Siddha system is the traditional system of medicine, Thokkanam or Marthanam is one of the 32 forms of Puramaruthuvam in siddha medicine. Thokkanam is a word framed by combining two words Thokku and Anam. Thokku means skin, Anam means support/tones/heat. It is a physical manipulation procedure usually done by hands on the body in nine different methods with (or) without application of medicated oil along with or without Internal medicines. These are Thattuthal, Irukkal, Pidithal, Murukal, Kaikattal, Amarthal, Izhuthal, Malathuthal, Asaithal. It is mentioned specially to treat Vaadha diseases like Pakkavaadham (Hemiplegia), Arunavatham (Paraplegia) ,Ekavaadham (Monoplegia), Thasaivadham (Muscular Dystropy), Iyakka Narambu vila noi (Motor Neuron Diseases), mugavatham (Bell's Palsy) etc. By improves the blood circulation, facilitates lymphatic drainage, improves skin tone and promotes the vitality. It not only improve muscle tone and power in the affected muscle like physiotherapy ,but also give relaxation of muscle, relief mental distress and relief the pain of affected joints. Standard operative procedure is a highly mandatory thing to follow to do any kind of procedures in order to attain consistency in its processes, to improve the quality and manage safety issues. Here the standard operating procedure is established for the above mentioned nine types of Thokkanam. This will lead into the systemic establishment of these procedure globally and can help to get the assured effectiveness of Thokkanam therapy.
A 21 years old lady presented with swelling of feet and face. Weight gain and stretch marks with cushingoid features on examination with hirsutism and she had a right adrenal adenoma measuring 3 × 2.5 × 1.5 cm which was black colored. We discuss this black colored adenoma in this image of interest.
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