UPADAMSHA (Chancroid / SOFT CHANCRE)

AYURVEDA, KAYACHIKITSA SYLLAUS, PAPER 2, PART B

1. ProfSriramChandraMishra
KayachikitsaDepartment
VYDSAyurvedMahavidyalaya,Khurja

2. •UPADAMSAisfirstdescriedbyAcharyaSushrutainS.NI.12,S.Chi.19chapter.
एतंध्वजभंगमुपदंशंकेचित्पंिववधंप्रिक्षते॥(GangadharRoy)
•ThediseaseDHWAJABHANGA (describedbyMaharshiCharak)havesimilarity
withUPADAMSA.
PARIBHASHA(Definition)
•उपदंशसंज्ञािदंशनोपाचधमंतरेणावपरुढाबोद्धव्या।(मा.नन.उपदंश​)
दंशअर्थात्कथटनथ।कथटनेसेयथअन्यआघथतसेगुह्यभथगमेंजोपिटीकथउत्िन्न
होतीहै,उसेउिदंशकहतेहैं।

3. •NIDANA(Etiology)
Atimaithuna,Yoniroga,Kshataetc

4. •SAMPRAPTI(Pathogenesis)
प्रकुवपतदोषााःक्षतेऽक्षतेवाश्वयथुमुपजनयन्तत,तमुपदंशममत्यािक्षते॥(सु.नन.17/7)
ननदथनोंकेसेवनसेप्रकुपितवथतथदददोषक्षतयथअक्षतशशश्नकीत्वचथमेंशोध
उत्िन्नकरदेतेहैं,तत्िश्चथत्व्रणोत्िपिहोकरउिदंशरोगकोउत्िन्नकरतेहै।
SampraptiGhatak
Dosha–PittaPradhanTridosha
Dushya–Rakta,Lasika
Srotas–Mutravaha,Sukravaha/ArtavVaha
Srotodusti–Atipravritti
Adhisthana-Jananendriya

6. •BHEDA(Types)–5
सपञ्िववधन्रिमभदोष ाःपृथक्समरत रसृजािेनत॥(Su.Ni.12/8)
1.Vataja,2.Pittaja,3.Kaphaja,4.Sannipataja,5.Raktaja

7. LAKSHANA(symptoms)

10. SADHYASADHYATA (Prognosis)

11. TREATMENT PRINCIPLE OF UPADAMSA

12. व्रणोपिार
1.वणण शोधनाथण
•िंचक्षीरी वृक्ष क्वथर्
•भूतघ्नचक्रिकथ द्रथव
•त्रिफलथ क्वथर्
•भृङ्गरथज स्वरस
•आरग्वध्यथदद कषथय
2.व्रण रोपण हेतु(स्र्थननक प्रयोग)
•त्रिफलथ मसी (त्रिफलथ की जली रथख) को मधु सैंधव शमश्रकर प्रलेि (भथ.प्र.) ।
•जथत्यथदद तैल तर्थ करंजथदद घृत, भूननम्बथदद घृत (भथ.प्र.) कथ प्रयोग ।
•जथत्यथदद घृत तर्थ कोशथतकी तैल
•व्रणरथक्षस तैल
•आगथर धूमथद्य तैल
3.कुष्ठ, नथडीव्रण तर्थ व्रणरोग में वर्णात घृतों कथ प्रयोग िररषेचनथर्ा, रोिणथर्ा तर्थ
िथन के शलए करनथ चथदहए ।

13. संशमनऔषधयोग
•रस/भरम/वपष्टी–त्रिवंगभस्म,व्यथधधहरणरसथयन,अष्टमूनतारसथयन,
उिदंशगजके शरीरस,रसमथर्णक्य,गंधकरसथयन,अमीररस,शुभ्रथभस्म,कथसीसभस्म,
गैररकभस्म,रसकिूार,प्रवथलपिष्टीआदद।
•वटी/गुग्गुलु-वरथददगुग्गुलु,आरोग्यवधधानीवटी,कै शोरगुग्गुलु,रसगुग्गुलु,रसशेखर
वटी,आदद।
•िूणण-कथसीसचूणा,चोिचीन्यथददचूणा,ननम्बथददचूणा
•क्वाथयोग-िटोलथददक्वथर्,उिदंशहरकषथय,ननम्बथदीकषथय,मंजजष्ठथददकषथय
आदद।
•आसव/अररष्ट-महथमंजजष्ठथद्यथररष्ट,देवदथव्यथाद्यथररष्ट,सथररवथद्यथसव
•अवलेह/पाक–सथररवथद्यवलेह,चोिचीनीिथक

14. •घृत/त ल
अन्तःप्रयोगथर्ा–करञ्जथद्यघृत,भूननम्बथद्यघृत।
बथह्यःप्रयोगथर्ा-जथत्यथददतैल,गोजजह्वथददतैल,आगथरधूमथद्यतैलतर्थकोशथतकीतैल।
•लेप—उिदंशहरमल्हर,उिदंशहरचूणाप्रलेि,गैररकथददलेि,िूगफललेि,करवीरमूल
लेि
•अवूिणणन–ननम्बथददचूणा,बबूलििचूणा,दथड़िमत्वकचूणा,मथनवअजस्र्चूणा,
अवचूणानतर्थकथसीसचूणाअवचूणान।
•प्रक्षालनयोग
जयन्ती,चमेली,करवीर,अका,अमलतथसकेििकथक्वथर्बनथकरमेढ्रव्रणप्रक्षथलनथर्ा
प्रयुक्तकरें।
त्रिफलथक्वथर्सेव्रणकथप्रक्षथलनकरें।
क्षीरीवृक्षकषथयसेव्रणप्रक्षथलनकरें।
आरग्वधथददक्वथर्सेप्रक्षथलनकरें।-

16. PATHYAPATHYA

17. CHANCROID
Definition
Chancroidisasexuallytransmitteddiseasecausedbythegram-
negativebacteriaHaemophilusducreyiandischaracterizedbypainful
necrotizinggenitalulcersthatmaybeaccompaniedbyinguinal
lymphadenopathy.

18. Transmission
•Sexuallybydirectcontactwithpurulentlesions
•Byautoinoculation(selfinfection)tononsexualsites,suchasthe
eyeandskin.
•Healthworkersbecomeinfectedthroughcontactwithinfected
patients.
Incubationperiod
•1dayto2weeks,withamediantimeof5-7days.

19. Pathophysiology
•H.ducreyipenetratestheskinthroughdisruptedmucosa
(injury/scratch/cut)andcausesalocalinflammatoryreaction.
•Itproducesacytocidaldistendingtoxinthatappearstobe
responsibleforitsdestructiveeffects.
•Thelocaltissuereactionleadsto
•Developmentoferythomatouspapule,
•Progressestopustulein4–7days.
•Thenundergoescentralnecrosistoulcerate.
Cytocidal–Kill the host cell through changes in cell morphology etc

20. Sign&Symptoms
•ThefirstlesionofChancroid
Beginsasasmalltenderpapulewithsurroundingerythema
Rapidlybecomespustular
Thenerodestoformanextremelypainfulanddeepulcer.
Theulcerispainful,bleedseasily,drainsagreyoryellowishpus.
Theadjacentulcersmaymergeandformconfluentlesions.
Superinfectionofulcers,especiallyfuso-spirochetal,mayoccur
andleadtorapiddestructionoftheexternalgenitalia,known
asphagedenicchancroid.

21. Ulcerbaseiscomposedof
•Easilyfriablegranulationtissuethatisusuallycoveredwith
malodorousyellow-grayexudates.(malodorous-veryunpleasant
smell)
•Ithassoft,sharplydefined,raggedmargins
(differfromprimarysyphillisChancre-typicallypainless,
induratedandhasacleanbase)
•Varyinsizefrom1-20mm.
Friable –Easily Crumbled

22. •Ulcerinmen&women
•Abouthalfofinfectedmenhaveonlyasingleulcer.
•Womenoftenhavefourormoreulcers.
•Womenmaybeasymptomaticcarriersofthedisease.
•Thechiefsymptommaybedysuriaordyspareunia.
•Mayhaveahigherincidenceofresolutionafterpapule
formationwithoutulcerformation.
Dyspareunia–Recurrent genital pain in intercourse

23. Commonlocationsofulcers
•Inmenaretheshaftorheadofthepenis,foreskin,thegroove
behindtheheadofthepenis,theopeningofthepenis,andthe
scrotum.
•Incircumcisedmen-Coronalsulcus
•Inuncircumcisedmen-Prepuce.Lesionsmaybeobscuredbya
painfulphimosisinuncircumcisedmen.
•Inwomen,commonlocationsarethelabiamajora(outerlips),labia
minora(innerlips),perianalarea(areaaroundtheanalopening)
andinnerthighs.

24. Lymphadenopathy
•Oneweekaftertheformationofthegenitalulcer,Painful,usually
unilateral,regionallymphadenopathyoccurs.(approximately50%
ofpatientsandismorecommoninmen)
•Ofpatientswithlymphadenitis,25%mayhaveprogressiontoa
suppurativebubowhichmayrupturespontaneouslyandulcerate.
(Theswollenlymphnodesandabscessesare
alsocalledbuboes)
•Ifuntreated,chronicdrainingsinusesmay
followandforminganotherulcer.

25. ChancroidMale
Regional adenopathy
Chancroidulcers

26. OthertypesofChancroid
Althoughrelativelyrare,chancroidsometimesmaybeassociatedwithvarious
presentationsthatdifferfromtheclassicformdescribedabove.
•Transientchancroidproducesanulcerthatrapidlyresolvesin4-6days,followed10-20
dayslaterbyasuppurativelymphadenitis.
•Dwarfchancroidmanifestsasoneorseveralherpeslikeulcerations,withorwithout
inguinallymphadenopathy.
•Follicularchancroidproducesulcerationsofthepilarapparatusinhair-bearingareas.
•Giantchancroidconsistsofmultiplesmallulcerations,whichcoalescetoformasingle
largelesion.
•Pseudogranulomainguinale-Pseudogranulomainguinaleisanotherchancroid
varietythatcloselyresemblesgranulomainguinale.

27. Laboratoryfindings
•Microscopically-Frombubopusorulcersecretions,H.ducreyican
beidentified.
•PCR-basedidentification
•Antigendetectionmethods-Simple,rapid,sensitiveand
inexpensive
•SerologicdetectionofH.Ducreyi(usesoutermembrane
proteinandlipooligosaccharide)

28. CHANCROID
Gram stain of Haemophilusducreyi

29. MANAGEMENT
•Antibiotics
•Azithromycin-1gorally(PO)asasingledose OR
•Ceftriaxone-250mgintramuscularlyasasingledose OR
•Erythromycinbase-500mgPO3timesdailyfor7days OR
•Ciprofloxacin-500mgPOtwicedailyfor3days OR
•Ceftriaxoneisthetreatmentofchoiceinpregnantwomen

30. •Theulcer(s)maybecleanedandsoakedtoreducetheswelling.
•Saltsolutiondressingsmaybeappliedtotheulcer(s)toreducethe
spreadofthebacteriaandpreventadditionalulcers.
•Aseriousinfectionoftheforeskinmayrequirecircumcision.
•Puswouldberemovedfrominfectedlymphnodesbyusinganeedle
andsyringe.
•Verylargebuboesmayrequiresurgicaldrainage.

31. PrognosisofChancroid/SoftChancre
•Withouttreatment,chancroidmayeithergoawayquicklyor
patientsmayexperiencethepainfululcersformanymonths.
•Acompletecureisobtainedwithantibiotictreatment.
•Severeulcersmaycausepermanentscars.
•Urethralfistulasmayoccurandrequirescorrectivesurgery.