Management of Lichen Planus through Ayurveda - A Case Report

C. V Remya; Nishat Barchiwale; AS Prashanth

Management of Lichen Planus through Ayurveda - A Case Report

Remya C.^1*, Barchiwale N.², Prashanth A.³

DOI:

^1* C. V Remya, Post Graduate Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka, India.

² Nishat Barchiwale, Post Graduate Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka, India.

³ AS Prashanth, Professor and HOD, Department of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka, India.

Autoimmunity is a biological paradox in which the cells and tissues of the body itself, by forming auto-antibodies and auto sensitized T-cells, react against antigens of the individual’s own tissue. Lichen Planus is also appearing to be such a disease. It is a chronic Skin disorder of unknown etiology. It is characterized by purplish or violaceous polyhedral, flat topped itchy papules, occurring mostly on the flexor surfaces and in the oral cavity. Vitiated Doshas destroy tissues in the Skin and produce discolouration and if not, properly treated produce disfiguration leading to Skin Diseases or Kushta. Kitibha is a type of Kshudra Kushta which is having Kshudra Mula described in Ayurvedic Classics. Kitibha Kushta closely resembles the clinical symptoms of Lichen Planus. This paper highlights a Case Study of Kitibha Kushta (Lichen Planus Pigmentosus) treated with the Ayurvedic Principles in particular Shodhana Chikitsa. A 55-year-old Male patient came to our OPD with chief compliant of Twak Vaivarnyam in both hands and lower abdomen with Kandu since 2yrs. He got better relief after a short period of treatment. Ayurvedic management involving Shamana Poorvaka Shodhana Karma with conducive diet and life style.

Keywords: Kitibha Kushta, Lichen Planus, Shodhana, Karappan Kashaya, Ayurveda, Case Report

Corresponding Author	How to Cite this Article	To Browse
C. V Remya, Post Graduate Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka, India. Email:	C. V Remya, Nishat Barchiwale, AS Prashanth, Management of Lichen Planus through Ayurveda - A Case Report. J Ayu Int Med Sci. 2022;7(4):156-160. Available From https://jaims.in/jaims/article/view/1852

Introduction

Skin is the protective covering of the body. As a seat of complexion, it is the index of health and disease. In Samhita of Ayurveda, the diseases which makes the Skin and Body ugly are described particularly under the heading of Kushta. The signs and symptoms of Lichen Planus almost equalize with Kitibha Kushta which is a form of Kshudra Kushta according to Ayurvedic classics. Kitibha Kushta (Lichen Planus) is dominated by Vata Kapha Dosha together with Psycho stress factors (Mano Vikaras) result in deterioration of Rasa, Rakta, Twak and Laseeka^[3]and manifesting the clinical symptoms. Due to vitiation of Doshas and Dhatus clinical symptoms such as constriction of channels brownish or blackish Skin lesions along with severe Pruritis appear on Skin. The primary lesion is an epidermal papule or macule. At first the papules have a regular round contour and a diameter of 1-2mm (size of a split pea) each, later they spread peripheral often attaining size, with an intensive itching and a sensation of Skin Tautness. The rash is bilateral and symmetrical. It is distributed along the front of wrist, the flexor surfaces of the forearms, the abdomen, the legs, the genetalia and the back. Ayurvedic texts have described general causative factors i.e., Samanya Nidana for all type of Kushta. Viruddha Ahara, Athi Snigdha Guru Ahara, Mithya Ahara and Vihara, Vegarodha are some of the Nidanas.^[4] A virus, drug or physical stresses also have been blamed.

The concept of Dooshivisha^[5] and Gara Visha^[6] also plays a major role in the pathogenesis of Kitibha Kushta. Dooshivisha is such a special concept of Ayurveda that is universally accepted by almost all the Acharya. The name itself indicates its Dooshana Swabhava means inside the body the main action is to vitiate Dhatu. It is not a type of poison rather it is a transformable state or latent stage which any type of poison can attain. According to Chakrapani, Gara Visha is a combination of Savisha and Nirvisha Dravya. According to Acharya Charaka, Gara Visa is a Samyogaja Visha (artificial poison) which exerts toxic effect after interval of some time. It does not kill the patient internally. Gara Visa have the specific property Kalanthara-Avipaki which means it is not to digested early. It takes long time to digest and not fatal.

Last of all, the line of treatment should be simple but sure. As it is stated to be a Metabolic Disorder probability of impairment in Dhatwagni is also suspected. To reverse all the Samprapti Ghatakas vitiated Vata and Kapha are to be brought under control and impaired Twak should be normalized. Dooshita Rakta is to be purified, Virechana has been adopted with Laghu Ahara for Rakta Shodhana. Keeping these principles in mind, Samanya Kushta Roga Chikitsa, Koshta Shodhana, and administration of Shamana Oushadhis along with Pathyapathya was selected for the present case.

Case Report

Brief history of patient: A 55-year Male patient, from Hubli came to OPD with brownish circular patches over both Hands and lower Stomach region with itching over patches for 2 years. These symptoms hampered daily activities of the patient. He is a Tailor belonging to Middle Socioeconomic class, Hindu family background. He consulted one allopathic physician before, but he couldn’t get any relief from the symptoms, later he consulted to our hospital OPD for treatment.

No relevant History of Past illness contributing to the current condition of the Patient.

No History of Diabetes Mellitus or Hypertension

All are said to be healthy in the family.

Figure 1: Before Treatment

Clinical Findings

Site of brownish patches - flexor and extensor surface of both Hands, Lower Abdomen.

Morphology - Circular Macular Patches, Size 0.5 cm to 1cm, Brownish in colour.

Laboratory Investigations

Hb - 12mg/dl

TLC - 6900/cu

ESR -15mm/hour

DC - P-70%, L-28%, E-2%

AEC - 250/cum

Rest other system findings also normal

Samprapti Ghataka

Dosha - Vata - Vyana Vayu, Kapha, Pitta - Brajaka Pitta
Dushya - Rasa, Rakta, Mamsa, Lasika
Ama - Jatharagnijanyama
Agni - Jataragnijanya
Srothas - Rasavaha, Raktavaha, Mamsavaha, Udakavaha, Swedavaha Srotas
Srothodushti Prakara - Sanga
Roga Marga - Bahya
Udbhava sthana - Amashaya
Vyaktasthana - Twacha
Roga Swabhava - Chirakari
Sadhyasadhyata - Krichrasadhya

Samprapti

Nidana Sevana like Aharaja-Viharaja-Manasika (Spicy foods, junk foods, exposure to cold air, Divaswapna, Dadhi Sevana in Ushna and Vasantha Kala, stress) leads to the formation of Jataragni and Rasadhatwagni Janya Ama which vitiates Tridosha along with Twak, Rakta, Mamsa, Lasika and gets Sthanasamshraya in Twacha with Kandu leading to Kitibha Kushta.

Materials and Methods

Ama Pachana
Arohana Snehapana
Virechana
Shamanaoushadhis
Pathya-Apathya

Table 1: Showing Treatment Schedule/ Intervention

Date	Treatment	Medicine/Procedure
7-03-2021	Ama Pachana	Mustha Choorna[7] 5gms with lukewarm water morning and evening before food
12-3-2021	Snehapana	Tiktha Shadpala Ghrita[8] 30ml 1st day, 60ml 2nd day, 100ml 3rd day
15-3-2021 16-3-2021	Abhyanga and Swedana	Khadirasara Taila[9] Abhyanga followed by Ushna Jala Parisheka
17-3-2021	Virechana Pathya: Ganji, Khichadi, Laghuahara, Snana, Shubhra Vastradharana, Taila Abhyanga, Dhyana. Apathya: Tila Taila, Dhadhi, Madhya Sevana, Mamsa, Matsya Sevana, Vegadharana, Adhikavyayama.	Nimbamrithadi Eranda Taila[10] 25ml morning 7: 30 am Total - 7 Vega observed
	Shamanaoushadhis	Karappan Kashaya 4tsp BD with equal hot water Before food. Guduchyadi Kashayam[11] tablet 1 TID before food. For 30 days Kaishoraguggulu[11] 1 Tid before food for 30 days

Results

Better change in brownish discolouration

No itching

Probable mode of action

Ama Pachana with Mustha Choorna which possess both Deepana and Pachana property, helps in the maintenance of Agni Sandeepana Karma.
Both Snehana and Swedana help in the movement of Dosha and Dosha Shithilikarana and bring Dosha from Shakha to Koshta. Snehapana was done with Tikta Shadpala Ghrita as Tikta Dravya are the drug of choice in Twak Vikara.
The Virechana Dravya spreads throughout the body in cellular level due to its pharmacological properties. Virechana is a procedure one can practice comfortably and expect good response in Kitibha Kushta and also other Skin manifestation.

Suitable Shamanaoushadhis was given for Shesha Dosha Nirharanam.
Nidana Parivarjana stops the further progression of the disease, by restricting vitiation of Dosha. Pathya Apathya described for Kushta was advised here.

Figure 2: After 15 days of treatment

Figure 3: After 30 days of treatment

Discussion

Observations shows incompatible diet pattern, Stress and Strain factors for the provocation of the Dosha and the condition led to obstruction in Sweat Mechanism. To regularise this Ghritha Pana was done. Ghrita promotes the process of digestion, absorption and delivery to target organ system. Since the active ingredients are mixed with Ghrita they are easily absorbed. Hot water bath was suggested during the treatment. All these improved better blood circulations, Absorption and Sweat Mechanism. Nimbamritadi Eranda Taila is one of the best medicines to treat Kupitavata, Shamana of Kupitavata and Sanchita Mala. Ingredients of Karappan Kashaya have properties like Kushtaghna, Kandughna, Krimighna and Raktha Shodhaka. This all treatment normalizes the vitiated Doshas.

Conclusion

This case study demonstrated that Ayurvedic management with Virechana as Shodhana Therapy along with Samshamana Aushadha seems very effective for the treatment of Kitibha Kushta (Lichen Planus) like Skin disorders.

On the basis of the result of this study, it may be concluded that Kitibha Kushta (Lichen Planus) is responding well with usual method of treatment based on the principles laid down in Kushta Chikitsa Chapter.

Reference

1. P N Behl, A Agarval, Govind Srinivastava. Practice of Dermatology. CBS Publishers and Distributers. 9th edition 2002-page number: 45, 264

2. Dr. Ram Karan Sharma and Vaidya Bhagwan Dash: Caraka Samhita of Agnivesa, by Chakrapanidata’s Ayurveda Dipika, Chikitsasthana, English translation volume 3, Chowkhamba Publishers, Varanasi. 2009 in 7thchapter 1st sloka page number: 318, 21-26th sloka, page number- 325

3. Vaidya Jadavaji Trikamji Acharya: Caraka Samhita of Agnivesa by Chakrapanidatta Ayurveda Dipika Commentary Nidanasthana, Chaukhambha Publications NewDelhi, 2017, 5th chapter 3rd and 4thsloka page number: 216.

4. Dr. Ram Karan Sharma and Vaidya Bhagwan Dash:Caraka Samhita of Agniveshaby Chakrapanidata’s Ayurveda Dipika, Chikitsasthana, English translation volume 3, Chowkhamba Publishers, Varanasi, 2009 in 7thchapter

5. P V Sharma. Sushrutha Samhita Volume 3. Chaukhambha Vishwabharati Oriental Publishers. first edition 2nd Chapter 25-26 Sloka, Page no;20

6. Kashinatha Sastri, Dr. Gorakhanatha Chaturvedi: Charaka Samhita of Agnivesa revised by Charaka and Drdhabala, Part 2, Chaukhambha Bharati academy, Varanasi 2004, Page no; 662

7. J L N Sastri: Illustrated Dravyaguna Vijnana Volume 2 Chaukhambha Orientalia 2010 119-musthaka page number: 550-557.

8. Dr. Ram Karan Sharma and Vaidya Bhagwan Dash: Caraka Samhita of Agnivesha, by Chakrapanidata’s Ayurveda Dipika, Chikitsasthana, English translation volume 3, Chowkhamba Publishers Varanasi, 2009 7thchapter 140-143rd sloka page number: 354, 7th chapter 119th sloka, page number: 349.

9. Dr. Ram Karan Sharma and Vaidya Bhagwan Dash: Caraka Samhita of Agnivesha, by Chakrapanidata’s Ayurveda Dipika, Chikitsasthana, English translation volume 3, Chowkhamba Publishers Varanasi, 2009, 7th chapter 119th sloka, page number: 349.

10. Prof. K R Srikantamurthy: Vagbhatas Ashtanga Hridayam Chikitsasthana, krishnadas Academy Publishers, 5th edition, 2001, 21st chapter 58 – 61th sloka page number: 508.

11. Dr. Nitesh Kumar and Dr. Vidyanath: Sahasrayogam, Text with English Translation, Chowkhamba Sanskrit Series

Office Publishers Varanasi,1st Edition, 2006 Parishishta Prakarana chapter 10, page no:397, Vati Prakarana, Page no: 303

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-03-29	2022-03-31	2022-04-07	2022-04-14	2022-04-21
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Lichen Planus

Journal of Ayurveda and Integrated Medical Sciences