www.wjpr.net Vol 8, Issue 12, 2019. 1368
AYURVEDIC
MANAGEMENT IN
VICHARCHIKA
- A CASE
PRESENTATION
Nirali Raut1* and Meenakshi Rewadkar-Kole2*
1
PG IInd Year, 2Associate Professor, Department of Kayachikitsa, R. A Podar Medical College (Ayu), Worli, Mumbai -18.
ABSTRACT
Eczema is a group of inflammatory skin disease provoked by a wide variety of stimuli i.e direct injury from toxic chemicals, mechanical trauma and immunological reactions. Acute eczema represents wet dermatitis characterized by intense puritis, erythema, oedema, papules, vesicles, oozing, crusting and even blister formation. Prevalence of Atopic eczema is 10-12% during childhood and less than 15% after puberty. Causes of atopic eczema are unknown, but genetic and environmental factors are equally important here. This condition in
Ayurveda can be correlated to Vicharchika. The symptoms mentioned by Charkacharya in Vicharchika are Kandu (itching), Pidika
(eruptions), Shyavta (blackish discoloration) and bahustrava (discharge); with kapha dosha pradhanya. Vicharchika is a type of Kshudra Kushta. The causes of Kushta include
viruddhaanna, asatmya sewan etc which can be related to exposure to allergens and thus presenting atopy. Here, the aim is to study the efficacy of Ayurveda in the management of Eczema with special reference to Vicharchika. This study deals with a case of atopic dermatitis (Wet Eczema), where a male patient was admitted in our hospital and was managed via Ayurvedic therapy which included Shamana, Shodhana and Sthanika karma
which was given for a month. Criteria were assesses before and after the treatment. On the basis of the assessed criteria, conclusion was drawn. The given Ayurvedic therapy was found to be significantly effective in the management of Eczema.
KEYWORDS:Ayurvedic Managment, Kushta, Vicharchika, Atopy, Eczema.
Volume 8, Issue 12, 1368-1375. Research Article ISSN 2277– 7105
Article Received on 18 Sept. 2019,
Revised on 08 Oct. 2019, Accepted on 29 Oct. 2019,
DOI: 10.20959/wjpr201912-16112
*Corresponding Author
Nirali Raut
PG IInd Year, Department of
Kayachikitsa, R. A Podar
Medical College (Ayu),
INTRODUCTION
Eczemas are a group of aetiologically unrelated conditions that have similar clinical morphology. They have been defined as a pattern of skin inflammation that has a characteristic morphology in acute, subacute and chronic phases. Acute phase shows clinical features like erythema, oedema, vesiculation, oozing and crusting. Subacute phase involves erythematous, hyperpigmented plaques with scaling and crusting whereas chronic phase shows Lichenification. The term dermatitis is used synonymously with eczema.[1] Atopic dermatitis is a common, chronic, relapsing, inflammatory skin disease that primarily affects young children. Atopy is defined as an inherited tendency to produce immunoglobulin E (IgE) antibodies in response to minute amounts of common environmental proteins such as pollen, house dust mites, and food allergens. Dermatitis derives from the Greek “derma,” which means skin, and “itis,” which means inflammation. Dermatitis and eczema are often used synonymously, although the term eczema is sometimes reserved for the acute manifestation of the disease (from Greek, ekzema, to boil over); here, no distinction is made.[2] Atopic dermatitis is a common form of endogenous eczema and its incidence is increasing in India. The exact aetiology is unknown but genetic and environmental factors are probably equally important in the development of atopic dermatitis. A family history of asthma, hay fever (rhinitis and conjunctivitis), atopic dermatitis and even urticaria is common in patients with this condition. The environmental factors which act as triggers for atopic dermatitis are climate changes, food items (eggs, dairy products. Nuts, etc.) bacterial infection and dry skin.[3] Atopy means a genetically determined state of hypersensitivity to environmental allergens and include asthma, hay fever and dermatitis.[4] Incidence of Atopic dermatitis, also referred to as atopic eczema, has increased 2- to 3-fold in industrialized nations since the 1970s, with approximately 15% to 20% of children and 1% to 3% of adults affected worldwide. An estimated 10% of all people worldwide are affected by eczema.[5] More than 10 million cases per year in India are noted of different types of Eczema.[6] Ayurvedically, eczema is considered to be a type of Kushtha, which is a disease of the skin. It is also known as a type of Twak Roga, which also signifies that it is a skin disease, as “Twak”
translate to skin and “Roga” translates to pain. Eczema is widely considered to be specific
strotodushti. For eg. Vidahi annapaan, snigdha, ushna, guru aahar, drava aahar, virrudha aahar etc. which in modern sense are aggravating factors for allergy causting atopy.
Pathophysiology
Two main hypotheses have been proposed to explain the inflammatory lesions in atopic dermatitis. The first hypothesis concerns an imbalance of the adaptive immune system; the second hypothesis concerns a defective skin barrier. Although these two hypotheses are not thought to be mutually exclusive, they may complement each other. The theory of immunological imbalance argues that atopic dermatitis results from an imbalance of T cells. The theory of skin barrier defects is more recent and has its origin in the observation that individuals with mutations in the filaggrin gene are at increased risk of developing atopic dermatitis.[8]Samprapti of kushta in our granthas state that; madhur, snighdha, guru guna of
kapha increases due to hetusewana, due to which picchilta, styanta and viscosity of Rakta
increases. In turn, it decreases dravya guna of rakta increasing its mandata. It leads to lasika
and Raktavarodha causing abhishyandata and strotavarodha causing shaithilya and thus presenting the above said symptoms on skin. There occurs twacha, lasika, rakta and maansa dushti with tridoshadushti and thereby leading to its shaithilya which spreads through tiryaka siras and thus present its symptoms on skin.[9]
MATERIALS AND METHODS Case Presentation
A male patient named XYZ aged 60 years came to the OPD of our institute with complaints of itching of bilateral lower limbs with mild swelling and secretions from the lesions over it, Dyspnoea on exertion since childhood (on and off). The patches were blackish in colour with watery discharge from it. The patient was asthmatic and was taking inhaler on SOS basis. The patient had an history of addiction to alcohol and tobacco 20 years ago. The patient did not have any other specific significant history with all vitals stable.
Treatment given
• Oral Drugs
1. Aarogyavardhini vati 500mg BD 2. Kaishor Guggul 500mg BD
3. Gangharva Haritaki choorna 3gm HS with lukewarm water
4. Khadir + Nimba + Kutki + Shirish + Daruharidra + Triphala siddha Kwatha
• Sthanik karma
1.Nimba + Triphala+ Daruharidra siddha Kwatha Dhawana BD 2.Nimba + Triphala+ Shirishtwak kalk lepa BD
• Shodhana
1. Anuloman with Gandharva Haritaki Choorna 10gm and Erand Tail 10ml- Three sittings
2. Jalukacharana
The above said treatment was given for one month and then the patient was discharged to continue sthanik and oral treatment at home and was told to give follow up after every fifteen days. Criteria were assessed before and after the treatment i.e after three months.
RESULTS
Before treatment After treatment
Kandu (Itching) +++ +
Pidika (Erruptions) ++ 0
Strava (Discharge) ++ 0
Vaivarnya (Discoloration) +++ ++
EASI score[16] 60 30
BEFORE TREATMENT AFTER TREATMENT
DISCUSSION
As mentioned in the ayurvedic texts the dosh dushti in this patients was tridoshaj but kapha pradhan as in Vicharchika with Kandu, Strava, Pikdika and Shyavta.[10] Also Rakta dushti was seen in this patient which centers the patient to atopic history.So, the samprapti in this patient can be postulated as follows.
Hetu Sevan
(guru, Snigdha, drava ahaar, Vidahi aahar)
Tridocsh dushti (Kapha dushti adhik)
(Madhur, snigdha, guru guna of kapha increases)
picchilta, styaanta, viscosity of rakta increases
drava guna of rakta decreases
its mandata increases
Lasika and Rakta gati awarodh occurs due to accumulation
abhishyandata and strotawarodh causing shaithiya
The treatment given works as follows.
1) Aarogyavardhini Vati - It contains Parad gandhak kajjali which is Kaphahar, kledhar, sukshma strotogaami and yogwaahi. Shilajit helps in kled haran and does lekhana karma. Loha is Raktavruddhikar and pushtikar. Abhraka acts on shleshmal kala and maansdhara kala. Guggul and tamra again help in lekhana karma. Kutki is bhedaka, yukruttotejak and acts on pitta dosh and rasa-rakta dhatu. Chitrak and triphala help in normalizing dhatwagni
and bhootagni.[11]
2) Kaishor guggul -It acts as antiallergic, antibacterial and a blood purifier.[12] It acts as a heathy growth promoter. Also it is mentioned in our granthas that is to be used in all types of
kushta.[13]
3) Gandharva haritaki choorna – It helps in removal of gases and thus helps in decreasing
koshta badhata and hence enhances digestion and improves jatharagni and thus aids in normalizing dhatwagni.
4)Khadir, Nimba, Kutki, Shirish, Daruharidra and Triphala siddha Kwatha – Most of the contents are katu and tikta rasatmak, laghu, ruksha and tikshna and hence act as
kaphapittaghna and also kushtaghna.[14]
5) Lepa and Dhawan – The contents for lepa and dhawana have similar property as the above given kwatha. The ruksha guna helps in kleda shoshna. They also help in wound healing, and aid in bringing back the original skin colour. They also help in decreasing the subcutaneous skin oedema.
6) Anulomana – Here, anuloma refers to giving purgative oral medication early in the morning as given in Virechana, but is given without giving snehapaan. Here, unlike
Virechana it does not penetrate into the cell for the removal of toxins but help in removal of
kleda i.e extra cellular fluid and thus helps in reducing oedema.
7) Jalukawacharana – As it is mentioned by Acharya Sushrut, Jalaukacharan works when
the dushti is in rasa, rakta and maans.[15] It acts as vranashodhana and vranaropaka. Letting out the vitiated blood leads to the removal of srotasavrodha from sira which decreases pressure from the sira. It improves microcirculation in the sira and also helps in nourishment of sira and thus assossiated tissues and thus helps in circulation which helps in healing and reduces discoloration and swelling.
CONCLUSION
and local applications were used which gave relief to the patient symptomatically. But, still further study is needed for more evaluation.
ACKNOWLEDGEMENTS
This article was supported by my guide Dr. Meenakshi Rewadkar-Kole, I also thank my colleagues from our institution, my seniors, juniors and our Medical institute.
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