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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 145-149

A case study on management of Shushka Vicharchika (Eczema) through Shamana Chikitsa (palliative ayurveda treatment)


Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India

Date of Submission30-Aug-2020
Date of Decision01-Oct-2020
Date of Acceptance15-Oct-2020
Date of Web Publication28-Jun-2021

Correspondence Address:
Dr. Uttamram Yadav
Department of Panchakarma, All India Institute of Ayurveda, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jism.jism_85_20

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  Abstract 

Eczema is a common, and at times challenging, condition to manage, and it is caused by a defect in skin barrier function; it is treated with corticosteroids and immunosuppressants in conventional medicine with periods of remission and flare-ups, which adversely affects the quality of life of patients and their families. Ayurveda classics have mentioned curative and safely management in the condition of Vicharchika (~Eczema). In this particular case of Shushka Vicharchika, oral Ayurveda drugs such as Mahamanjisthadi Kwatha, Panchanimba Churna, Gandhaka Rasayana, and Agasthya Rasayana (Ayurveda formulations) ere given for a period of two months. The assessment was done on the 0th day, 58th day, 98th day, and 123rd day; the criteria were EASI score and signs and symptoms of Shushka Vicharchika. The outcomes on EASI score per body region was found to be highly significant [BT(0th day)–4.5 AT3(123th day)-0.1] and improvement in cardinal sign and symptoms, total score was 8 on before treatment (0th day) which was reduced to 0 on 123rd day after the treatment. This study shows that oral administration of Shamana Chikitsa (Palliative Ayurveda treatment) is highly effective in the management of eczema, as evidenced by the reduction in EASI score assessed on the basis of improvement in both signs and symptoms.

Keywords: Bio-cleansing, Mahamanjishthadi Kwatha, Nitya Virechana, Vicharchika


How to cite this article:
Yadav U, Bhatted SK, Sain K. A case study on management of Shushka Vicharchika (Eczema) through Shamana Chikitsa (palliative ayurveda treatment). J Indian Sys Medicine 2021;9:145-9

How to cite this URL:
Yadav U, Bhatted SK, Sain K. A case study on management of Shushka Vicharchika (Eczema) through Shamana Chikitsa (palliative ayurveda treatment). J Indian Sys Medicine [serial online] 2021 [cited 2021 Jul 27];9:145-9. Available from: https://www.joinsysmed.com/text.asp?2021/9/2/145/319468




  Introduction Top


Eczema (dermatitis) is the most common painful allergic condition among skin disorders. Acutely, epidermal edema (spongiosis) and intraepidermal vesiculation predominate, whereas with chronicity there is more epidermal thickening (acanthosis).[1] The clinical presentation of eczema in similar to that of Shushka Vicharchika described in Ayurveda.[2] Ayurveda describes a wide range of skin disorders such as “Kushtha” and is classified into two divisions, that is Mahakushtha and Kshudrakushtha. Vicharchika is enlisted under Kshudrakushtha. All types of Kushtha occur due to Tridoshaprakopa (involving vitiation of these biohumors) and Raktadushti (~blood impurities); hence, Shushka Vicharchika is also a vitiation of Tridosha in general and Kapha in particular described by Acharya Charaka[3] and Acharya Sushruta has mentioned it under Pitta dominancy,[4] which comes under Raktapradoshaja Vikara (disorder occurring due to vitiation of blood).[5] Modern medical science treats eczema with systemic steroids and other therapeutics to give symptomatic relief. The use of steroids suppresses eczema, but it incurs significant costs in terms of severe long-term toxicity, including osteoporosis, skin fragility, susceptibility to infection, and pituitary–adrenal axis suppression.[6] Thus, Anulomana (~induced purgation) and Rasayana (~rejuvenative)[7] are safely indicated in a disease developed due to vitiating Pitta, Kaphadosha and Raktadushti.[8] Hence, this study was aimed at assessing the efficacy of Nitya Virechana (~mild purgation)[6] with Mahamanjishthadi kwatha[9] along with Rasayana in the management of Shushka Vicharchika.


  Case Information Top


A 19-year-old male, name xyz, UHID 422709, presented to the OPD of Panchakarma on 26 October 2019, with chief complaints of pruritus, reddish-black eruption, dryness, and burning sensation in the neck and both elbow joints since 16 years; associated complaints of sneezing, lacrimation in both eyes since 16 years; and breathlessness on/ off since 1 year.

H/O present illness

The patient was asymptomatic 16 years ago when he gradually developed a reddish-black color eruption on the posterior region of the neck, which gradually spread to the elbow and knuckles. He took allopathic medicines but could not find much relief; it was then that he came to the OPD of Panchakarma.

Treatment history

The patient was regularly taking allopathy medicines such as antibiotics and antihistamines along with tropical application of antifungal ointment since 2 years.


  Clinical Findings Top


On Examination

  • General condition: moderate, afebrile


  • Pulse rate: 76/min


  • BP: 120/80 mm of hg


  • Respiration rate: 18/min


  • Site of eruption: posterior aspect of neck and ears, and dorsal aspect of knuckles


  • Distribution: asymmetrical


  • Color: Black


  • Margin: irregular and well-demarcated (neck and both elbow joints)


  • Surface: dry and thick with no discharge (neck and both elbow joints)


  • Type of Lesion: non-purulent, non-scaly (neck and both elbow joints)



  •   Timeline Top


    Details are mentioned in [Table 1].
    Table 1: Development of disease and treatment in case

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      Diagnostic Assessment Top


    Assessment criteria, that is, the Eczema Area Severity Index (EASI) scoring scale was used and assessed based on the signs and symptoms of Shushka Vicharchika, which were Kandu (pruritus), Pidika (eruption), Vaivarnya (discoloration), Daha (burning), and Rukshata (dryness), the details of which are mentioned in [Table 2]. Area of involvement: Each body region has potentially 100% involvement. The details of score from 0 to 6 are mentioned in [Table 2].
    Table 2: Eczema area and severity index (EASI)

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      Therapeutic Intervention Top


    Oral Ayurveda medicines were given for a period of 2 months. The details are mentioned in [Table 3].
    Table 3: Assessment score on the basis of signs and symptoms

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      Follow-Up and Outcome Top


    Follow-up was done on the 58th day, 95th day, and 123rd day. The intervention showed significant result in terms of reduction in the EASI scoring scale, which was BT – 4.5 reduced to AT1 – 1.1, AT2 – 0.8, and AT3 – 0.1, EASI score detail was mentioned in [Table 3][Table 4][Table 5][Table 6] and [Graph 1]. The patient showed improvement in cardinal signs and symptoms [Video 1]. The composite score of cardinal signs and symptoms of Shushka Vicharchika was 8 before treatment, which was reduced to 2 on AT1, and then declined to 1 on AT2; the 123rd-day score was zero. All these details are mentioned in [Table 5][Table 6][Table 7][Table 8][Table 9].
    Table 4: Treatment module of eczema

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    Table 5: Assessment on EASI scoring scale before treatment (0 day)

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    Table 6: Assessment on EASI scoring scale at AT1 (58th day)

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    Graph 1: Effect of intervention on EASI score

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    Table 7: Assessment on EASI scoring scale at AT2 (95th day)

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    Table 8: Assessment on EASI scoring scale at AT3 (123rd day)

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    Table 9: Effect of intervention on cardinal signs and symptoms

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      Discussion Top


    In this case, the EASI scoring scale was used for the assessment of improvement in eczema. The EASI scoring scale was found to be highly significant [BT(0thday)–4.5 AT3(123day)-0.1] and it showed reduction in cardinal signs and symptoms of Shushka Vicharchika, which was 8 before treatment and declined to zero on the 123rd day of treatment. Vitiated Pittadosha due to changed food habits (junk and fast food), and disturbed sleep pattern (day sleeping and awakening of the night) in children led to vitiating Tridosha, in general, and Pitta, in particular, to hyperresponsiveness in skin, bronchioles, eyes, and nose, which led to eczema in this study. Legion of skin disorders affected the epidermis and dermis, lymphatic channel, blood circulation around the legion, and muscles around the legion, which indicates the involvement of Pitta and Rakta. Here in this case, treatment was planned for Nitya Shodhana (~bio-cleansing), Pitta-Kapha Shamaka, Rakta Prasadhana (~blood purifying), Rasayana (~rejuvenation), and Nidana Parivarjana to break etiopathogenesis (Sampraptivightana) and bring back state homeostasis. Mahamanjisthadi Kwatha was used here, as it has bio-cleansing property due to the ingredients Manjistha, Vidanga, Triphala, Kushtha, Katuka, Trayamana, Trivrit, and Indravaruni, which are Laghu, Ushna, and Teekshna, and it has Rechana (~purgative) action. Bio-cleansing, which is indicated in all types of skin disorder, acts as mild and slow bio-cleansing of the body, and act on the level of Agni (~digestive fire)[10] and Pitta, which removes vitiated Bhrajaka Pitta, subsides hyperresponsiveness of the body, and restores digestive fire and other related constituents. Panchanimba Churna, Laghu, Ruksha in Guna (property), Tikta in Rasa, which act as Pitta-Kapha Shamaka and also act as blood purifier that is why it is commonly used in skin disorder.[11]Gandhaka rasayana, which is Deepana (~appetizers), Pachana (~carminatives),[12] rejuvenation, Shoshana (~absorption), Vishaghna (~anti-poisonous), Krimighna (~anti-helminthic), Pleehagna (~useful in splenomegaly), Balya (~strength promoting activity), and Aamdoshanashak (~useful in digestive fire), is specifically indicated in Kushtha (~psoriasis), Kandu (~itchiness), Visarpa (~herpes zoster), Jwara (~fever), Kasa (~cough), Shwasa (~asthma), Dadru (~fungal infection), Kshaya (~emaciation), Amajeerna (~useful in indigestion), and Garavisha (~concocted poison) due to it being Madhura, Katu, Tikta, Kashyarasa, Sara, Snigdhaguna, and Kapha-Vatahara in nature and its pharmacodynamic action.[13]Agasthya Rasayana was given to the patient for whom it was specifically indicated, as he had associated complaints of breathlessness, sneezing, and lacrimation in both eyes.


      Conclusion Top


    The management of eczema can be done on the line of treatment of Vicharchika. Eczema is a Tridoshajavyadhi having dominance of Pitta and Kapha. Bio-cleansing, Kapha-pittashamaka, and blood-purifying treatment are advised in eczema. Ayurveda medicine shows significant results in the EASI scoring scale (BT-4.5 AT-0.1) and improvement in the cardinal signs and symptoms of Shushka Vicharchika (BT-8 AT-0) in the management of eczema. There was no adverse drug reaction seen during the period of intervention. Lead may be taken from this case study to carry out further studies with a larger sample size.

    Patient Perspective

    I have been suffering from eczema since 2003 and I visited many allopathic hospitals in Delhi for curative treatment but not got relief, I came to the All India Institute of Ayurveda hospital and took treatment as advised. Now I am not taking any medicine and am absolutely normal.

    Informed consent

    An appropriate patient consent form was obtained before starting the treatment.

    Financial support and sponsorship

    Nil.

    Conflict of interest

    None.



     
      References Top

    1.
    Hunter J, Savin J, Dahl M. Clinical Dermatology. 3rd ed. Reprint. Hoboken, NJ: Wiley-Blackwell; 2003. p. 70.  Back to cited text no. 1
        
    2.
    Sushruta, Sushruta samhita, Dalhanacharya, Tika. Shastri K (editor). Nidanasthana, Chapter 5, Verse 9. Varanasi: Chaukhambha Surbharti Publisher; 2018. p. 285.  Back to cited text no. 2
        
    3.
    Kashinnath P, Gorakhnath C, editor. Agnivesha of Charaka samhita, Chikitsa sthana, Kushthachikitsa, Chapter 7, Verse 30. Varanasi: Chaukhambha Sanskrita Series Office; 2013. p. 253.  Back to cited text no. 3
        
    4.
    Sushruta, Sushruta samhita, Dalhanacharya, Tika. Shastri K (editor). Nidanasthana, Chapter 5, Verse 16. Varanasi: Chaukhambha Surbharti Publisher; 2018. p. 286.  Back to cited text no. 4
        
    5.
    Kashinnath P, Gorakhnath C, editor. Agnivesha of Charaka samhita, Sutra sthana, Chapter 28, Verse 11. Varanasi: Chaukhambha Sanskrita Series Office; 2013. p. 571.  Back to cited text no. 5
        
    6.
    Talekar MT, Mandal SK, Sharma RR. Clinical evaluation of trivṛta powder (Operculina turpethum Linn.) and aragvadha patra lepa (paste of leaves of Cassia fistula Linn.) in the management of vicharchika (eczema). Ayu 2018;39:9-15.  Back to cited text no. 6
        
    7.
    Kashinnath P, Gorakhnath C, editor. Agnivesha of Charaka samhita, Chikitsasthana, Chapter 1, Verse 8. Varanasi: Chaukhambha Sanskrita Series Office; 2013. p. 4-5.  Back to cited text no. 7
        
    8.
    Shivprasad S, editor. Vagbhatta of Asthang samgraha Chikitsa sthana, Vamanavirechanavidhi, Chapter 27, Verse 4. Varanasi: Chaukhambha Sanskrita Series Office; 2012. p. 203.  Back to cited text no. 8
        
    9.
    Sharangdhar, Sharangdhar Samhita, Shailaja S. editor. Madhyam khandha. Varanasi: Chaukhamba Sanskrita Sansthana, edition 2016 2/137 – 142.  Back to cited text no. 9
        
    10.
    Agnivesha, Charaka Samhita, Kashinnath P, Gorakhnath C, editor. Sutra sthana, Grahnichikitsa, Chapter 15, Verse 44. Varanasi: Chaukhambha Sanskrita Series Office; 2013. p. 560.  Back to cited text no. 10
        
    11.
    Gas G, Bhaishjya ratnavali, Ambikadutta S. editor. Kushtha rogadhikar, Varanasi: Chaukhamba Sanskrita Academy, Edition 2014, p. 86-91.  Back to cited text no. 11
        
    12.
    Pandit Parasuram Shastri Vidyasagar, editors. Prathamkhanda, Deepanpachana, Chapter 4, Verse 1. Varanasi: Chaukhamba Surbharti Prakashan; 2013. p. 34.  Back to cited text no. 12
        
    13.
    Panigrahi D. Pharmaceutico therapeutics of sulphur (gandhaka) an ayurvedic review. JBPR 2018;7:54-60.  Back to cited text no. 13
        


        Figures

      [Figure 1]
     
     
        Tables

      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



     

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