Importance of Karappan and its Morphology
Dr.Anand.P.K.V.
M.D.(Ay)
Vaidyaratnam Ayurveda College
Ollur – Thaikkattussery
Thrissur 680322
Dr. Kunnathu Manackal Vasudevan Namboodiry
Thiruvambady, Thrissur 680 022
Visarpas are the kind of skin lesion with a fast spreading character. Kushtas are slow spreading in nature. Many kshudrarogas are also skin lesions. They have a short and specific course of samprapthi are treated with specific approaches and medications. Many other diseases have skin manifestations in their symptoms or complications. They also often need attention as a skin disease along with the treatment of main disease. Differentiating skin lesions and identifying the category of disease to which it belong, seems to loose importance prior to planning treatments, in the recent periods.
Bala visarpa is unique in many aspects. The clinical manifestations can vary from a seemingly insignificant stomatitis to skin decaying all over the body. The associated symptoms, complications or the sequels can even be presented in different systems as weakness of limbs in kuzhalvathakkarappan, hernia in vridhikkarappan, etc. It is differentiated each other by age and the clinical manifestations. Young age, where the patient can’t explain his clinical complaints, is a factor which makes the specificity in diagnosis a challenging task. The same is the case with treatments also.
When clinical manifestations are different in two individuals with same disease, the causative factor is also taken as different among them. In karappan the samanya nidana of visarpa is applicable for all varieties. It is not an easy job to separate the nidana of one type of karappan from another. Children does not have much chronic exposure to nidanas by themselves as we see the karappan affecting them sometimes at very early days of childhood. There are other factors precipitating these conditions such as sthanyadushti, beejadushti, environmental factors etc. Even obstetric history has a role in making skin lesion. For example, “nigooda nidana” of balachikitsa says, if a girl gets pregnant for second time without having treatment for the previous miscarriage she had in the previous pregnancy, the baby develops skin lesions, fever etc. The time of fertilization and becoming pregnant can also take a role in the karappan. If she becomes pregnant during menstruation, the baby develops everted, round skin lesions with itching and oozing. If she gets pregnant in day time the baby develops hypo pigmented lesions like tenia versicolor etc. Thus it becomes very important to specifically select the treatment regime according to each and every variations in clinical presentation.
Bhela says :
“vikarabhede samdrishte hethorbhede na samshayah
Ithi bhelah pridhak thasmal asyopakramamabhyadhal”
There are differences in the number of karappan in different books. The classification is in consideration of various factors such as age, constitutional manifestations, character of skin lesions, associated manifestations etc. Karappan are primarily classified into 9 types as per Arogyakalpadruma. They are Vatha, pitha, Kapha, Vathapithaja, Vathakaphaja, Kaphapithaja, Sannipathaja, Rakthaja and Vishaja. The vathika visarpa is again of 8 types. Pithaja is of 16 types and Kaphaja of 21 types. The Vathapitha is agnivisarpa (theekarappan), Vathakapha is grandhivisarpa (muzhakkarappan), Kaphapitha is kardama visarpa ( cherkkarappan), Thridoshaja visarpa is Asanivisarpa ( Idival karappan), Rakthaja is Raktashteevi visarpa (chorakarappan), Vishajavisarpa is salyaka visarpa (chillikarappan). N.A.Kaimal in his book on Balachikitsa has described the 56 types of Karappan as below.
The morphology of skin lesions is the easiest method to identify the kind of Karappan. Conspicuously, the boils in the karappan will have the following characters in these lesions.
Akakarappan ulcerated mouth and anal region
Panikkarappan Stomatitis
Purakkarappan Loculated boils located in back of ears and trunk
Rakthakkarappan Ulcer in anal region
Kuppikkarappan glossy clear boils of pepper size
Neerkkarappan clear & watery boils
Vranakkarappan Ulcerations all over
Karinkarappan bluish saucer shaped later ulcerating
Chilanthikkarappan pustules later ulcerating
Polakkarappan boils resembling burns
Kalthamarakkarappan hard glossy boils
Kantamala karappan boils connected each other located around neck
Muyaladi karappan small clustered red boils with white tint
Valli karappan clustered elongated boils
Peeli karappan mustard size bluish glossy boils
Vridhi karappan No skin manifestations
Erikkarappan Blackish, hard, clustered
Kirali karappan Boils with extensions resembling camel shapes
Chenkar karappan Blackish red boils not much elevated
Chenkarappan Clustered red boils spread all over
Valayakkodi karappan Sharp thorny boils
Poruma karappan Bluish, triangular, or semicircular boils
Chida karappan thin small elongated bluish red boils
Podi karappan Powder coated thick saucer shaped bluish pustule
Thalika karappan Clustered saucer shaped boils
Adarkkarappan boils with peeling of skin
Pillakkarappan Small clustered hot to touch boils
Kudal karappan stomatitis and anal ulcers
Kalkkarappan clustered boils with hard and peeling skin
Muzhankal karappan boils with thin secretions appearing first in knees
Chemparappu karappan Red and thick spreading lesions with no boils
Akamundi karappan Tonsilitis with no skin lesions
Puramundi karappan Blackish swellin externally with tonsilitis
Manalkarappan rashes
Venkarappan white elevated patches
Enikarappan Pale glossy elevated and depressed boils
Pada karappan Swelling with elevated separated margins
Thairneer karappan Clear boils with curd like secretion
Palaka karappan Flat elevated boils
Chootha karappan copper red skin turning to white clustered small boils
Neela karappan bluish round big boils
Muzha karappan no skin leisions
Pulinkuru karappan boils to the size of a tamarind seed with exfoliation
Veneer karappan Powdery,exfoliating boils with clear fluid
Athikkayakkarappan bluish red boils with a red tip
Pravalakkarappan Red big oozing boils
Madakkal karappan Bluish red elongated boils which crack in the center
Aama karappan boils on a swelled surface
Kozhichuttan Erythmatous . No boils
Thee karappan Boils turning black later
Mulanel karappan Spindle, shaped, clustered, pale red and hard
Durva karappan Itching small clustered boils limited to a well marinated area
Idival karappan Extensive boils even in eyes
Onkan karappan Spindle shaped boils in anal region and eyes
The described morphological identification can help us to select the specific medications prescribed for each variety of the karappan. It will be helpful for us if we keep this description in mind it can help us differentiating skin lesions of all kinds in various diseases. For example, Chilanni are a group of skin lesions which is ulcerated oozing with a peculiar smell, and the lesion spreads wherever the oozing is touched. This is of atleast 5 types. Another skin lesion named as Varppu (Rakthanavasthatha), is a variant of Vathasonitha. It affects in childhood only. Varppu is of 18 types and needs specific treatments to get cured. There are other diseases like Kshudra rogas, Seethapitha etc which needs to be included in differential diagnostic list. Being the commonest and the one with broad treatment principles, assuming all skin complaints as Karappan and adopting its treatment approaches, until a specific diagnosis is established is a useful practical stand in the management of skin lesions of children.
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