Clinical applications of

Rasayogas-Mercurial
medicaments in Skin diseases
Posted on March 3, 2014 by Dr.Krishnamurthy Leave a comment
This is an invited guest article by Dr. Sathyanarayana B M.D.(Ayu).
Abstract:The skin is the largest organ of the human body, which protects us
against mechanical, chemical and biological hazards. The 21st Century, with
its continuous changing life styles, environment and dietary habits have
made man as main victim of many diseases. Now-a-days skin diseases are
very common. Though skin diseases are common at any age of the
individual, they are particularly frequent in the elderly. The patients always
experiences physical, emotional and socioeconomic embarrassment in the
society. Normally, 10 15% of the General Practitioners work is with skin
disorders and about 30% of all the skin diseases are eczematous. It is a
second commonest cause of loss of work.

Ayurveda has discussed all skin disease under the umbrella of Kushtha, in
other word it can be listed as Ayurvedic dermatology. It is not a vis--vis
correlation but one can cover up all dermatological manifestations under 18
subtypes of Kushtha.

Now- a- days, modern science reach top of the hill by great advance
particularly in dermatology as topic is concerned and also availability of
powerful antibiotics, antifungal, antihistaminic, steroids, etc. but better
management could not be searched out till today. Few drugs are available for
symptomatic relief only. Their indiscriminate use is most undesirable.
Nowadays, whole world is gradually turning towards Ayurveda for safe and
complete cure of diseases. Especially in the field of skin problems Ayurveda
can contribute remarkably. Efficacy of Shodhana therapy in treating chronic
dermatological afflictions is well established. However, Shamana therapy is
also equally important. Especially in general clinical practice physicians
largely depend on Shamana therapy (both external and internal) while
treating skin diseases. Even after Shodhana, Shamana Chikitsa is essential.
Among hundreds of Ayurvedic formulations used in treating skin diseases,
Rasayogas or herbo-mineral formulations have a unique role and a clear
edge over pure herbal formulations. It is a known fact that Rasoushadhi are
superior to Kashthoushadhi owing to their small dose, quick action, easy
palatability and long shelf life. Several experienced doctors over several
years in their clinical practice have observed and are confident regarding the
excellent efficacy of Rasoushadhi in managing challenging, chronic skin
diseases like eczema, psoriasis etc. The products like Arogyavarddhani
Vatee, Rasamanikya, Gandhaka Rasayana are clinically established and
scientifically proved for their efficacy in dermatological practices.

Introduction: The skin is the largest organ of the human body, which
protects us against mechanical, chemical and biological hazards. The 21st
Century, with its continuous changing life styles, environment and dietary
habits has made man as main victim of many diseases. Nowadays skin
diseases are very common. The patients always experience physical,
emotional & socioeconomic embarrassment in the society. Normally, 10
15% of the General Practitioners work is with skin disorders and it is the
second commonest cause of loss of work.
Dermatology is the branch of medicine dealing with the skin and its
diseases [1], a unique specialty with both medical and surgical aspects. [2][3]

[4]
Dermatosis (plural dermatoses), is defined as any disease of the skin,[5]
[6][7] and, while thousands of skin disorders have been described, only a
small number account for most visits to the doctor.[7]
Dermatology is a very dynamic subject with multiple advances in various
fields including dermatosurgery, dermatopathology, genetics and molecular
research, melanocyte research, Lasers, cosmetic dermatology, etc..
Availability of various new therapies including lasers, botox, dermal fillers,
biologicals, and immunoglobulins for treatment of various disorders have
created a lot of excitement among the young dermatologists although the
senior and eminent dermatologists still prefer to restrict themselves to the
time-tested older therapies [8]
Antibiotic resistance, diabetes, asthma, eczema etc. have surfaced in
epidemic proportions, perhaps as a result of winning the battle against
infection. This has encouraged votaries of alternative paradigms [9].

Now a days, modern science reach top of the hill by great advance
particularly in dermatology as topic is concerned and also availability of
powerful antibiotics, antifungal, antihistaminic, steroids, etc. but better
management could not be searched out till today. Few drugs are available for
symptomatic relief only. Their indiscriminate use is most undesirable.
Nowadays, whole world is gradually turning towards Ayurveda for safe and
complete cure of diseases.

Ayurveda has discussed all skin disease under the umbrella of Kushtha, in
other word it can be listed as Ayurvedic dermatology. It is not a vis--vis
correlation but one can cover up all dermatological manifestations under 18
subtypes of Kushtha.

Efficacy of Shodhana therapy in treating chronic dermatological afflictions is

well established. However, Shamana therapy is also equally important.
Especially in general clinical practice, physicians largely depend on Shamana
therapy (both external and internal) while treating skin diseases. Even after
Shodhana, Shamana Chikitsa is essential. Among hundreds of Ayurvedic
formulations used in treating skin diseases, Rasayogas or herbo-mineral
formulations have a unique role and a clear edge over pure herbal
formulations. It is a known fact that Rasoushadhi are superior to
Kashthoushadhi owing to their small dose, quick action, easy palatability and
long shelf life . Several experienced doctors over several years in their
[10]

clinical practice have observed and are confident regarding the excellent
efficacy of Rasoushadhi in managing challenging, chronic skin diseases like
eczema, psoriasis etc.
Rasadravya-Mercurial medicaments useful in dermatological
conditions:

The materials described in Rasashastra have been classified under several

categories like Maharasa, Uparasa, Sadharana Rasa, Dhatu, Upadhatu,
Ratna, Uparatna, Sudhavarga, Sikatavarga etc. Some of the raw materials
(metal/mineral/plant product/animal product) mentioned under these
categories have their special application in healing skin ailments. Their mode
of action may vary from antimicrobial to immune modulation. However, they
are proven to be potent and efficacious in managing dermatological
conditions. eg; Gandhaka (Sulfur), Gairika(Haematite-ferric oxide),
Kasisa(green vitriol-ferrous sulfate), Kankshee(alunite/potash alum), Haratala
(yellow orpiment-arsenic trisulfide), Manahshila (realgar-arsenic disulfide),
Rasanjana(extract of Berberis aristata), Pushpanjana (Zinc oxide), Kampillaka
(a product of the tree mallotus philippinensis), Girisindura(montoydite-
mercuric oxide) , Naga Sindura(lead trioxide),Mrddarashrnga (litharge-lead
monoxide) etc. Occasionally, Parada (mecury), Hingula(cinnabar),
Kapardika(cowries), Shilajatu (asphaltum), Tamra (copper), Kansya (bronze)
etc are also used.

However, following are most important and widely used:-

Gandhaka (Sulfur): This is the most popular and widely used rug in
treating skin diseases in the form of various formulations meant for
external and internal use. Its special efficacy in treating the conditions
like Pama (scabies), Dadru (teniasis), Vicharchika (eczema) are well
established. Gandhaka acts as immune modulator, antimicrobial and
antibiotic
Gairika(Haematite): This drug is popularly being used in the
conditions like urticaria and allergic skin manifestations that can be
correlated with the conditions like Shitapitta, Udarda and Kotha. This
Pittahara, Rakta shodhaka and Rakta Prasadaka drug is found to be
having antihistamine like action.
Haratala(Yellow orpiment) : This is most potent among the
Rasadravya in treating the chronic, challenging skin diseases. Its
formulations like Rasamanikya, Tala Sindura, Talakodaya Malahara etc
have been clinically established to be the wonder drugs in treating the
conditions like eczema, psoriasis, lichen planus etc. Haratala being the
trisulfide of arsenic is a potent immune suppressant and antimicrobial.
 However, it should be used cautiously, in right dose, with right vehicle
and after proper detoxifying and processing techniques.
Table 1 : List of Rasayogas popularly used in dermatological
practice:
S.N Name of the Chief Anupan Indication
o. product ingredients Dose a s
Katuki, Kajjalee,
Loha Bhasma,
Abhraka Bhasma,
Tamra Bhasma,
Shuddha
Shilajatu,
Shuddha
Chitraka, Triphala, 500
Arogyavarddha Shuddha Guggulu 750 Sarva
1. nee Vatee[11] etc. mg Jala Kushtha
Shuddha
Gandhaka,
Godugdha,
Chaturjataka,Gud
uchi, Triphala, Sita,
Gandhaka Bhrngaraja, 0.5-1 Jala, Sarva
2. Rasayana[12] Ardraka.. gm Ksheera Kushtha
Sphutita
60 Madhu and Galita
Shuddha Patra 120 and Kushtha,
3. Rasamanikya[13] Tala mg Ghrta Vicharchika
Sita,
Laghu Suta Jala,
Shekhara 0.5-1 Ardraka Sheeta
4. Rasa[14] Gairika, Shunthi.. gm Swarasa Pitta
Kajjalee, Tamra
Bhasma, Loha
Bhasma, Abhraka
Bhasma, Shuddha
Shilajatu,
Shuddha
Chitraka, Triphala,
Shuddha 500 Madhu Karna Nasa
Galat Kushthari Guggulu, Karanja 750 and Galita
5. Rasa[15] Beeja etc. mg Ghrta Kushtha
 Kajjalee, Haratala, 500
Talakeshvara Bakuchi Churna 750 Shvitra
6. Rasa[16] etc. mg Jala Kushtha
Bakuchi
Kajjalee, Tamra 250 taila
Shashilekha Bhasma, Bakuchi -500 and Shvitra
7. Vati[17] Kvatha mg Madhu Kushtha
Kajjalee, Triphala,
Bhrngaraja,
Bakuchi, 500
Bhallataka, Nimba 750 Madhu, Shvitra
8. Shvetari Rasa [18]
Beeja majja mg Ghrta Kushtha
Kajjalee, Loha Madhu
Bhasma, Tamra 125- and
Krshnamanikya Bhasma, Shuddha 250 Pippalee Sarva
9. Rasa[19] Vatsanabha mg churna Kushtha
Kajjalee, Arka Madhu,
ksheeramardita Ghrta
Rasakarpura, 60- and
Vyadhiharana Haratala, 125 Pippalee Sarva
10. Rasa[20] Navasadara.. mg churna Kushtha

Kajjalee,
Triphala,
Loha
Bhasma,
Tamra
Bhasma,
Abhraka
Bhasma,
Shuddha Jala,
Bhallataka, Ksheera,
Amrtankura Guggulu, 500- Narikela Sarva
11. Louha[21] Ghrta 750 mg Jala Kushtha
12. Nageshvara-Naga Naga, Tila 500- with Galat
Bhasma[22] Taila, 750 mg equal Kushtha
Shveta quantites
Kasisa, of tvak,
Kajjalee, devadaru
Chincha and
 bakuchi
Tvak churna churna
Mahishee
Mutra,
Churnodaka
,
Sharapunkh
a etc,
treated Galatkushtha
Siddha Haratala Haratala 60-120 Madhu , Shveta
13. Bhasma[23] Bhasma mg and Ghrta Kushtha
Madhu
Prepared by and
processing Ghrta, Kandu,
Haratala with 60-120 Ksheera Kushtha,
14. Bhasma[24] Punarnava mg etc. Galatkushtha

Note: Only those Bhasma having specific indications in Kushtha are

mentioned here. However, other Bhasmas like Abhraka Bhasma, Tamra
Bhasma, Trivanga Bhasma, Godanti Bhasma etc. can also be used in skin
diseases, judicially combining them with relevant ingredients and Anupana.
Table 2: List of selected herbo-mineral products for external
application:
[a] Lepa:
S.No
. Name of the product Chief ingredients Indications
Hingula,
Rasakarpura, Kitibha, Pundarika,
1. Chandamruta Lepam[25] Souvira, Gandhaka.. Sidhma, Kakana
Kajjali, Sindura,
Manahshila,
Jeerakadwaya, Pama, Kandu,
2. Rasottamadi Lepam [26]
Haridradwaya.. vicharchika
Rasa sindura, rasa
Karpura,
Mrddarashrnga,
Madhucchishta, Vicharchika, Vipadika,
3 Sinduradi Lepa[27] Narikela Taila Vrana, Kandu

[b] Malahara
S.No
. Name of the product Chief ingredients Indications
Gandhaka, Siktha
Taila, Shuddha
Tankana,
Dadru Vidravana Chakramarda,
Malahara[28] Laksha Dadru
Tuttha, Kampillaka,
Shvata Khadira,
Darunanashaka Gairika, Surya
Malahara[28] Kshara.. Darunaka
Gairika, Haridra,
Gairikadya Malahara [28]
Sindura, Siktha taila Kandu, Daha, Vrana
Gandhaka, Siktha
Gandhakadya Taila, Girisindura,
Malahara[28] Tankana, Karpura Pama
Phiranga Vranahara,
Siktha Taila, Sindura, (in ulcerative, infected
Hinguladya Malahara[28] Darada skin diseases)
Vrana Shodhana-
Siktha Taila, Sindura, Ropan(in ulcerative,
Darada, Tankana, infected skin
Hingulamrta Malahara[28] Karpura diseases)
Vrana Shodhana-
Kajjali, Siktha Taila, Ropan(in ulcerative,
Kajjalikodaya Mrddarashrnga, infected skin
Malahara[28] Kampillaka, Tuttha diseases)
Tuttha, Haratala,
Manahshila,
Kajjalee,
Samudraphena,
Kharpara,
chakramarda Beeja,
Vatsanabha,
Dhattura Beeja,
Kitibhari Malahara[29] Tankana, Dadru, Pama, Kitibha
Kampillaka, Siktha
Kampillaka Malahara[30] Taila Vicharchika
 Mrddrashrngadya Mrddarashrnga, Pama, Kandu,
Malahara[28] Siktha Taila Vipadika.
Kajjali, Tuttha,
Jeerakadwaya,
Sindura, Maricha,
Pamahara Malahara[28] Dhouta Ghrta Pama, Kacchu
Rasapushpadya Rasapushpa, Siktha
Malahara[28] Taila Chirodbhuta Vicharhika
Sindura, Siktha taila, Vrana Shodhana-
Siduradya malahara[28] Tankana Ropana
Taala, Sindura,
Gairika, Kajjali, Vicharchika, Dadru,
Talakodaya Malahara[28] Siktha taila Pama..
Shuddha Tankana,
Tankanamrta Malahara[28] Siktha taila, Sarjika.. Dushta Vrana
Vrana Shodhana-
Tuttha, Ghrta, rala, Ropan(in ulcerative,
Tutthakadya Malahara[28] Khatika.. infected skin diseases)
Tutthamrta Malahara[28] Tuttha, Siktha taila Chira Samutthita Pama
Yashada Pushpa, Vicharchika, Vrana,
Yashadamrta Malahara [28]
Siktha Taila Dagdha Vrana

[c] Draava:
S.No
. Name of the product Chief ingredients Indications
1. Kasisa Drava[28] Kasisa, Jala Vicharchika, Kandu..
Hasta paada
smaraagaara
gehaadigata
bhutanut, Phiranga
2. Rasakarpura Drava[28] Rasakarpura, Jala Vrana

[d] Taila/Ghrta:
S.No
. Name of the product Chief ingredients Indications
 Gandhaka, Trikatu, Kshudra Kushtha,
1. Gandhaka Taila/Druti[31] Tila Taila Visarpa
Kasisa, Haratala,
Manahshil, Haridra,
Chakramarda, Pama, Vicharchika,
2. Kasisadi Ghrta [32]
Ghrta.. Dadru
Girisindura,
Sarshapa Taila, Pama, Vicharchika,
Tuttha, Nisha, Arka Visphota, Kshata,
3. Sinduradya Taila[28] Patra Kandu

Table 3: Kushtha specific Rasayogas[33]:

S.N Type of
o. Kushtha Medicines Dose Anupana Sevana Kala
60-
Vatajah Haratala 120 Ghrta and Adhobhaktam,
1. (kapalam) Bhasma mg Sharkara twice daily
Pittajah 60-
(Oudumbara Tala Bhasma 120 Ghrta and Madhyebhaktam
2. m) Mishranam* mg Sharkara twice daily
500-
Kaphajah Arogyavarddhan 750 Ghrta and Pragbhaktamtwi
3. (Mandalam) ee mg Madhu ce daily
Vatapittajah
(Rshyajihva Arogyamishrana 0.5- Ghrta and Antarabhaktamt
4. m) m** 1gm Sharkara wice daily
Kaphapittaja
h External
(Pundareeka Chandamaruta Q.S.- with application
5. m) Lepa ext Navaneeta twice daily
External
Vatakaphaja Chandamaruta Q.S.- with application
6. h (Sidhmam) Lepa ext Navaneeta twice daily
External
Tridoshajah Chandamaruta Q.S.- with application
7. (Kakanam) Lepa ext Navaneeta twice daily
Kaphajah
(Vicharchika Arogyamishrana 0.5- Khadiraris Antarabhaktamt
8. ) m** 1gm hta wice daily
 60
120 Madhu Adhobhaktam,
Vatakaphaja
Rasamanikya mg and Ghrta twice daily
h
(Vaipadikam, QS- directly
9. Alasakam) Sinduradi Lepa ext appled twice daily
Kaphapittaja Arogyamishrana 0.5- Manjishtha Antarabhaktamt
h (Dadru, m** 1gm di Kvathah wice daily
Charmadala,
Pama,
Kacchu, Gandhaka 2-5 Antarabhaktamt
10. Shataru) Drutih drops Godugdha hrice daily
Vatapittaja
(Ekakushtha,
Charma, Gandhaka 0.5- Ghrta and Adhobhaktam,
11. Kitibha) Rasayanam 1gm Sharkara twice daily
500-
Arogyavarddhan 750 Ghrta and Adhobhaktamtwi
ee mg Sharkara ce daily
250 Bakuchi
-500 taila and Adhobhaktamtwi
12. Shvitram Shashilekha Vati mg Madhu ce daily

* Tala Bhasma Mishranam: A mixture of Tala Bhasma 1 part, Mouktika

Bhasma1 part and Kamadugha 8 parts [33]
**Arogyamishranam: A mixture of Arogya varddhanee and Chandraprabhaa
in equal quantities [33]

Let us discuss the application of selected Rasayogas most popularly and

effectively used in clinical practice:-

1. Arogyavarddhanee Vatee:
This is a wonder drug in treating skin diseases. The presence of ingredients
like Katuki, Shilajatu, Tamra Bhasma, Guggulu and Kajjalee made its action
multidimensional. It is Rata shodhaka and Pittasaraka. It improves digestion
and metabolism. Its hepatoprotective effect, laxative action has made its
action unique in the management of multiple types of skin diseases. It also
improves the health of skin. It is found to be more efficacious when used in
early stages of skin diseases. It is advised to use this product for a period of
48 days (one Mandala) for optimum results[34]. Its main action is on liver and
intestines. It helps to eliminate toxins from the body. It can be used in any
type of skin diseases and in any stage. But, it may not be so effective when
the disease is deep seated, presented with severe excoriation, ulceration and
pain where other products are to be essentially added.
2. Gandhaka Rasayana:
This product is a very useful medicine in a variety of dermatological
conditions and hence rightly quoted as effective in Ashtadasha
Kushtha[35] Here also most important is the quality of the product which is
ensured by strict adherence to the GMP norms by following SOP. All 83
Bhavana should be properly given. It is essential to mix the final product with
equal quantity of Sita so that it acts as Rasayana and can be used safely in
therapeutically effective dose. This product is highly efficient anti bacterial
and immune modulator and can be used in all the types of skin diseases.
However, its efficacy is most appreciated in the conditions like eczema,
ecthyma, taeniasis, skin diseases with secondary infections etc.
3. Rasamanikya:
This is a very potent and effective product in treating skin diseases. Its
efficacy is proved even in treating leprosy. It is an arsenic compound
prepared by using Shuddha Patratala. Rasamanikya is an extensively
evaluated product chemically, toxicologically and clinically[36]. It is mainly
useful in Vatakaphaja Kushtha. Its potent antimicrobial and immune
modulating effects have made it a drug of choice in treating the conditions
like psoriasis, chronic eczema and leucoderma. Its dose should be 60-120 mg
and should always be used with appropriate Anupana like Madhu and Ghrta.
It can be divided into accurately divided dosage packets and dispensed to
the patient or it can be homogenously and uniformly distributed in herbal
diluents (like Triphala Churna, Guduchi Sattva etc) and used.
In a clinical study, 15 patients of Psoriasis vis--vis Ekakushtha were
administered Rasamanikya at a dose of 125 mg with oney and ghee, twice
daily for 28 days and the results were highly encouraging with the remission
in the symptoms as follows: Aswedanam 90%, Mahavastu 70%, Kandu 100%,
Matsyashakalopam 75%. There was no elevation of serum arsenic level even
after a months treatment[36].
Here, Anupana is very crucial and Rasamanikya has to be administered with
honey and ghee.

Mild to moderate fatty changes to liver was significant and decreased liver
weight, increased cholesterol and decreased blood sugar level were reported
in earlier (D.K.Mishra et al) when it is given with water, in present study it is
given with honey and ghee and proven safe[36].
4. Lagu Suta Shekhara Vatee:

Chief constituents of this product are Shuddha Gairika and Shunthi. This
product even though is indicated in Amplapitta, is being used popularly by
Ayurvedic practitioners in the management of skin diseases. Gairika is known
Pittahara and Rakta prasadaka drug and efficacy of Shunthi in treating Shita
Pitta is classically referred and clinically established. This product is found to
be having potential antihistamine like action and hence being used
successfully in treating allergic skin manifestations especially the Urticaria. It
also helps to dry up the secretions quickly. Hence, Laghu Suta Vatee can be
effectively employed to relieve the symptoms of itching and discharge in any
of the dermatological conditions.

Factors to be considered while using Rasayoga in clinical practice:

There is nothing to be worried about the toxicity of Rasayoga once the

quality is established and physician has adequate knowledge about the
planning of the medicine.

Following points should be borne in mind before prescribing Rasayogas:

1. The quality of the product should be ascertained (adequate information

about the source of supply including the quality standards maintained by
the company should be known) to be confident about the safety and
efficacy of the product.
2. The dose of the drug must be appropriate. By considering all the
factors like classical guidelines, age of the patient, sex of the patient,
time of administration, potency of the drug, form of the drug etc, ideal
 dose is to be fixed to avoid any untoward effects (especially in arsenic
compounds).
3. A proper vehicle is to be used (honey, ghee, milk, butter, specific
herbal juice, decoction etc.) to get desired efficacy and also the safety.
eg; if Rasamanikya is given with water instead of honey and ghee (as
mentioned in the text) it may show mild toxic symptoms[36]
4. Course or duration of the treatment is also crucial in the case of
Rasoushadhi. Some Rasoushadhi (especially arsenic compounds) may
have cumulative toxic effects if are used for considerably prolonged
period
5. Pathyapathya mentioned during the administration of particular
Rasayoga should be strictly followed.
Summary and conclusion:

The classical references, clinical experiences, pharmacological and clinical

studies carried out in various centres have confirmed the efficacy of
Rasyogas in dermatological practice. They have a clear edge over pure
herbal formulations especially in treating chronic persisting skin diseases like
psoriasis, lichen planus, eczema etc. This is because of their potency, strong
antimicrobial, antihistaminic and immune modulating actions. Unfortunately,
only a limited number of Rasayogas are being used in clinical practice. It is
essential for clinical practitioners to explore the possibilities of using more
and more herbo-mineral preparations in treating dermatological afflictions.
However, one should be careful regarding the quality of the product with
special reference to SOP of production and final quality specification. If these
are within acceptable limits one need not worry about the safety of the
product as several multi centric studies carried out on toxicity of
herbomineral products have proved their safety beyond doubt. A physician
should know their judicial application with much attention to the dose, time
of administration, duration of administration, Anupana, diet restrictions etc.
aspects to ensure safety and maximum efficacy.

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