Doshas

Vataja Visarpa Chikitsa

  1. Initial Management:
    • Snehan (Oleation):
      • Internal and external application of medicated oils.
    • Swedana (Sudation):
      • Mild sweating therapies to alleviate stiffness.
  2. Herbal Formulations:
    • Use of Tikta Ghrita:
      • Medicated ghee prepared with bitter herbs.
    • Herbs:
      • Dashamoola (ten roots), Nirgundi (Vitex negundo).
  3. External Applications:
    • Warm Oil Massages:
      • Using oils like Mahanarayan Taila.
  4. Dietary Recommendations:
    • Warm and Nourishing Foods:
      • Soups, grains, and easily digestible meals.
    • Avoid Cold and Dry Foods:
      • Preventing further Vata aggravation.

Sanskrit Reference:

  • “Vātōlbaṇē tikta-ghr̥taṁ… snaihikāni anilātmakē.” (Verses 46, 116)

Pittaja Visarpa Chikitsa

  1. Initial Management:
    • Virechana (Purgation):
      • Using mild laxatives to eliminate Pitta.
    • Raktamokshana (Bloodletting):
      • Jalauka (leech therapy) for removing vitiated blood.
  2. Herbal Formulations:
    • Use of Cooling Herbs:
      • Neem (Azadirachta indica), Guduchi (Tinospora cordifolia).
    • Kaishora Guggulu:
      • Classical formulation for Pitta-related skin disorders.
  3. External Applications:
    • Cool Pastes (Lepa):
      • Using sandalwood, licorice, and lotus petals.
  4. Dietary Recommendations:
    • Cooling Foods:
      • Coconut water, pomegranate juice, bitter vegetables.
    • Avoid Spicy and Hot Foods:
      • Reducing Pitta accumulation.

Sanskrit References:

  • “Pittasthānagatē… virēkaṁ ca viśēṣataḥ.” (Verses 45, 117)
  • “Kuryāccikitsitād asmācchīta-prāyāṇi paittikē.” (Verse 116)

Kaphaja Visarpa Chikitsa

  1. Initial Management:
    • Vamana (Emesis):
      • Inducing vomiting to expel excess Kapha.
    • Rukshana (Drying Therapies):
      • Using dry heat and herbal powders.
  2. Herbal Formulations:
    • Use of Pungent Herbs:
      • Trikatu (ginger, black pepper, long pepper).
    • Herbs:
      • Musta (Cyperus rotundus), Haridra (turmeric).
  3. External Applications:
    • Warm Pastes:
      • Using mustard, rock salt, and ginger.
  4. Dietary Recommendations:
    • Light and Warm Foods:
      • Barley, millet, and spiced soups.
    • Avoid Heavy, Oily Foods:
      • Preventing Kapha accumulation.

Sanskrit References:

  • “Laṅghana-ullēkhane śastē… rūkṣa-śītaiḥ pralēpayēt.” (Verse 44)
  • “Kaphajē… rūkṣa-prāyāṇi.” (Verse 116)

Agnivisarpa Chikitsa

  1. Management Challenges:
    • Rapid Progression:
      • Requires immediate and intensive care.
    • Prognosis:
      • Considered Asadhya (incurable) due to severity.
  2. Therapeutic Approach:
    • Palliative Measures:
      • Aimed at reducing suffering.
    • Symptomatic Treatment:
      • Managing fever, pain, and delirium.

Sanskrit Reference:

  • “Tam ēvaṁvidham agni-visarpa-parītaṁ acikitsyaṁ vidyāt.” (Verse 36)

Kardama Visarpa Chikitsa

  1. Initial Management:
    • Purification Therapies:
      • Combined use of Vamana and Virechana.
    • Raktamokshana:
      • To remove vitiated blood.
  2. Herbal Formulations:
    • Use of Bitter and Astringent Herbs:
      • Neem, Manjistha (Rubia cordifolia).
  3. External Applications:
    • Drying Pastes:
      • Using clay, neem leaves, and sandalwood.
  4. Dietary Recommendations:
    • Light Diet:
      • Avoiding heavy and oily foods.

Sanskrit Reference:

  • “Kaphapitta-praśamanaṁ prāyaḥ kardama-saṁjñitē.” (Verse 117)

Granthi Visarpa Chikitsa

  1. Initial Management:
    • Rukshana (Drying Therapies):
      • To reduce Kapha and meda (fat tissue).
    • Raktamokshana:
      • Bloodletting to remove vitiated Rakta.
  2. Herbal Formulations:
    • Use of Lekhana Herbs:
      • Guggulu (Commiphora mukul), Musta.
  3. External Applications:
    • Pastes to Reduce Nodules:
      • Applying herbs that dissolve granthi.
  4. Dietary Recommendations:
    • Light and Dry Foods:
      • Barley, millets, avoiding dairy products.

Sanskrit References:

  • “Granthivisarpaṁ ajātōpadravam ārabhēta cikitsitum…” (Verse 42)
  • “Rūkṣaṇair laṅghanaiḥ sēkaiḥ pradēhaiḥ pāñcavalkalaiḥ…” (Verse 118)

Common Therapeutic Measures

  1. Raktamokshana (Bloodletting):
    • Methods:
      • Siravyadha (venesection), Jalauka (leech therapy), Alabu (cupping).
    • Indications:
      • When Rakta Dushti is prominent.
  2. Herbal Formulations:
    • Decoctions (Kashayam):
      • Using herbs like Neem, Guduchi, and Manjistha.
    • Medicated Ghee (Ghrita):
      • Mahatikta Ghrita for Pitta disorders.
    • Powders (Churna):
      • Triphala Churna for detoxification.
  3. External Therapies:
    • Lepa (Herbal Pastes):
      • Cooling pastes in Pittaja Visarpa.
    • Seka (Pouring of Liquids):
      • Using cold herbal decoctions over affected areas.
  4. Dietary Management:
    • Avoidance of Aggravating Foods:
      • Spicy, sour, and salty foods.
    • Inclusion of Beneficial Foods:
      • Bitter vegetables, old rice, barley.
  5. Lifestyle Modifications:
    • Rest:
      • Adequate rest to conserve energy.
    • Hygiene:
      • Keeping affected areas clean and dry.
    • Avoiding Heat Exposure:
      • Preventing Pitta aggravation.

Sanskrit References:

  • “Yānīhōktāni karmāṇi visarpāṇāṁ nivr̥ttayē…” (Verse 141)
  • “Vidāhīny annapānāni viruddhaṁ svapanaṁ divā…” (Verse 115)

Modern Medical Management

  1. Antibiotic Therapy:
    • Oral or Intravenous Antibiotics:
      • Penicillin, cephalosporins for bacterial infections.
    • Antiviral Medications:
      • Acyclovir for herpes zoster.
  2. Supportive Care:
    • Pain Management:
      • Analgesics for pain relief.
    • Antipyretics:
      • To reduce fever.
  3. Wound Care:
    • Cleaning and Dressing:
      • Keeping lesions clean to prevent secondary infection.
    • Debridement:
      • Removal of necrotic tissue if necessary.
  4. Surgical Intervention:
    • For Severe Cases:
      • Necrotizing fasciitis may require surgical debridement.
  5. Management of Complications:
    • Fluid Replacement:
      • In cases of severe infection and dehydration.
    • Monitoring Vital Signs:
      • To detect systemic involvement.
  6. Preventive Measures:
    • Vaccination:
      • Shingles vaccine for herpes zoster.
    • Hygiene Practices:
      • Reducing risk of skin infections.

Discussion

The Ayurvedic concept of Visarpa encompasses several acute skin conditions characterized by rapid spread and severe symptoms. The descriptions in Charaka Samhita align with modern medical conditions like erysipelas, cellulitis, herpes zoster, and necrotizing fasciitis.

Key Correlations:

  • Vataja Visarpa and Neuropathic Skin Disorders:
    • Similar to shingles with nerve involvement.
  • Pittaja Visarpa and Bacterial Skin Infections:
    • Resembling erysipelas and cellulitis with inflammation.
  • Kaphaja Visarpa and Edematous Skin Conditions:
    • Associated with swelling and sluggish circulation.
  • Granthi Visarpa and Nodular Skin Lesions:
    • Comparable to nodular lymphangitis.

Ayurvedic Treatment Approaches:

  • Holistic Management:
    • Emphasizes balancing Doshas, detoxification, and strengthening immunity.
  • Use of Herbal Remedies:
    • Many herbs used have antimicrobial, anti-inflammatory, and immunomodulatory properties.
  • Diet and Lifestyle:
    • Importance of diet in managing inflammation and supporting healing.

Modern Medicine Approaches:

  • Targeted Therapy:
    • Use of specific antibiotics or antivirals.
  • Symptomatic Relief:
    • Managing pain, fever, and discomfort.
  • Preventive Measures:
    • Vaccinations and hygiene to prevent infections.

Integrative Potential:

  • Complementary Therapies:
    • Incorporating Ayurvedic herbs with known medicinal properties.
  • Holistic Care:
    • Combining dietary advice and lifestyle modifications from Ayurveda with modern treatments.

Conclusion

Visarpa Chikitsa as outlined by Acharya Charaka provides a comprehensive framework for understanding and managing acute skin conditions with rapid progression. The emphasis on identifying the underlying Dosha imbalance, appropriate purification therapies, and supportive care aligns with modern approaches to treating similar conditions.

By correlating Ayurvedic principles with contemporary medical knowledge, healthcare providers can explore integrative strategies that enhance patient outcomes. The holistic perspective of Ayurveda, focusing on the individual’s constitution and the root cause of disease, offers valuable insights into managing complex skin disorders.

References

  1. Charaka Samhita, Chikitsa Sthana, Chapter 21: Visarpa Chikitsa.
  2. Sharma, P. V. (1981). Charaka Samhita: Text with English Translation. Chaukhambha Orientalia.
  3. Lad, V. (2002). Textbook of Ayurveda. Ayurvedic Press.
  4. Habif, T. P. (2016). Clinical Dermatology: A Color Guide to Diagnosis and Therapy. Elsevier.
  5. World Health Organization (WHO). (2017). Skin and Soft Tissue Infections.
  6. National Institutes of Health (NIH). (2020). Shingles (Herpes Zoster).
  7. Tripathi, K. D. (2013). Essentials of Medical Pharmacology. Jaypee Brothers Medical Publishers.
  8. Ernst, E. (2000). Herbal medicines for skin diseases. Journal of the European Academy of Dermatology and Venereology, 14(3), 188-196.
  9. Rastogi, S., & Pandey, M. M. (2020). Evidence-based practice of traditional medicines in the treatment of skin disorders. Chinese Herbal Medicines, 12(1), 1-14.
  10. Chintamani, M. (2014). API Textbook of Medicine. Jaypee Brothers Medical Publishers.

Related Posts

Leave a Comment

Your email address will not be published. Required fields are marked *

Home
Latest articles
Submit article
Back
×
Scroll to Top