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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 147-150

Role of Shaman and Nitya Virechan in the management of Vicharchika (eczema): a case study


1 Department of Kayachikitsa, Mahatma Gandhi Ayurveda College Hospital & Research Centre, Salod (H), Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
2 Department of Swasthavritta, Mahatma Gandhi Ayurveda College Hospital & Research Centre, Salod (H), Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission17-Jul-2020
Date of Decision29-May-2020
Date of Acceptance18-Jul-2020
Date of Web Publication07-Sep-2020

Correspondence Address:
Dr. Sadhana Misar (Wajpeyi)
Department of Swasthavritta, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_38_20

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  Abstract 

Background: Kushtha is the broad term used for all skin conditions in Ayurveda. Vicharchika is a subtype of Kshudrakushtha. It is Rakta Pradoshaj Vyadhi involving all three Doshas in its Samprapti. It can be correlated with atopic dermatitis (eczema) due to similarity in clinical features, such as Kandu (pruritus), Pidika (papules, vesicles, and pustules), Shyavata (erythema with discoloration), Srava (copious discharge), Raji (thickening, lichenification of skin), Ruja (pain), and Rukshata (dry lesion). In Ayurveda, Shodhana and Shamana chikitsa are mentioned for Kushthavyadhi. Case Report: A 63-year-old male reported having blackish thick patches on back side of both knee joints with severe itching, burning sensation, and watery discharge for the last 3 months. The case was treated with Nitya Virechan with Aragvadha Kadha and Avipattikar Churna for 7 days followed by Shaman Aushadhi (Arogyavardhini Vati, Khadirarishtha, Panchtiktaghrit guggul, and Karanja tail) for 15 days. Result and Discussion: The assessment of subjective parameters like Kandu (pruritus), Srava (discharge), Daha (burning sensation), Shyavata (discoloration), and Rookshata (dry skin) was done on days 0, 7, and 14 as well as photographs of the affected areas compared before and after treatment. Patient showed remarkable relief from all symptoms after treatment. Conclusion: Nitya Virechan followed by Shamana Aushadhi is very effective in the management of Vicharchika (eczema).

Keywords: Atopic dermatitis, eczema, Kushta, Nitya Virechan, Vicharchika


How to cite this article:
Nimbhorkar AU, Misar (Wajpeyi) S. Role of Shaman and Nitya Virechan in the management of Vicharchika (eczema): a case study. J Indian Sys Medicine 2020;8:147-50

How to cite this URL:
Nimbhorkar AU, Misar (Wajpeyi) S. Role of Shaman and Nitya Virechan in the management of Vicharchika (eczema): a case study. J Indian Sys Medicine [serial online] 2020 [cited 2020 Sep 23];8:147-50. Available from: http://www.joinsysmed.com/text.asp?2020/8/2/147/294432




  Introduction Top


All skin conditions are described under Kushthavyadhi in Ayurveda. It is further divided into two types: Mahakushtha and Kshudrakushtha. Vicharchika (eczema) is a subtype of Kshudrakushtha.[1],[2] The Acharya described Trodoshaja nature with Kapha dominance in Vicharchika, included under Raktapradoshaja Vikara with vitiation of Dushya like Rasa, Rakta, Mamsa, and Kleda.[3] The main symptoms of Vicharchika are Kandu (pruritus), Pidika (papules, vesicles, and pustules), Shyavata (erythema with discolouration), Srava (profuse discharge, oozing), Raji (thickening, lichenification of skin), Ruja (pain), and Rukshata (dry lesion).[4] In this disease, dryness, blackish lesions occur due to Vata, itching due to Kapha, and Pitta is responsible for Srava and Daha. It can be correlated with atopic dermatitis (eczema) due to their similarity in clinical features. Eczema can be defined as a non-contagious inflammation of the skin characterized by erythema, scaling, oedema, vesiculation and oozing.[5] Its prevalence is 2–5% in children and young adults, atopic eczema being the most frequently seen dermatoses (World Allergy Organization).[6] In Ayurveda, Nidanparivarjana (avoiding etiological factors), Shodhana (elimination therapy), and Shamana Chikitsa (drug therapy) are mentioned for Kushtha.[7]Vicharchika had a chronic and relapsing nature. Hence, to avoid relapse, radical cure by Shodhana is the best Chikitsa given in Ayurveda. Hence the present case was managed by Nitya Virechana (daily therapeutic purgation) followed by Abhyantar Shamanaushadhi.


  Case Report Top


A 63-year-old male reported to Kayachikitsa OPD of Mahatma Gandhi Ayurved College (MGAC) Hospital and Research Centre, Salod (H), Wardha, with chief complaints of blackish thick lesions on back side of both knee joints with pain, severe itching, burning sensation, and watery discharge for the last 3 months.

History of present illness: The patient gradually developed patches behind both knee joints with severe itching. Then patches increased in size and started burning coupled with a watery discharge. He had taken allopathic treatment for 1 month, but got temporarily relief. So he visited the MGAC hospital for further management.

Past history: No H/O-DM/HTN, asthma, hypothyroidism, accident, operation.

Family history: Not significant

Clinical examination: Ashtavidha Pariksha showed no abnormality except Malabaddhata. Patient had Madhyam Aakruti.

Vital parameters: Vitals were within normal limits.

Laboratory investigations: Complete blood count, random blood sugar, and urological routine and microscopic test were in normal range.

Skin Examination

Multiple ill-defined erythematous deep black patches with fine scales present behind both knee joints. Local lesion was thick with watery discharge.

Diagnosis: From clinical features, it was diagnosed as Vichrchika (eczema).

Consent: Consent of the patient was taken to publish his data.

Therapeutic Interventions

Bahya (external)

Local application of Karanja tail at bed time.

Abhyantar (internal)

Nitya Virechana 40ml freshly prepared kwath as per procedure mentioned in Sharandhar Samhita by adding Aragvadha Churna (5 gm) and Avipatikar Churna (10 gm) once at 7 am for 7 days. After 7 days, Shamana Chikitsa (internal medicine) was started for 14 days. All drugs used in the study were procured from the Dattatrya Ayurveda Rasashala, MGAC Saload (H), Wardha.


  Observations and Results Top


In present case study the patient was treated by daily purgation with 40 ml freshly prepared decoction of Aragvadha Churna and Avipatikar Churna for continuous 7 days followed by internal drug therapy as shown in [Table 1] for 14 days. Patient was assessed by decrease in the severity of subjective parameters on the basis of gradation shown in [Table 2]. After completion of treatment there was reduction in symptoms as shown in [Table 3]. Assessment of patient was also done by taking photographs of lesion before treatment as shown in [Figure 1] and after treatment as shown in [Figure 2].
Table 1: ShamanChikitsa (internal medicine) given to the patient during Nitya Virechan

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Table 2: Gradation of subjective parameters

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Table 3: Assessment of subjective parameters on Days 0, 7, and 21

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Figure 1: Before treatment

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Figure 2: After treatment

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  Discussion Top


Probable Mode of Action of Nitya Virechana

In the present study, Kwath prepared from Aragvadha Churna and Avipatikar Churna was selected for Virechana Karma. Vicharchika is a type of Kushtha that is Bahupradoshaja and Raktapradoshaja Vyadhi involving three Doshaja with dominance of Kaphadosha. Rakta and Pitta both have Ashrayashrayibhava (association). Hence, for elimination of vitiated Kapha and Pitta, Rakta Virechana is the best therapy. Virechana expels out the Doshas, dragging them towards the Adhobhaga through the Guda (rectum). For Pitta and Kaphadosha, Amashaya is specific site. Though Virechana is a specific therapy for Pitta Dosha, it also eliminates Kapha Dosha. Virechana drugs with the Ushna, Tikshna, Sukshma, Vyavayi, and Vikasi properties reach the Hridaya by virtue of its Virya, then following the Dhamani it spreads the whole body through large and small Srotasa. Virechaka drugs by their properties bring the vitiated Doshas from the Shakha to Kshotha. These drugs have dominance of Pruthvi and Jala Mahabhoota, so Doshas travel to Adhobhaga. Prabhav of the medicine is responsible for the expulsion of these Doshas out of the body by Gudmarga (anal region).[8]

Probable action of Aragvadha Churna

Acharya Charak described Aragvadha as a Phalini Virechana drug.[9] In Aragvadhiya, Adhyaya Aravadha is described as a Kushthaghna (external application in Kushtha).[10] It has Raktashodhaka (blood purifier) and Mrudu Virechak (mild laxative) property. Aragvadha Churna has Madhura Kashaya, Tikta Rasa, Katu Vipaka, and Ushna Veerya that help to pacify and expel out Pitta and Kapha Dhosha. It possesses Kushthaghna, Krimighna, Rakta Shodhana, and Tridoshaghna properties[11] that help in alleviating symptoms.

Probable action of Avipattikar Churna

Avipattikar Churna is a polyherbal formulation whose constituents are Trikatu, Triphala, Musta (Cyperus rotundus Linn.), Vida Lavan (Vida salt), Vidanga (Embelia ribes Burm.f.), Ela (Elettaria cardamomum (Linn.)), Tejpatra (Cinnamomum tamala Nees and Ebern.), Lavanga (Syzgium aromaticum Linn.), Trivritta (Operculina terpethum Linn.), and Sharkara (cane sugar).[12],[13]

Avipattikar Churna has Mrudu Virechaka (mild laxative), Deepan, and Pachan properties. It causes removal of aggravated Doshas, corrects Agnimandya, and thereby removes Strotorodha. All these actions break Samprapti of Vicharchika.[14]

Probable action of Arogyavardhani Vati

This mineral formulation described in Rasaratnasamucchaya as Sarvarogaprashamani could destroy all vyadhi.[15] Its main ingredients are Kutaki (Picrorhiza kurroa), Chitrak (Plumbago zeylanica), Shuddha Gugglu, emblica, Shilajit (purified asphaltum), mercury, sulphur, Loha Bhasma (Fe), and Abhraka Bhasma (Mica). It is specifically indicated for many skin disorders. It has Kushthghna, Kandughna, Krumighna Shothhar, and Shulahar properties. These properties help in reducing symptoms and balancing all Tridoshas. It also has antioxidant property, which helps in scavenging free radicals, and Kandughna helps in relieving Kandu.[16]

Probable action of Khadirarishtha

Khadirarishtha is described in Bhaishjya Ratnavali and Sharangdhar Samhita as mainly containing Khadira (Acasia catechu), Deodaru (Cedrus deodara), Bakuchi (Psoralea corylifolia), Daruharidra (Berberis aristata), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellerika), and Amalaki (Emblica officinalis). Khadira has Kushtaghna, Kandughna, Kushthaghna, Krumighna, Raktashodhaka, and Vranaropaka properties. It possesses antioxidant, antifungal, anti-inflammatory, and antimicrobial properties, which aid in alleviation of symptoms of Vichachika.[17]

Probable action of Panchatiktaghrita Guggul

Panchatiktaghrita guggul is described in Bhaishjyaratnavali Kushthrogadhikara.[18] It mainly contains dravyas of Panchatikta Gana, ghee, and Guggul. All dravyas of Panchatikta Gana have Tikta Rasa, Laghu, and Ruksha Guna, which help in breaking Samprapti by reducing Kleda and Vikrutmeda causing Vranaropana. It has Kandughna (antipruritic) action.[19] It causes reduction in increased Kleda, Lasika (plasma), Rakta (blood), Pitta, and Shleshma due to its Tikta Katu Rasa and Ruksha Lekhana properties.[20]Nimb (Azadirecta indica) has phytochemicals such as nimbin and nimbidin having antimicrobial and anti-inflammatory activity. Guduchi (Tinosporia cordifolia) contains phytochemicals such as tinosporin and berberin, which are antioxidative and immunomodulatory.[21]

Probable action of Karanj Talia

Karanj taila is mentioned in Bhaishajya Ratnavali Visarpa Chikitsa. Its main ingredients are Karanja (Pongamia pinnata (Linn) Merr.), Saptachada (Alsoniascholaris R.Br.), Snuhi (Euphorbia nerifolia Linn.), Langli (Gloriosa superb Linn.), Arka (Calatropisprocera R. Br.), Anala (Plumbago zeylanica Linn.), Nisha (Curcuma longa Linn), Bhrigaraja (Eclipta alba Linn.), Gomutra (cow urine), Visha (Aconitum ferox Wall. ex Ser.) in Murcchita sesame oil.[21] It has Kruminashaka (antibacterial/antifungal), Kandughna (antipruritic), Vranashodhaka (wound cleaning), and Vranaropaka (wound healing) properties.[22] These properties help in reducing symptoms. Oil helps in the absorption of herbal drugs and enhances their action when applied locally.


  Conclusion Top


The present case study concludes that Nitya Virechana with Shamana Chikitsa (internal medicine) are effective in relieving the symptoms of Vicharchika (eczema).

Patient consent statement

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
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Yadav ji T. Charaka Samhita revised by Charaka & Dridabala, with Ayurveda Dipika comentary by Chakrapanidatta. Varanasi: Choukhamba Sanskrit Sansthan;2001. p. 451.  Back to cited text no. 4
    
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Mohan H. Textbook of Pathology, 6th revised edition. Jaypee Brothers Medical Publishers Ltd.; 2010.  Back to cited text no. 5
    
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Brown S. Atopic and non-atopic eczema. BMJ 2006;332:584-588.  Back to cited text no. 6
    
7.
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8.
Agnivesha , Charaka Samhita with Ayurveda Dipika Commentary. Kalpa Sthan Choukhamba Sanskrit Series.Varanasi. 2014. p. 651.  Back to cited text no. 8
    
9.
Agnivesha, Charaka Samhita with Ayurveda Dipika Commentary. Kalpa Sthan Choukhamba Sanskrit Series.Varanasi. 2014. p. 662.  Back to cited text no. 9
    
10.
Deshpande AP. Dravyaguna Vijnana Part I / II, A.R. Nandurkar, 1st edition. Pune:Proficient Publishing House;2004. p. 381-382.  Back to cited text no. 10
    
11.
Chunekar KC, Bhav Prakash Nigantu. Varanasi: Chaukhambha Bharti Acedemy;1998.  Back to cited text no. 11
    
12.
Anonymous.The Ayurvedic Formulary of India: Part I, 2nd revised English edition, Vol. 7. Delhi: Ministry of Health and Family Welfare, Govt. of India. Avipattikar Churna;2003. p. 41.  Back to cited text no. 12
    
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Mohan M, Punam S. Efficacy of Nitya Virechana with Trivrit Churna in the management of stage 1 essential hypertension–a pilot study. Int J Ayurvedic Med 2020;11:249-54.  Back to cited text no. 13
    
14.
Shatri K. Charaka Smhita with Vidhyotini Hindi commentary Chikitsa Sthan, Vol. 7. Varanasi: Chakhambha Bharti Academy;2008. p. 128-268.  Back to cited text no. 14
    
15.
Shashtri A. Rasaratnasamucchaya, 9th edition, Chapter no. 20/87. Varanasi: Chaukhamba Sanskrit Publisher;1994. p. 400.  Back to cited text no. 15
    
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Chavhan M, Misar Wajpeyi S. Management of Dadru Kushta (Tinea corporis) – A Case Study. Int J Ayurved Med 2020;11: 120-3.  Back to cited text no. 16
    
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Ahmad F, Anwar F, Hira S. Review on medicinal importance of Fabaceae family. Pharmacologyonline 2016:3:151-7.  Back to cited text no. 17
    
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Sharma PV, Dravyaguna Vidnyana Part 2. Choukhamba Bharti Academy;2003.  Back to cited text no. 20
    
21.
Bramhashankar M. Bhaishajya Ratnavali, Vol. III, 1st edition. New Delhi: Chaukhamba Sanskrit Bhavan;2006. p. 145.  Back to cited text no. 21
    
22.
Rajput SH, Dhangarmali VD, Dhaval B, Phatak AA, Choudhari PD. Use of Karanj oil (Pongamia glabra) in topical formulation. Res J Pharmaceut Biol Chem Sci 2014;5:546-51.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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