E-ISSN:2456-3110

Case Report

Shwitra

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

Management of Shwitra by Ayurvedic Shaman Chiktsa - A Case Study

Kaluram Sain N.1*, Sabu N.2
DOI:

1* Nirmal Kaluram Sain, Post Graduate Scholar, Dept. of Ayurved Samhita and Siddhant, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.

2 Narayan Sabu, HOD and Professor, Dept. of Ayurved Samhita and Siddhant, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.

Vitiligo is among the skin disorder presenting with white patches (Hypopigmented patches) over the skin, mainly caused by loss of melanin pigment or due to destruction of pigment forming cells known as Melanocytes or associated with Auto-Immune diseases like Diabetes mellitus, Pernicious Anaemia, Addison’s disease. In Ayurvedic literature this is incorporated under Shwitra which is described in kushtha (Dermatosis). It is caused by Dosha Dhatu Sammurchana mainly include Tridosha and Dhatus like Rasa, Rakta, Mamsa, & Meda leads to Bhrajak Pitta Dushti. The condition is often a matter of concern for social embarrassment & for cosmetic purpose. The following case study of treating the condition of Shwitra is a safe and effective method which includes diet and Internal Ayurvedic medication, as a Shaman Aushadhi followed by Lep Chikitsa and exposure to sun light. Above treatment was aimed to stimulate Melanocytes pigmentation in the skin. We observed good results in the patient of Shwitra Kushtha By above management.

Keywords: Shwitra, Vitiligo, Shaman Chikitsa

Corresponding Author How to Cite this Article To Browse
Nirmal Kaluram Sain, Post Graduate Scholar, Dept. of Ayurved Samhita and Siddhant, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.
Email: 		Nirmal Kaluram Sain, Narayan Sabu, Management of Shwitra by Ayurvedic Shaman Chiktsa - A Case Study. J Ayu Int Med Sci. 2022;7(9):211-215.
Available From
https://www.jaims.in/jaims/article/view/2008

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-27 2022-08-29 2022-09-05 2022-09-12 2022-09-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Nirmal Kaluram Sain, Narayan Sabuand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

It is an acquired pigmentary disorder of the skin and mucous membrane which manifests as white macules and patches due to Selective loss of melanocytes. Etiological hypotheses of vitiligo Include genetic, immunological, neurohormonal, cytotoxic, Biochemical, oxidative stress.[1] The exact cause of the vitiligo is still debatable.[2] Prevalence in the general population varies between 0-2% worldwide.[3] Twacha (Skin) consists of seven layers, out of which, disease Shwitra occurs in the Tamra (A type of skin layer) layer[4] which is the fourth layer of the Twak. In Ayurveda Shwitra is a skin disease described under Kushtha Roga (skin disorders). Shwitra or Shweta-Kushtha can be co-related with skin disease “vitiligo” In biomedicine. The word Shwitra is derived from Sanskrit word ‘Shweta’, which means white patch (Hypopigmentation) caused Due to derangement in Vata (energy of movement) and Bhrajaka Pitta (normal pigmentation of skin). It is caused due vitiation of Tridoshas and Rasa (plasma), Rakta (blood), Mamsa (muscle) and Meda Dhatu (fat)[5] Ayurveda has great potential to treat such Autoimmune diseases considering treatment principles described In classical texts. General line of treatment of Kushta Roga (skin Disorders), can also be advocated in Shwitra i.e., Rakta Mokshana (bloodletting), Virechana (purgation) and Vamana (emesis)[6] In Modern science, main stream treatment is PUVA (psoralen + Ultraviolet A exposure) therapy along with that moderate-to-high strength topical corticosteroids and calcineurin inhibitors, systemic corticosteroids which have many side-effects like skin cancer, photo ageing, nausea, ultraviolet light burning strength topical corticosteroids and calcineurin inhibitors, systemic corticosteroids which have many side-effects like skin cancer, photo ageing, nausea, ultraviolet light burning.[7] The diagnosis of Vitiligo is based exclusively on the clinical examination of the patient. The physical examination includes the presence of acquired asymptomatic depigmented Macules or patches, usually without clinical signs of inflammation.

Case History

Case description: A 22 years old female patient, Hindu by Religion reported to OPD of our hospital on 20/06/2022 with complains of white patches over

Right side of face, Right upper eyelid, and eyebrow since 8 months, after throughout history it was found that she was apparently normal 8 months back, one day she noticed a small white patches over Right side of face, but she neglected as it was very small. Later she noticed that it’s getting increased & spreading to other areas as Right upper eye lid and eyebrow hence she took treatment from nearby Allopathic hospital, Patches resolves slightly, but after stopping UV Therapy & steroids, again same hypopigmentation started, Then she took some Homeopathy treatment for 4 months, but there was no improvement in condition, & thus she came to our hospital for better treatment, also in her family her grandmother had same hypopigmented patches over both hands.

Diagnosis: Kaphaj Shwitra Kushtha.

Chief complaints: Shweta Twak Vaivarnya (white discoloration) over right upper eyebrow, eyelid, and over right side of face since 8 months. Size of patch was approximately 2cm x 1cm, 2cm x 2cm.

Past History: No any major illness in the past

Family History of Shwitra Kushtha found. (Grandmother having Vitiligo patches over both hands.)

History of Treatment: Patient taken Allopathic medicines (UV therapy and steroids for 2 months, Homeopathic medicine taken for 4 months.

Hetu

Family History: Grandmother had history of Shwitra Kushtha.

Ahara: Aniyamita Ahara (Irregular food habits), Viruddha Ahara (Fruit salad i.e., fruits + milk), Dadhi (over use of Curd), Ati Madhur-Lavan Rasa Sevana (excessive use of Sweet and Salty food in diet).

Vihar: Diwaswap, Mutra Veg Dharan.

Samprapti: After Hetu (causative factors) sevan all three Doshas got vitiated. Tridoshas reached all over body by Tiryak Gati. Sthansanshraya (pathogenesis) took place underneath the skin at Right upper eyebrow,eyelid and face region giving rise to white discoloration of the skin at that place (Vyakti). In this way Shwitra Kushtha Abhivyakti was observed in the patient. Following Samprapti Ghataka were observed in the patient.



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Samprapti Ghatak

Dosha: Vaat, Pitta and Kapha Dosha.

Dushya: Rakta, Mamsa, Meda and Ambu[8]

Adhishthan: Bahya Roga Marg i.e.Twacha (skin).

Srotodushti type: Srotoavrodh

Examination of the Patient

General examination
BP = 110/70 mm of hg

Pulse = 70/min

Systemic examination

Respiratory system - AEBE clear

Cardiovascular system - S1S2 Normal

Per abdomen - soft

Dashvidha Rogi Pariksha

Prakruti = Vaat Pitta

Vikruti = Kapha Pradhan Tridosha

Dushya = Rasa, Rakta, Mamsa

Sara = Madhyama

Samhanan = Heena

Satva = Heena

Aahar Shakti = Madhyama

Jaran Shakti = Madhyama

Vyayam Shakti = Heena

Satmya = Madhyama

Vaya = Youvana

Pramana = Madhyama

Ashtavidha Pariksha
Nadi = 70/min

Mala = Twice a day

Mootra = Regular 4-5 times a day

Jivha = Aliptata

Shabda = Prakruta

Sparsha = Anushna Sheeta

Drik = Prakruta

Aakruti = Madhyama

Local examination

Site of lesion - Right side of face, Right upper eye lid & eyebrow.

Distribution - Asymmetrical

Colour - white

Itching - Absent

Inflammation - Absent

Discharge - Absent

Superior sensation on lesion - pain absent, swelling absent

Chikitsa Vivaran: Shaman Chikitsa was given to patient for 3 months as follows.

Table 1: Treatment schedule

SN Treatment given Dose and Anupana Days
1.. Arogyavardhini Vati 500mg tds with luke warm water 15
2. Krumikuthar Rasa 250mg bd with luke warm water 15
3. Soothsekhar Rasa 500mg bd with luke warm water 15
4. Patolkaturohinyadi Kashay 10ml bd with luke warm water 15
5. Aaragvadh Kapilla Vati 400mg HS with luke warm water 15

Table 2: Treatment given

1. Kamdudha Rasa 500mg bd with luke warm water 45
2. Gomutra Haritaki 250MG TDS with luke warm water 15
3. Swayambhuva Guggulu 250mg tds with lukw warm water 45
4. Khadirarishtha 10ml tds with luke warm water 45

Table 3: Treatment given

1. Mahamanjisthadi Kwath 10ml tds with luke warm water 30
2. Khadir + Nimba+ Kasis Bhasma Churna 250mg + 250mg + 150mg with luke warm water 15
3. Bakuchyadya Churna 500mg bd with luke warm water 30

For local application following Lepas were given

1st month - Bakuchi Lepa Goli + Manjishtha Churna + Nimba Churna + Khadir Churna + Madyantika

2nd month - Bakuchi Churna + Chitraka Churna + Madyantika + Gomutra

3rd month - Bakuchi Churna + Tulsi + Madyantika

Discussion

After evaluating patient history following line of treatment were designed. There Are two main goals of any vitiligo treatment; first is to stop or arrest the further de-pigmentation and second is to induce repigmentation.


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1. Pachan -Deepan, Klednashak & Krumihar Chikitsa in Saama-Avastha with Nitya Sramsan was given in form of Ak pills

2. External application of Lepa Dravya in order to stabilize the progression of patches & sunlight exposure avoided in 1st month.

3. Once Nirama Lakshana were observed, Kapha-Pitta Nashak and Vyadhipratyanik Chikitsa were administered for 1½ months, along with Lepa Dravya.

4. Bakuchi is Vyadhi Pratyanik drug for Shwitra Kushtha, hence it was started from Day 1 in form of external application with other internal medication. Once Nirama-Avastha was achieved Bakuchi was administered internally as Churna.

5. UV rays of morning sun light along with application of Bakuchi Lepa encourages the growth of melanocytes & the local circulation to affected areas also increased which gives rise to formation of Prakrut Bhrajak Pitta.

6. Once pigmentation started and progression of disease controlled well, patient started with Rasayana as Khadir ,Nimba & Kasish Bhasma along with Bakuchyadya Churna.

Assessment was done according to the grading score given in the table.

Table 4: Grading score

Score 0 1 2 3
Type No improvement Stationary Resistant Progressive
Location   Follicular Mucousal Acral
No. of patches Absent Single Segmentary Generalised
Hairs in patches Black Mild black White  
Margin of patches normal Irregular Inflammed  
Colour of patches Normal Pigment spot on patch Pink Milky white
 Repigmentation Fully pigmented Peri follicular pigmentation Hyper pigmentation No pigmentation

Assessment observed as per the criteria in this patient every month is given in the table as below.

Table 5: Assessment before and after treatment

Sign and symptoms Before treatment After treatment
1st follow up 2nd follow up 3rd follow up
Type 3 1 1 1
No. of patches 3 3 2 2
Margin of patches 1 1 2 0
Colour of patches 3 1 1 0
Repigmentation 3 3 1 1

jaims_2008_01.JPGBefore Treatment

jaims_2008_02.JPGAfter Treatment

Conclusion

Finding of the present case report shows the effective management of vitiligo with Ayurvedic formulations, without Shodhan Chikitsa highlighting the basic Dhatu Siddhanta (Theory of tissue formation) of Ayurveda. Further trials are needed in large sample, for longer duration using controlled drugs.

The lesions or white patches which were developed on the face of the patient were recovered after 3 months of treatment by Ayurvedic Medications and diet.

This treatment proved very effective in the management of Shwitra (vitiligo). Vyadhihara Rasayana like Bakuchi was well tolerated in this study, even it was administered in larger dosage form.

Reference

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2. Glassman SJ. Vitiligo, reactive oxygen species and T-cells. Clin Sci (Lond.) 2011; 120: 99–120.

3. Lu T, Gao T, Wang A, Jin Y, Li Q, Li C. Vitiligo Prevalence study in Shaanxi Province, China. Int Dermatol 2007; 46: 47-51.


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4. Behl PN, Aggarwal A, Srivastava G. Vitiligo. In: Behl PN, Srivastava G, editors. Practice of Dermatology.9thEd. New Delhi: CBS Publishers; 2003. P.238-41.

5. Acharya Vidyadhara Shukla, Ravi Dutt Tripathi (ed.). Charaka Samhita. Edited with Vaidya Manorama Hindi Commentary, 2nd volume, Chaukhambha Sanskrit Pratishthan, Varanasi.

6. Ashtanga Hridaya Commentaries, Ayurveda Rasayana of Hemadri and Sarvangasundara of Arunadatta, edited by Hari Sastri Paradakara Vaidya. 10th edition Varanasi Chaukhambha publications, Chikitsa sthana, chapter-19, Verse -96; 2014. P. 956, 718.

7. Shingadiya RK, Sharma R, Beaker P, Prajapati PK.Autoimmune bullous skin disease managed with Ayurvedic Treatment: A case report. Ancient Sci Life 2017; 36: 229-33, 2015; p.335.

8. Bramhanand Tripathi Editor(s), (2015 ed.). Commentary Charakchandrika of Agnivesh On Charak samhita of Charakacharya, Chikitsa Sthan; Kushtachikitsa: Chapter 7, Verse 173-174. Varanasi: Chaukhamba Surbharti publication, 2015; p.336.


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