Ojas Ayurved

Ayurvedic Treatment for Other Diseases like Skin, IBS, Migraine, Hepatitis and More.

Other Diseases

Skin Diseases

Skin diseases are conditions that affect the skin. These skin diseases may cause skin itching, rashes, inflammation, dryness or blisters.

Common causes of skin diseases:

  • Bacteria trapped in hair follicles.
  • Fungus or Parasites Living on skin. Virus infect 
  • Contact with another person’s skin.
  • Contact with allergens.
  • Genetics
  • Some of medicines
  • Sun rays
  • Immune system

 How is skin disease diagnosed ?

  • Visually examining skin.
  • Biopsy :  Removing a small piece of skin to examine under a microscope.                
  • Culture :  taking a skin sample to test for fungus, virus or bacteria.
  • Wood light test : using an UV light to view skin’s pigment.
  • Dermoscopy : using a dermoscope to diagnose skin lesions.

Most Common types of skin diseases:

  • Acne
  • Eczema (Contact / Atopic / Seborrheic dermatitis)
  • Psoriasis
  • Urticaria
  • Vitiligo
  • Herpes
  • Alopecia areata
  • Lupus
  • Ringworm (Tinea infection)
  • Pemphigus
  • Lichen planus
  • Carbuncles

Risk factors of developing skin diseases:

  • Diabetes : may have Tinea infection, carbuncles and trouble with wound healing.
  • Lupus :This chronic condition can lead to skin problems.
  • Pregnancy / Hormonal changes : Melasma (Brown patches on a face) is a common skin disease that mostly affects pregnant women.
  • Stress : Alopecia areata, acne, vitiligo, dermatitis may get worse when stressed.
  • Medicines : Some medicines can lead to skin problems.

 How to prevent skin diseases:

  • Avoid sharing personal items or cosmetics.
  • Limit contact with irritants or chemicals.
  • Use some protection to prevent sunburn.
  • Disinfect objects.
  • Drink plenty of water and eat a nutritious diet.
  • Sleep 7 to 8 hours per night.
  • Do regular exercise and yoga.
  • Wash hands with soap and water.
  • Reduce stress and anxiety.

Ayurvedic concept on skin diseases:

  • Skin diseases are called “Kustha” in ayurvedic texts (Acharya Charak, Acharya Sushruta,Acharya Vagbhat etc). Kustha is caused due to vitiation of 7 body elements.
  • Skin diseases are caused due to imbalance in 3 doshas – Vata, pitta and kapha and 4 Dushya – Twak (skin), Rakta (Blood), Mansa (muscle tissue) and Ambu (Water element).

Causative factors of skin diseases (Ayurveda)

विरोधि अन्न पानानि द्रव स्निग्घ गुरूणि च |

भजताम् आगतां छर्दि वेगान च अन्यान् प्रतिघ्नताम् |

व्यायामम् अति संतापम् अति भुक्त्वोपसेविनाम्

शीत उष्ण लङघन आहारान् क्रमं मुक्त्वा निषेविणाम् |

घर्म श्रम भय आर्तानाम् द्रुतं शीत अम्बु सेविनाम् ||

अजीर्ण अघ्यशिनां च एव पंचकर्म अपचारिणाम् |

नव अन्न दधि मत्स्य अतिलवण अम्ल निषेविणाम् |

माष मूलक पिष्टान्न तिल क्षीर गुड अशिनाम् |

व्यवायं च अपि अजीर्णे अन्ने निद्रां च भजतां दिवा |

विप्रान् गुरुन् घर्षयतां पापं कर्म च कुर्विताम् ||     चरक चिकित्सा 7/4

Wrong diet habit

  • Excessive intake of heavy food (Milk, cheese, paneer),yogurt, oily food, jaggery, sour and salty food, fermented food, fish, incompatible diet (fish and milk, fruits and milk together) and overeating.

Wrong lifestyle

  • With holding natural urges (Excretion, urination, vomiting) Specially urge of vomiting can cause skin disease.
  • Immediate exercising after eating.
  • Take cold water or bath immediately after physical exercise.

Sin action

  • Ayurved believes that some skin diseases are caused due to misbehaviour done in previous birth.

Genetics

स्त्री पुंसयो: कुष्ठ दोषाद् दुष्ट शोणित शुक्रयो: |

यत् अपत्यं तजोजातं ज्ञेयं तद अपि कुष्ठितम् ||     सुश्रुत निदान 5/27

The child born of a woman and a man with vitiated ovum and sperm due to  skin diseases may be inherited with skin diseases.

Contagious

प्रसंगाद् गात्र संस्पॅशात् निश्वासात् सहभोजनात् |

सहसय्या आसनाच्चापि वस्त्रमाला अनुलेपनात् ||

कुष्ठं ज्वर: च शोष: च नेत्राभिष्यद एव च |

औपसगिॅक रोगा: च संड्क्रामन्ति नरान् नरम् ||     सुश्रुत निदान 5/32

Kustha (skin diseases), fever, conjunctivitis and infectious diseases spared from human beings to human being due to sexual intercourse, touching, even sharing the same bed, clothing, ornaments and cosmetics.

Common prodromal features: (पूर्वरूप)

तस्य पूर्वरूपाणि – त्वक् पारुष्यम् अकस्मात् रोमहर्ष: कन्डू :

स्वेदबाहुल्यम् अस्वेदनम् वाङगप्रदेशानां स्वाप: क्षत् विसर्पणम्

असृज: कृष्णता च इति||     सुश्रुत निदान 5/4

  • Roughness of skin
  • Sudden horripilation.
  • Itching
  • Excessive sweating or absence of sweating.
  • Loss of sensation in the limbs.
  • Increase in the size of wounds (in spite of treatment)
  • Blackish discoloration of the blood.

Types of skin diseases: (कुष्ठ भेद)

तत्र सप्त महाकुष्ठानि, एकादश क्षुद्र कुष्ठानि |     सुश्रुत निदान 5/5

  • Major kustha – 7 Aruna, Udumbara, Jihva, Kapala, Kakanaka, Pundarika and dadru.
  • Minor kustha – 11 Sthularuska, Mahakustha, Akakusth, Charmadala, Visarpa, Parisarp, Vicharchika, Siddhma, Kitibha, Pama, Raksa.
The kustha has been popularly used for leprosy but it appears that many of these do not have leprosy, but in fact are near to many other skin diseases so kustha should be used for skin diseases including leprosy.

Prognosis of skin diseases:

कुष्ठम् आत्मवत: साध्ये त्वक् रक्त पिशित आश्रितम् |

मेदोगतं भवेत् याप्यम् असाध्यतम् उतरम् ||     सुश्रुत निदान 5/29

  • Skin diseases are curable in the prudent (wise) persons if it is located within twak (skin) rakta (blood) and pishit (muscle tissue).
  • It is relievable if it involves meda (fat tissue).
  • It is incurable in the rest of the dhatus (bone, bone marrow or shukra).

Treatment of skin diseases (Ayurveda):

वात उतरेषु सर्पि: वमनं श्लेष्म उतरेषु कुष्ठेषु |

पित उतरषु मोक्षो रक्तस्य विरेचनं च अग्रे ||     चरक संहिता चि. 7/39

  • In vataj kustha, firstly administer ghritpana.
  • In kaphaja kustha vaman procedure should be done.
  • In pittaja kustha virechan along with Raktamokshana (Remove Circulating toxins from the blood) should be the first line of treatment.

बहु दोष: संशोध्य: कुष्ठी बहुशो अनुरक्षता प्राणान् |     चरक संहिता चि. 7/41

  • Patients with excessive vitiated dosha should be given shodhana therapy, taking care about their prama (Strength).

                     वमन विरेचन योगा: कल्प उफ्ता: कुष्ठिनां प्रयोत्कव्या |     चरक संहिता चि. 7/40

  • For vamana and virechana therapy, drugs mentioned in kalpa sthana should be used.

कफ पित रक्त हरणं तिक्त कषायै: प्रशमनं च |     चरक संहिता चि. 7/58

  • Kapha, pitta and rakta should be eliminated with panchakarma therapy and tikta (Bitter) Kashaya (astringent) drugs are to be used for pacifying the dosha.

Kidney Stone

Kidney Stone or renal calculi which are hard deposits made up of minerals, acids and salts (calcium oxalate, calcium phosphate, urates). Stones are formed inside kidneys ureters and bladder.

Causes of kidney stone:

  • Oxalate rich food, excess body weight.
  • Some Medical conditions and certain medicines.
  • Eating food with too much salt or sugar.
  • Family history.
  • Urinary tract infection.
  • Drinking too little water.
  • Exercise (too much or too little)

 

Symptoms:

  • Severe pain on either side of abdomen and back.
  • Stomach pain, vomiting, or nausea.
  • Blood in urine, bed smell or looks cloudy.
  • Chills and fever if infection.

 

Types of kidney stones:

  • Calcium oxalate stones: most common type.
  • Calcium phosphate: caused by abnormalities in the urinary system functions     
  • Uric acid stones: more likely to occur in people who have gout.
  • Struvite stones: more common in women.
  • Cystine stones: caused by a hereditary disorder called cystinuria.

 

Self-care steps to prevent kidney stones:

  • Drink enough water and fluid to pass at least 2.5 litres of urine each day.
  • Ginger, lemon and fruit juice could help prevent the formation of stones.
  • Reduce intake of oxalate rich food. (green vegetables, soya, potatoes, tea, beet).
  • Limiting salt and animal proteins  can also lower risk of kidney stones.

Ayurved concept on urinary stone (अश्मरी):

Urinary stone is described in ayurved books such as Sushruta Samhita (before 3000 years) Charak Samhita (before 2000 years) and Ashtanga Hridaya (6th Century).

 

Causes and aetiology of urinary stone:

अशंशोधनशीलस्य अपथ्य कारिण: प्रकुपित: श्लेष्मा: 

मुत्रसम्प्रुक्तो अनुप्रविश्य बस्तिम् अश्मरी जनयति ||     सुश्रुत निदान. 3/4

  • In those who do not observe proper cleansing procedures (panchakarma – emesis, purgation, enema, nashya, blood-letting / fasting or exercise) and in those who are careless regarding dietary habit the shleshma gets aggravated and mixed with urine, enters the urinary bladder and there in it produce calculi.

 

Common initial symptoms:

बस्ति पीडा अरोचकौ मूत्रकृच्छं बस्तिशिरो मुष्क शेफसां वेदना

ज्वर: कुच्छ अवसादो, बस्तगंधित्वं मुत्रस्येति ||     सुश्रुत निदान. 3/5

  • Pain over bladder, dysuria.
  • Pain over ureter, orifice, scrotum and penis.
  • Fever, depression.
  • Pass urine like goat urine.

 

Common symptoms:

नाभि बस्ति सेवनी मेह्नेषु अन्यतम् अश्मिन् महती वेदना |

मूत्रघारासंडग़: सरुधिरमूत्रता मूत्रविकीरणं गोमेद प्रकाशम् अत्य आविलं ससिफ्तं विसृजति|

घावन लाङघन प्लवन पृष्ठयानोष्णाघ्व गमनै: च अस्य वेदना भवन्ति |     सुश्रुत निदान. 3/7

  • Severe pain in the umbilicus, urinary bladder, inguinal region and penis.
  • A slowed urinary stream, blood in the urine, urine colour is like hessonite.
  • Urine passes dirty and with gravel.

 

Types of urinary stones:

  • Vataj Ashmari (Calcium oxalate)
  • Pittaj Ashmari (Uric acid calculi)
  • Kaphaj Ashmari (Calcium phosphate)
  • Shukraj Ashmari (Spermatic Concretion).

 

Useful Ayurvedic herbs for kidney stones:

Punarnava, Varuna, Gokshur, Pashanbhed, Apamarg, Kantkari, Shatavari.

Urethral Stricture

  • A urethral stricture can cause a very slow urinary stream and make it difficult to completely empty the bladder. It may feel a frequent or urgent need to urinate.This condition can cause pain, bleeding and a fear of urinating.
  • Long time, a urethral stricture can cause permanent bladder damage, urinary tract infection, blood in urine, retention of urine in the kidneys and may lead to kidney damage.

 

Causes of urethral stricture:

  • Injury such as an accident or surgery.
  • Complications from urethral catheter placement.
  • An infection of the urethra.

 

Treatment:

Treatment depends on the types of stricture and size.

  • Catheterization
  • Dilation
  • Urethroplasty
  • Urethrotomy
  • Implanted Stent

 

Ayurved concept on urinary stricture ( Mutramarg Sankoch – Mutraghat):

  • Urethral stricture can be correlated with mutramarga sankocha in Ayurveda. Uttarabasti a para-surgical procedure is the most effective available treatment in Ayurveda for the diseases of urethral stricture (Mutramarg Sankoch).
  • Sushruta has described 12 varieties of Mutraghata (Suppression of urine) in the uttartantra chp – 58. Mutraghatta is classified on the basis of dominance of doshas, but vata is the basis for all types of Mutraghata.
  • In this condition uttar basti of medicated oils is the most effective treatment described by the Ayurveda. Medicated Apamarg kshar oil is effective in urethral stricture.

Ulcerative colitis

Overview:

  • A chronic, inflammatory bowel disease with remitting and relapsing pattern in the large intestine. That causes inflammation and ulcers in the digestive tract.
  • Ulcerative colitis affects the innermost lining of the colon and rectum. Symptoms usually develop over time. Having ulcerative colitis puts a patient at risk of developing colon cancer.

 

Symptoms:

  • Diarrhoea, often stool passing with blood or pus
  • Urgency to defecate (Stool Passing)
  • Abdominal and rectal pain
  • Weight loss, Fatigue, Fever

 

Causes:

  • The exact cause remains unknown. Spicy diet and stress are suspected.
  • Immune system malfunction may be a cause.
  • Heredity also seems to play a role.

 

Ayurved concept on ulcerative colitis (“Raktatisar” Hemorrhagic Diarrhoea):

In Ayurveda, Raktatisar is described as a type of hemorrhagic diarrhoea. That shares certain symptoms with ulcerative colitis, including Atisar (diarrhoea), shula (abdominal pain), gudapakka (Rectal ulcers) and Trishna (thirst). The disease is caused by pitta Pradhan vata dosha.

Causes and aetiology:

 पित अतिसारी यस्त्वेतां क्रियां मुक्त्वा निषेवते |

पितलानि अन्नपानानि तस्य पितं महाबलम् ||

कुर्यात् रक्तातिसारं तु रक्तम् आशु प्रदुष्येत् ||     चरक संहिता चि. 19/69

 

If the patient suffers from paittika diarrhoea and does not follow the above mentioned therapeutic measures, and take more food and drinks which cause aggravation of pitta, then causes Raktatisar.

Symptoms:

तृष्णां शूलं विदाहं च गुदपाकं च दारूणम् |     चरक संहिता चि. 19/70

  • Diarrhoea with blood.
  • Excessive thirst.
  • Colic pain.
  • Burning sensation.
  • Ulcers of the anus and rectum.
  • Very unpleasant.

 

Treatment:

तत्र च्छागं पय: शस्तं शीतं समधु शर्करम् |

पानार्थ भोजनार्थ च गुदप्रक्षालनं तथा || चरक संहिता चि. 19/71

 

  • In ulcerative colitis goat’s milk is very useful. Cold milk with honey and sugar for drink, along with food and for washing the anal region is found to be effective.
  • Acharya Charak described many herbal remedies.
  • Basti Chikitsa is listed as a method of managing Raktatisar (ulcerative colitis).

Jaundice

Overview:

  • Jaundice is a condition, where skin, eye’s sclera and mucous membranes turn yellow. Many medical conditions can cause jaundice, like hepatitis, gallstones and tumours.
  • When RBC (red blood cells) die, they leave behind bilirubin (a yellow orange pigment) in the blood. The liver filters bilirubin from the bloodstream to be removed in the stool. Too much bilirubin in the blood is known as hyperbilirubinemia. This causes jaundice, where skin and sclera look yellow.

 

Causes:

  • Hepatitis: Liver inflammation can be caused by viral infection (Hepatitis A,B,C,D,E), autoimmune disorders, alcohol, chemical or drug use. Long turn inflammation can damage the liver, causing jaundice.
  • Other liver diseases: Cirrhosis, fatty liver can cause inflammation, which damages the liver.
  • Blocked bile duct: If the bile duct is blocked by gallstones, cancer or inflammation, could get jaundice.
  • Pancreatic cancer: It can block the bile duct causing jaundice.

 

Symptoms:

  • Yellowing of the skin and eyes.
  • Fever, stomach pain, weight loss, anorexia, nausea, vomiting.
  • Dark urine, tar or clay-coloured stool.
  • Itchy skin, drowsiness, irritability.

 

Types of jaundice:

  • Prehepatic: breaking down more red blood cells and creating more bilirubin than the liver can process.                         
  • Hepatic: Inflamed liver isn’t able to process bilirubin well.
  • Posthepatic: Bilirubin builds up after passing through the liver and the body can’t clear it.
  • Obstructive: Due to blocked bile duct or pancreatic duct.

 

Ayurved concept on jaundice (कामला):

Cause and aetiology

पाण्डुरोगी तु यो अत्यर्थ पितलानि निषेवते |

तस्य पितम् असृक् मांसं द्ग्ध्वा रोगाय कल्पते ||     चरक संहिता चि.16/34

If the patient suffers from pandu and takes a pitta aggravating diet, so pitta burns the rakta (blood) and mansa (muscle tissue) causing the kamala (jaundice).

 

Symptoms:

हारिद्र नेत्र: स भृशं हारिद्र त्वक् नख आनन: |

रक्तपीत शकृत मुत्रो भेकवर्णों हतेन्द्रिय ||

दाह अविपाक दौबँल्य सदन अरुचि कर्षित: |     चरक संहिता चि.16/35

  • Yellowing eyes, skin, nails and face.
  • Red and yellow urine and stool.
  • Frog-like body colour.
  • Sense organs are impaired.
  • Burning sensation, indigestion, anorexia, weakness and body ache.

 

Line of Treatment:

मृदुभि: तिक्तै: कामला तु विरेचनै: |     चरक संहिता चि. 16/40

Purgation therapy with mild and bitter medicines are useful for jaundice.

 

त्रिफला गुडूच्या वा दाव्याँ निम्बस्य वा रसम् |

शीतं मधुयुतं प्रातः कामलार्त: पिबेत् नर: ||     चरक संहिता चि. 16/63

  • The patient suffering from jaundice should take in the morning the decoction of following herbs and need to add honey in it after it cools down.
  1. Abhya – Terminalia chebula
  2. Bibhitaki – Terminalia bellirica
  3. Amalaki – Emblica officinalis
  4. Guduchi – Tinospora cordifolia
  5. Darubaridra – Berberis aristata.
  6. Nimbpatra – Azandirachta indica

Migraine

Overview :

  • A Migraine is a severe headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head.
  • It is often accompanied by nausea, vomiting and sensitivity to light and sound.
  • Migraine attacks can last for hours to days, and a painful headache interferes with daily activities.


Causes Of Migraine:

  • It can depend on genes.
  • Family history.
  • Certain types of foods – spicy, oily.
  • Skipping meals, irregular sleep, lack of physical activities.
  • Stress, fear and Anxiety.
  • Environmental factors.


Symptoms:

Migraines can progress through four stages. Prodrome, aura, attack and postdrome but not everyone goes through all four stages.

 

Prodrome:

One or two days before a person might notice changes that warn him of an oncoming migraine, which includes symptoms like:

  • Mood changes.
  • Constipation.
  • Food cravings.
  • Increased urination.
  • Neck stiffness.

 

Aura:

For some people, an aura might occur before or during migraine, symptoms are:

  • Vision change.
  • Pins sensation in an arm or leg.
  • Weakness or numbness in the face.
  • Difficulty speaking.

Attack:

A migraine usually lasts 4 to 72 hours if untreated. Migraine occur rarely or several times a month, symptoms are:

  • Pain usually on one side of the head or rarely on both sides.
  • Throbbing or pulsing sensation.
  • Sensitivity to light or sound.
  • Nausea and vomiting.

 

Postdrome:

  • After a migraine attack might feel drained, confused and washed out for up to a day.
  • Sudden head movement might bring on the pain again.

 

Ayurved concept on migraine (अर्धावभेदक):

  • अर्ध : Half side of the head..
  • अवभेदक : Penetrating or breaking pain.

Causes:

रुक्ष अत्य अध्यशनात् पूर्ववातावश्याय मैथुनै: |

वेगसंधारण आयास व्यायामै: कुपितो अनिल: ||     चरकसंहिता उतरतंत्र 9/74

  • Excessive consumption of dry substances.
  • Consumption of excessive food.
  • Exposure to easterly breeze or fog.
  • Excessive sex activity.
  • Suppression of natural urges.
  • Exhaustion or exercise.

Pathogenesis:

केवल: सकफो वा अर्ध गृहीत्वा शिरस: तत: |     चरकसंहिता उतरतंत्र 9/75

  • Vata either singly or along with kapha, affecting half of the head produces severe pain.


Symptoms:

       मन्या अभ्र शंख कर्ण अक्षि ललाट अर्धे अति वेदनाम् ||

       शस्त्र अरणिनिभां कुर्यात् तीव्रां स: अर्धावभेदक: |

नयनं वा अथवा श्रोत्रम् अतिवृद्धो विनाशयेत |     चरकसंहिता उतरतंत्र 9/75

  • Pain experienced is similar to pain felt when injured by a sharp weapon. Usually sites for pain are neck, eyebrow, temple, ear, eye and forehead of the asspociated half of the head.
  • Blindness or deafness occur when the condition is severe

Treatment:

चतु: स्नेह उतमा मात्रा शिर: काय: विरेचनम् |

नाडीस्वेदो घृतं जीणँ बस्तिकर्म अनुवासनम् ||

उपनाह: शिरोबस्ति: दहनं च अत्र शस्यते |

प्रतिश्याये शिरोरोगे यत् उदिष्टं चिकित्सितम् || चरक संहिता उतरतंत्र 9/78

  • The 4 snehas (Taila, ghrita, vasa, majja) in the proper dosage.
  • Purgation
  • Purificatory errhines
  • Steam procedure
  • Old ghee
  • Oil enemas
  • Poultices
  • External Oil application
  • Cautery
  • The treatment should be the same as treatment given for pratishyay (Rhinitis) and shirorog (Headache).

IBS – Irritable Bowel Syndrome

Irritable bowel syndrome is stomach and intestine disorder. Symptoms include diarrhoea, constipation, abdominal pain, bloating, abdominal gas and cramping. IBS is a chronic disease and doesn’t damage the digestive track or increase risk of colon cancer.


Causes of IBS:

 The exact cause of IBS isn’t known. Some factors to play a role include:

  • Muscle contractions in the intestine: Large intestine muscles tend to contract more in people with IBS. These contractions cause cramps and abdominal pain.
  • Nervous system: Poorly coordinated signals between the brain and intestine can cause the body to overreact to changes that occur in the digestive process. This can result in abdominal pain, diarrhoea or constipation.
  • Infection: IBS can develop after a diarrhoea caused by bacterial or viral infection. IBS might also be associated with altered bacteria in the gut.
  • Stress: IBS is more common in people who have severe stress in childhood or physical, sexual and emotional abuse.


Symptoms:

  • Diarrhoea or constipation
  • Excess gas and bloating
  • Abdominal pain
  • Mucus with stool
  • Sensation of incomplete evacuation

 

Risk factors:

  • Age: IBS occurs more frequently in people under age 50. 
  • Family history: Genes may play a role.
  • Female: More common among women.
  • Mental health issues: Anxiety, depression or other issues might be a risk factor.


Ayurved concept on IBS:

  • Ayurveda mentioned one disease known as Grahani. (Charak sanhita. Chp. 15)
  • The symptoms of IBS resemble most of grahani.
  • Normally, grahani (duodenum) holds up the food (till it is digested) and releases food after it is digested. But due to weak digestive fire it releases ingested material even in unripe condition.
  • This condition caused diarrhoea, abdominal pain and gas.


Causes of grahani (IBS):

  • Excessive fasting, irregular eating
  • Eating when digestion strength is low.
  • Intake of heavy, cold or polluted food.
  • Improper administration of panchkarma.
  • Suppression of natural urges.

Symptoms of grahani (IBS):

अतिसृष्टं विबध्दं वा एवं तत् उपदिश्यते |

तृष्णां अरोचक वैरस्य प्रसेक तमकान्वित: ||

शूनपादकर: सांस्थिपर्वरुक छर्दन ज्वर: |

लोह आम गन्धि तिक्त अम्ल उदगार: च अस्य जायते ||     (चरक चिकित्सा 15/53)

  • Constipation or diarrhoea
  • Excess thrust, anorexia, distaste in mouth
  • Excessive salivation, asthma
  • Pain in small joints
  • Vomiting and fever
  • Belching has a metabolic smell, the smell of undigested food, bitter and sour tastes.
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