An Ayurvedic insight into managing Multi-Drug-Resistant Tinea w.s.r. to Dadru...

[Full title: An Ayurvedic insight into managing Multi-Drug-Resistant Tinea w.s.r. to Dadru - A Case Series]

[Find the meaning and references behind the names: Anupam, Biswas, Ayu, Nil, Tapas, Med, Kaya]

Journal of Ayurveda and Integrated Medical Sciences 2025 Volume 10 Number 3 MARCH E-ISSN:2456-3110 Case Report Multi-Drug-Resistant Publisher www.maharshicharaka.in An Ayurvedic insight into managing Multi-Drug-Resistant Tinea w.s.r to Dadru - A Case Series Biswas A 1* , Tiwari S 2 , Tiwari S 3 , Chakraborty N 4 , Bhaduri T 5 DOI:10.21760/jaims.10.3.65 1* Anupam Biswas, Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India 2 Swadha Tiwari, Post Graduate Scholar, Department of Panchakarma, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India 3 Shomya Tiwari, Post Graduate Scholar, Department of Roga Nidan Evam Vikriti Vijnana, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India 4 Nabanita Chakraborty, Lecturer, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India 5 Tapas Bhaduri, Reader and HOD, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India Skin, the largest organ of human body acts as a shield for external agent. But in today’s modern world, a remarkable increase in the prevalence of skin is witnessed with dermatophytes infection alone accounting for 20-25% of world population. Dermatophytes are fungi that invade and multiply within keratinised tissues (skin, hair and nails) causing infection. Inappropriate, inadequate and overuse of tropical antifungal and corticosteroids drugs results in altered clinical presentation with extensive lesions, ultimately giving rise to a condition unresponsive to conventional treatment and thereby developing resistance. Multi-drug-resistant tinea, over past few years, has become a major health concern, especially in India. To address this need, Ayurveda is looked upon as a safe and effective treatment option. Dadru Kustha, on the basis of clinical presentation shows significant similarities with Tinea infection. In this context, 5 patients of multi-drug-resistant tinea infection with extensive lesions and history of reoccurrence were selected from the OPD of Kaya Chikitsa. Classical Virechan Karma with Trivrit Avaleha followed by Shaman Aushadhi (Aragvadhadi Kashayam, Gandhak Rasayan and Panchatiktaghrita Guggulu Vati), External application (Siddharthak Snan Churna and Brihat Marichyadi Taila with Tankan Churna) and Lifestyle modification were prescribed. After completion of treatment, significant improvement was noted in Subjective criteria {Kandu (itching), Raga (erythema), Pidika (eruptions) & Utsanna Mandala (elevated circular lesion)} and pictorial representation with no signs of reoccurrence during the 1-month follow-up. Panchakarma therapy and Samana Aushadhi (both external and internal) along with lifestyle modification provides a safe and effective treatment option for multi-drug-resistance tinea, highlighting the potential of Ayurvedic interventions in dermatology Keywords: Dadru, Dermatophytes, Multi-drug-resistant tinea, Ayurveda Corresponding Author How to Cite this Article To Browse Anupam Biswas, Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Benga, India. Email: Biswas A, Tiwari S, Tiwari S, Chakraborty N, Bhaduri T, An Ayurvedic insight into managing Multi-Drug- Resistant Tinea w.s.r. to Dadru - A Case Series . J Ayu Int Med Sci. 2025;10(3):417-424. Available From https://jaims.in/jaims/article/view/4075/ Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted 2025-02-10 2025-02-25 2025-03-05 2025-03-15 2025-03-25 Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note None Nil Not required 11.77 © 2025 by Biswas A, Tiwari S, Tiwari S, Chakraborty N, Bhaduri T and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0] J Ayu Int Med Sci 2025 ; 10 ( 3 ) 417

[Find the meaning and references behind the names: Guna, Islam, Hinduism, Maha, Rasa]

Introduction The human skin is the biggest organ in the body. It is vulnerable to a wide range of illnesses due to its size and external position. Skin diseases are seen to be a serious health issue for all In tropical and developing nations like India, the prevalence of skin disorders has significantly increased recently for a variety of reasons, including pollution, inadequate sanitation, poverty, and unclean living conditions. According to Ayurveda , all skin diseases fall under the general category of Kustha , which are separated into Kshudra Kustha and Maha Kustha Acharya Charaka has described Dadru as a Kshudra Kustha [1 ] whereas Acharya Sushruta & Vagbhatta has described Dadru as a Maha Kustha. [2,3] Tinea or Ringworm infections are group of highly contagious segmented fungal infections, characterized by circular lesions which are usually having sharp margins with raised edges, where related fungi are dermatophytes In today’s modern world, a remarkable increase in the prevalence of skin is witnessed with dermatophytes infection alone accounting for 20- 25% of world population. The prevalence of tinea infections in India is considered very high, range from 36.6-78.4% of population affected by dermatophytosis, where tinea corporis being the most common presentation This high prevalence is likely due to warm and humid climate in most parts of the country, contributing to favourable conditions for the fungal growth [4] The Kushta having the Lakshanas of Kandu (itching), Raga (erythema), Pidaka (eruption) and Utsanna Mandala (elevated circular lesion) is called as Dadru . Mainly Kapha & Pitta Dosha predominant Materials and Methods Case Reports 5 patients with chief complaints of severe itchy hyper pigmented round skin lesions over different parts of their bodies and having history of reoccurrence after intake and external application of contemporary medicine were selected from the Kayachikitsa OPD of I.P.G.A.E&R, Kolkata Table 1: Inclusion and exclusion Criteria Inclusive criteria Exclusive criteria Patient’s information Table 2: Showing Patient’s information of all 5 cases Case 1 Case 2 Case 3 Case 4 Case 5 OPD No. 5924 6286 6743 7009 7528 Name SK BS GP HR NK Age 53 yr 57 yr 23 yr 56 yr 46 yr Sex Male Male Male Male Female Religion Islam Hinduism Hinduism Islam Islam Occupation Businessman Shopkeeper Student Businessman Housewife Socioeconomic status Middle Middle Lower middle Lower middle Lower middle Marital status Married Married Unmarried Married Married Past History Medical HTN N.S N.S N.S N.S Surgical N.S N.S N.S N.S N.S Family N.S N.S N.S N.S N.S Personal history Table 3: Showing Personal history of all 5 cases Case 1 Case 2 Case 3 Case 4 Case 5 Appetite Poor Poor Normal Normal Poor Bowel Constipated Constipated Unsatisfactory Normal Constipated Bladder Normal Normal Normal Normal Normal Sleep Disturbed Disturbed Normal Disturbed Disturbed Addiction No such Tobacco No such No such No such Dietary Mix Mix Mix Mix Vegetarian Rasa Amla, Lavan, Katu Amla, LavanAmla, Lavan Amla, Katu Amla, Lavan Guna Ushna, Snigdha Snigdha Snigdha Ushna Ushna, Snigdha Agni Mandagni Vishamagni Vishamagni Mandagni Mandagni Kostha Krura Krura Madhyam Mridu Krura Anupam B et al. Multi-Drug-Resistant Tinea w.s.r. to Dadru Age between 18 to 70 years Age <18 years and >70 years Subjects presenting with classical features of Dadru Kustha Immune-compromised patients – HIV, HBV Both male and female Diabetes mellitus, Congestive cardiac failure, chronic kidney disease History less than 3 years of origin Pregnant and Lactating mother J Ayu Int Med Sci 2025 ; 10 ( 3 ) 418

[Find the meaning and references behind the names: Luke, Anna, Deep, Red]

Local Examination Table 4: Showing Local Examination of 5 cases Patches Case 1 Case 2 Case 3 Case 4 Case 5 Location Chest Groin, Leg Back Axilla Buttock Shape Circular Ovoid Circular Ovoid Circular, ovoid Number 1 5-6 1 2 2 Colour Erythematous Erythematous Blackish Erythematous Blackish Border Well demarcated Well demarcated Well demarcated Well demarcated Well demarcated Texture Elevated, Rough Elevated, Rough Elevated, Rough Elevated, Rough Elevated, Rough Distribution Symmetrical Symmetrical Symmetrical Symmetrical Symmetrical Assessment criteria of Subjective parameters as per PARGOTRA et al. 2011 SN Parameters Findings Arbitrary score 1 Kandu (Itching) Absent 0 Mild occasional itching 1 Moderate itching 2 Severe itching 3 2 Raga (erythema) Absent 0 Mild redness 1 Moderate redness 2 Deep red coloration 3 3 Pidika (eruptions) Absent 0 1 to 3 in number 1 4 to 7 in number 2 > 7 in number 3 4 Utsanna mandala (elevated circular lesion) Absent 0 Mild elevated 1 Moderate elevated 2 Severe elevated 3 Timeline of Therapeutic Intervention Table 5: Showing timeline of therapeutic intervention SN Karma Drug & Dose Duration 1 Deepana and Pachana Panchakola Churna 5 gm twice daily before meal with luke warm water (L.W.W) 5 days 2 Snehapana Mahatikta Ghrita (D 1-30 ml, D 2-60 ml, D 3-90 ml, D 4-120 ml, D 5-150 ml) 5 days 3 Sarvanga Abhyanga Neem Taila (Q.S) 3 days 4 Sarvanga Bashpa Swedana Dasamoola Kwath for 10 minutes 3 days 5 Virechana Karma Trivritavaleha 100 gm with L.W.W 1 day 6 Samsarjana Krama As per classics 5 days 7 a. Kwath Aragwadhadhi Kashaya 20 ml twice daily after meal with L.W.W 30 days b. Vati Gandhak Rasayan 250 mg twice daily after meal with L.W.W 30 days Panchatikta Ghrita Guggulu 500 mg twice daily after meal with L.W.W 30 days c. External application Brihat Marichyadi Taila with Tankan Churna twice daily 30 days Siddharthak Snan Churna once daily 30 days Pathyapathya Table 6: Showing Pathya-Apathya of Kustha Pathya Apathya Karvellaka Amla, Lavan Rasa Mudga Dadhi Nimba Patra Guda Nitya Snan Anupa Mamsa Mridu Vastra Dharana Suktha Vegadharan Varjana Ati Snigdha Anna Matravat Asana Virudhasana Anupam B et al. Multi-Drug-Resistant Tinea w.s.r. to Dadru J Ayu Int Med Sci 2025 ; 10 ( 3 ) 419

[Find the meaning and references behind the names: Vega]

Precautions 1. Wash clothes & towels in hot water daily. 2. Change socks and wash feet regularly. 3. Do not share towels, soaps, clothes & combs. 4. Do not walk barefoot, especially in wet places. 5. Avoid wearing tight and sweaty innerwear Observations and Results Table 7: Showing number of Virechan Vega 5 cases No. of Vega Case 1 16 Case 2 19 Case 3 18 Case 4 17 Case 5 18 Table 8: Showing BT-AT comparison of Subjective Parameters Case Kandu Raga Pidika Utsanna Mandala BT AT BT AT BT AT BT AT Case 1 3 0 3 1 2 0 2 0 Case 2 3 0 3 1 2 0 2 0 Case 3 3 0 2 0 3 0 3 0 Case 4 3 1 3 0 2 0 3 0 Case 5 3 1 3 1 2 0 3 1 Table 9: Showing results of Subjective Parameters Parameter n Mean score Mean difference S.D S.E t value % of relief p value BT AT Kandu 5 3 0.40 2.60 0.54 0.24 10.83 73.33 0.001 Raga 5 2.80 0.60 2.20 0.44 0.19 11.57 78.57 0.001 Pidika 5 2.20 0 2.20 0.44 0.19 11.57 100 0.001 Utsanna mandala 5 2.60 0.20 2.40 0.54 0.24 10 92.30 0.001 Picture 1: Pictorial assessment of the study Graph 1: Showing BT-AT comparison on Subjective parameters in patients Anupam B et al. Multi-Drug-Resistant Tinea w.s.r. to Dadru J Ayu Int Med Sci 2025 ; 10 ( 3 ) 420

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Graph 2: Showing effect of treatment on Subjective parameters in Patients Follow Up and Outcome After completion of treatment there was significant improvement in signs & symptoms i.e., Kandu (itching), Raga (erythema), Pidika (eruption) and Utsanna Mandala (elevated circular lesion) along with Pictorial changes On follow-up after one-month patients were satisfied with the multi modal Ayurvedic management Probable Mode of Action of Treatment Modalities: Table 10: Showing Probable mode of action of treatment modalities Treatment modality Drug used Main ingredients Mode of action 1. Deepana- Pachana Panchakola Churna[5] Pippali, Pippali Mula, Chavya, Chitrak, Nagara Enhances secretion of digestive enzymes like amylase, lipase and protease facilitating the breakdown and absorption of nutrients. Prevents indigestion and promotes intestinal motility 2. Snehapana Mahatikta Ghrita[6] Chandan, Yastimadhu, Sariba, Khadira, Abhaya, Amlaki, Aragwadha, Saptaparna etc Cures diseases like Kustha, Kandu, Visphota, Pidaka due to its Tikta Rasa. It has Raktashodhak and Varnya properties. It also maintains the normal texture of skin due to its lipophilic action 3. Sarvanga Abhyanga Neem Taila[7] Neem Act on the site of disease manifestation by the virtue of fungicidal, antibacterial, antiviral, insecticidal etc. properties 4. Sarvanga Baspa Sveda Dasamoola Kwath[8] Bilva, Agnimantha, Gambhari, Shyonak, Patala, Brihati, Salaparni, Prisniparni, Kantikari, Gokshura Has potent anti-inflammatory, anti-microbial, antiseptic, anti-oxidant properties 5. Virechana Karma Trivrit Avaleha[9] Trivrit Included in Bhedaniya, Vishaghna and Asthapanopaga Mahakasaya. Helps in elimination of toxins due to Adhobhagahara Guna (i.e. elimination of Dosha from lower half of the body) 6. Samsarjana Karma[10] As per classics Peya, Vilepi, Yusa, Rasa Restores the deranged or weakened Agni, normalises the equilibrium of Dosha by gradually normalizing digestive process and digestive fire 7. Kwath Aragwadhadi Kashayam[11] Amlatasa, Neem, Guduchi, Patha, Karanja etc Indicated in Kaphavikar, Sodhana of Dusta Vrana. Acts as Raktasodhak, Twak prasadak. Possesses anti-pruritic, anti-microbial, anti-oxidant, anti-inflammatory properties. It enhances re-epithelialization and neo-vascularisation of skin 8. Vati i. Gandhak Rasayan[12] Shuddha Gandhak, Triphala, Trijata, Sunthi etc Possesses Agnideepak, Ama Nasak, Vishahara, Soshak and Kriminasak properties ii. Pancatikta Ghrita Guggulu[13] Neem, Guduchi, Vasa, Patola, Nidigdhka, Ghrita, Guggulu It acts by the virtue of Kledaghna, Kandughna and Vranasodhak properties Anupam B et al. Multi-Drug-Resistant Tinea w.s.r. to Dadru J Ayu Int Med Sci 2025 ; 10 ( 3 ) 421

[Find the meaning and references behind the names: Sneha, Mustak]

Discussion Tinea infection is a challenging condition that has become refractory to conventional treatments due to an increase in emergence of multidrug resistance. Dadru Kustha presenting clinical correlation with Tinea, is a chronic skin condition characterised by intense itching, inflammation, scaling etc. due to predominance of Kapha and Pitta Doshas . In this case series, 5 cases fulfilling the inclusion criteria were randomly selected from the Kayachikitsa OPD. Percentage of relief for Kandu was 73.33%, for Raga 78.57%, for Pidika 100% and for Utsanna Mandala, it was 92.3%. The p values of all the symptoms were 0.001, which shows highly significant results in all the 5 cases. Virechan Karma was chosen as prime Samsodhana (Purificatory) therapy due to its function of eliminating aggravated Pitta Dosha and thereby pacifying vitiated Rakta Dosha . It also aids in moderately eliminating aggravated Kapha Dosha [17 ] Deepana-Pachana Karma conducted before Virechan Karma helps in digestion of Ama Dosha , increases the Abhyavaharana and Jarana Sakti , facilitates the separation of Dosha from dhatu and prepares body for Snehapana [18 ] Snehapana was done with Mahatikta Ghrita in ascending dose till appearance of Samyak Snigdha Lakshana. Ghrita is generally Vata- Pitta Samak but it has ability to transform itself so as to incorporate qualities of ingredients (Shown in table no. 10) added to it [19] Sneha acts as solvent. It increases Kleda Guna due to an increase in Apya Amsha (watery or moisture content) leading to Utklesha Avastha and promotes Vriddhya, Vishyandana etc. factors which are required for movement of Doshas from Sakha to Kostha [20 ] Sarvanga Abhyanga may help in moistening of Dhatu and Srotas by Snigdha Guna Sarvanga Baspa Swedana applied after Abhyanga facilitated liquefaction of vitiated Doshas due to its Ushna Guna . It also helped in Srotomukha Vishodhana (clearing of channels of circulation) promoting movement of liquefied Doshas from Sakha to Kostha [21] Thereafter, administration of Virechana Yoga facilitates easy evacuation of aggravated Doshas and toxins by the virtue of its Guna (Ushna, Tikshna, Suksma, Vyavayi, Vikasai), Virya (through which it reaches Hridaya , circulates through micro & macro channels etc.), Prabhav (Adhobhagahara) and predominance of Prithvi and Jala Mahabhuta . It rectified the Rakta Dhusti due to its Ashraya- Ashrayi Bhava with Pitta Dosha . By eliminating the toxins and ensuring balance condition of Dosha and Dhatu, Virechan Karma helped in minimising the presenting symptoms by breaking the pathology of the disease [22] Shaman Aushadis administered after Sodhan Karma acted more efficiently upon the involved Doshas and Dhatus due to the absence of Shrota-Rodha . Gandhak Rasayan possesses Rakta Sodhak property. It acts upon the vitiated Kapha Dosha due to its Ushna Virya and Katu-Kashaya Rasa . It is also having Agni Deepana, Pachana and Kledaghna properties which might have helped in reducing symptoms like Kandu, Pidika, Utsanna Mandala etc . [23] Aragvadhadi Kashayam contains ingredients (Shown in table no.10) promoting Rakta Sodhan and Tvak Prasadana . It also has Kandughna, Vishaghna etc. properties which pacified Kandu, Daha, Utsanna Mandala etc symptoms of Dadru [24] Panchatiktaghrita Guggulu possesses Tikta Rasa which acts on both vitiated Kapha and Pitta dosha. Guggulu acts as Yogavahi, Upshoshak, Vranashodhak and Kledaghna . By these properties it acts upon the pathogenesis of Dadru Kustha [25 ] Along with Shaman Aushadhi , topical application of Brihat Marichyadi Taila and Sidhhartaka Snan Churna were prescribed. Both the drugs are indicated in managing Tvak Vikar due to the presence of their ingredients (Shown in Table no. 10). Siddhartaka Snan Churna was applied in the form of Lepa in the affected region with the aim to pacify the Doshas provoked locally. It also bears Sodhana, Utsadana and Ropana Guna requires for overcoming the clinical presentation of Dadru Kustha [26 ] Siddhartaka Snan Churna tropical application treat fungal infection like Tinea by killing the fungus or stopping it from growing, probably it targets fungal cell membrane causing destruction 9. Bahira Parimarjan Chikitsa / Tropical application i. Brihat Marichyadi Taila[14,15] Chandan, Haridra, Saptaparna, Khadira, Guduchi, Daruharidra, Sirisha, Katu Taila, Haritala, Manashila, Gomutra etc It possesses Kandughna, Vishaghna, Varniya, Dahaprasamana, Kusthaghna properties. Majority of its ingredients are having antiseptic and anti-fungal action Also, ingredients like Gomutra have Lekhaniya or exfoliating property helping in breaking down dead skin cells, promoting new cell growth ii. Siddhartak Snana Churna[15,16] Mustak, Madana, Triphala, Karanja, Aragvadha, Daruharidra, Saptaparna etc Cures Tvak Vikara by the virtue of Kandughna, Kusthaghna, Krimighna and Lehaniya properties. Majority of the ingredients are having anti-inflammatory, anti-bacterial and anti-fungal effect Anupam B et al. Multi-Drug-Resistant Tinea w.s.r. to Dadru J Ayu Int Med Sci 2025 ; 10 ( 3 ) 422

[Find the meaning and references behind the names: Syed, Sayyed, Patil, Shaikh, Rajput, Mandal, Jan]

Lot of articles reviewed the efficacy of Siddhartaka Snan Churna’s antifungal activity [27 ] Topical application of Brihat Marichyadi Taila increases local blood flow and nutrient supply, decreases stagnation of fluid, balances moisture content, removes dead skin, eliminates waste product and fights against Dadru due to its antifungal and antiseptic properties, contributing to microbiological clearance [28] Conclusion The present case series demonstrates the potential efficacy of multi-modal Ayurvedic intervention in managing multi-drug-resistant Tinea (Clinically correlated with Dadru ). The significant improvement in all cases, including reduction in symptoms, skin lesions and fungal load, the combination of Shodhana (Purification) and Shamana (Pacification) therapies along with Bahirparimarjana (External) therapies confirmed the efficacy and safety of Ayurvedic interventions in managing multi-drugresistant tinea where conventional treatments has failed or did not provide satisfactory effect. Further research is warranted to explore the potential benefits of Ayurvedic interventions in dermatology References 1. Cakrapaṇidatta S. Caraka Samhita. Ayurveda Dipika. In: Paṇḍita Yadavaji Trikamaji Acarya, editor Varanasi: Chaukhambha Surabharati Prakashana; 2017. Chikitsa Sthana 7 [Crossref][PubMed][Google Scholar] 2. Dalhaṇa. Sushruta Samhita with Nibandha Sangraha. In: Jadavaji Trikamaji Acarya, editor. Varanasi: Chaukhambha Sanskrita Sansthana; 2017. Nidan Sthana 5 [Crossref][PubMed][Google Scholar] 3. Vagbhatta. Astanga Hridaya; commentaries Sarvangasundara of Arunadatta & Ayurveda Rasayana of Hemadri. In: Pandita HS Paradakara, editor; Anna MK Sastri, Navare KR, annotators. Varanasi: Chaukhambha Orientalia; 2002. Nidan Sthana 14 [Crossref][PubMed][Google Scholar] 4. BMC Dermatology [Internet]. Available from: https://bmcdermatol. biomedcentral. com [Crossref][PubMed][Google Scholar] 5. Shaikh S, Kshirsagar M, Garje S, Sayyed G. A comprehensive review on polyherbal formulation (Panchkol Churna): Utilized in the treatment of indigestion and acidity. Int J Res Publ Rev. [Crossref][PubMed][Google Scholar] 6. Kushwaha HCS. The Charak Samhita (Ayurveda- Dipika’s Ayushi Hindi Commentary). Part II. Varanasi: Chaukhambha Orientalia; 2012. Chikitsa Sthan 7/144-150. p. 214 [Crossref][PubMed] [Google Scholar] 7. National Research Council (US) Panel on Neem. Neem: A Tree for Solving Global Problems. Washington (DC): National Academies Press (US); 1992. Chapter 7, Medicinals. Available from: [Article][Crossref][PubMed][Google Scholar] 8. Taru P, Syed S, Kute P, Shikalgar M, Kad D, Gadakh A. Dashamoola: A systematic overview. GIS-Zeitschrift für Geoinformatik. 2022;9:1334- 1345. [Crossref][PubMed][Google Scholar] 9. Rajput S, Mata S, Dei L, Harisha C, Shukla V. Evaluation of Trivrit Avaleha with reference to pharmacognostical & physico-chemical characteristics. 2016; p. 226-234. [Crossref] [PubMed][Google Scholar] 10. Patil VC. Principles and Practice of Panchakarma. Reprint ed. New Delhi: Chaukhambha Publications; 2016. p. 267-268 [Crossref][PubMed][Google Scholar] 11. Biswas A, Tiwari S, Mahapatra PBK. Management of chronic persisting varicose ulcer through modest Ayurvedic intervention. Ayushdhara [Internet]. 2024 May 7 [cited 2025 Jan 30];11(2):62-70. Available from: [Article][Crossref] [PubMed][Google Scholar] 12. Haritha MM, Jadar PG. A review on probable mode of action of Gandhaka Rasayana—An Ayurvedic herbo-mineral formulation with multifaceted action. Int J Ayurveda Pharma Res. 2024;12(2):173-179. [Article][Crossref][PubMed] [Google Scholar] 13. Lokhande S, Patil S, Parshurami S. Efficacy of Panchatikta Ghrit Guggul in the management of Mandal Kushtha with special reference to psoriasis. Int J Res Ayurveda Pharm. Jul-Aug 2016;7(Suppl 3):94-96. [Article][Crossref][PubMed][Google Scholar] Anupam B et al. Multi-Drug-Resistant Tinea w.s.r. to Dadru J Ayu Int Med Sci 2025 ; 10 ( 3 ) 423

[Find the meaning and references behind the names: Sahu, Murthy, Kaushik, Krishnadas, Kumar, Mahesh, Patel]

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