Tuttak Drava ” an effective treatment in Ahiputana – A case study

Tuttha also known as “Copper Sulphate” is a crystalline aqueous mineral which has been in use in Ayurveda since ancient time. “Tutthak Drava” which is one of the ayurvedic kalpa mentioned by Rasatarangini is a kalpa of Copper Sulphate. Tuttha is widely used in skin conditions as per ayurvedic texts and the kalpas varies from aqueous solution, creams, ointments, suppositories to upto oral preparation. The respective contain mainly focus on use of “Tutthak Drava” (Aqueous solution of copper sulphate i.e. 500mg CuSO4 in 50ml Water) in skin condition primarily seen in child group i.e. Ahiputana (Napkin Rash). In 21 st era the use of diapers is profoundly increased and due to lack of hygiene the cases of Ahiputana has been increased. Ahiputana which is Kapha-Pitta Pradhan avastha is subsided by Kapha-Pittaghna guna of Tuttha along with Vranaghna, Lekhana, Kushtaghna and Garavishaghna guna of Tuttha . A 6 months old female child suffering from Ahiputana with complains of erythema, discharge, skin excoriation, burning sensation and tenderness at legion was treated with local application of “Tuttha Drava” by cotton pad on legion every 6hrly for 5days. The subject got significant relief within the 5days.


Introduction:
Ahiputana, which is also known as diaper dermatitis is a commonly occurring skin condition which further if untreated gets complications and secondary infection. Both Acharya Sushruta and Vagbhatta has explained Ahiputana as a Rakta-Kaphaj Vyadi. Which is primarily caused due to unhygine. Mainly local sweat, urine and stool if not cleaned properly causes this skin condition. The skin irritation caused due to thease waste products causes itching which leads to small papule and skin excoriation. From this papules and excoriated skin oozes secretions which further leads to secondary infections. The drug "Tuttak Drava" is nothing but 1-2 percent Aqueous solution of copper sulphate. "Tutta" is Tikta rasatmak hence it is Pitta-Kapha shamak and as it is Pittaghna so it is Raktadoshhara. If applied locally it is Grahi, Twacya, Kushtaghna, Vranaghna, Vranadoshahara, Gara-visha-dosha hara, Kandughna and Lekhana. All of these properties helps to relive sign and symptoms like Kandu, lasika strav, lalima, sphota, daha, toda, Vrana, putistrava present

Acording to Acharya Vagbhatta
and Sushruta the sthanik Mala, sweda causes rakta and kapha dushti. This rakta and kapha further disturbs local dhatus including twak , rakta and mamsa. This dhatu dushti causes local skin irritation, itching and rahses. When child scratches this rashes small wounds are made from which serous discharge is secreated. Further these small wounds combine together to form one large wound which is called "Ahiputana" which if not taken good care can go into "Paaka" condition. In Ahiputana continues contact with local Mala i.e sweda, mutra and Shakruta causes formation of garavisha at local mamsa dhatu. This vishar ghatak then causes irritation , inflammation, excoriation and popular eruptions at the skin. Thus to treat the wound caused by these local toxin one must follow the bahiparimarjana chikitsa to do sthanik shodhana of the skin. Also according to modern studies when the wound is open and has serous discharge it is most likely to get infected with microorganisms.
Most commonly occurring staphylococci are leading cause for the "Paaka" (secondary infection) condition. This may lead to further eruption of systemic signs and symptoms like fever.

SAMPRAPTI OF AHIPUTANA:
Poor "Tuttha" is a crystalline solid fragile mineral salt which is soluble in water. Many ancient Ayurvedic texts explained properties and clinical administration of "Tuttha" in details. "Rasatarangini" described a kalpa named "Tutthak Drava" which is nothing but 1-2% Aquious solution of Copper sulphate. As "Tuttha" is a toxic drug when taken orally though for bahirparimarjana chikitsa it is very useful to cure variety of skin conditions. In Ahiputana not only there is wound but also serous discharge and minor bruises are great source of having envision of secondary infection. According to modern studies the Copper sulphate has antimicrobial , antifungal properties which is helpful in such scenario. Also copper sulphate has great efficacy even to resistant staphylococci strains. Thus it is very helpful in "Paaka" condition.
The properties of "Tuttha" according to various granthakara as follows: "Tutthak Drava" is prepaired by adding 2-4 Gunja (250mg-500mg) "Tutthak" in 5 Tola(50ml) "jala". That is ; 1 part of Tuttha (Copper Sulphate) in 100 part of Jala (Distilled Water) in sterile container. When all the salt is dissolved in water then the preparation is ready to use and stored in sterile container for further use.
Dose: As per lesion; every 6 hourly with sterile cotton pad. Route of administration: Topical application.

Method of sampling and study design:
Simple randomised single case study.

Result:
Clinical examination of patient on follow up days revealed significant decrease in sign and symptoms daha, lasika strav and twak lalima also Vrana was healed within 5 days of drug application.

Discussion:
In Ahiputana the cause is "Atipravrutti of Doshas" as the local Doshas are vitiated due to improper hygiene. The increased Doshas should be levelled and for that shodhana is needed. In this case sthanik shodhana is more important than abhyantara shodhana. As the disesase is of Bhahya marga. So bahirparimarjana chikitsa is needed. The drug used in this case is one of the potent bahirparimarjana drug. The "Tutthak Drava" is sheeta in sparsha so decreases the local daha and relives tenderness present at the lesion. The Kashaya-tikta rasa helps to level the vitiated Kapha and Pitta Doshas. Grahi and laghu guna decreases the strava oozing from wound and helps to conract the wound margins.
Vishada, lekhana guna cleanse the wound and helps the wound foor for better reepithelization. As "Tuttha" it self is one of the kshara so it eliminates the local microbes present at the wound site and helps to prevent the "Paaka" stage. The guna and their Karmukta is explained in following chart:

Dravya Guna (Properties of Drug) Dravya Karmukta (Action of Drug) Kashaya-Tikta rasa
Balances the vitiated Pitta, Rakta and Kapha Doshas. Laghu Balances the Kapha dosha. Grahi Decreases the discharges from lesion and helps to bind the wound margins.

Vishada
Cleanse the lesion so helps wound healing.

Lekhana
Cleanse lesion and helps wound healing.

Kushtahara
Balances sthanik Doshas which caused this skin condition.

Kanduhara
Decreases the local skin irritation by Kaphaghna properties.

Krumihara
Eliminates local Krimi (microbes present in the wound).

Conclusion:
As Tuttha Drava is easy to prepare and apply. The properties of drug effectively do samprapti bhanga of disease thereby the above case study proves that "Tuttak Drava" is effective ayurvedic management in childs suffering form Ahiputana.