Role of Raktamokshana by Jalaukavacharana in management of Vicharchika - A Case Study

Seema D. Bahatkar; Tanvi Sunil Joshi

Role of Raktamokshana by Jalaukavacharana in management of Vicharchika - A Case Study

D. Bahatkar S.¹, Sunil Joshi T.^2*

DOI:

¹ Seema D. Bahatkar, Professor and HOD, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.

^2* Tanvi Sunil Joshi, Final Year PG Scholar, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.

According to Ayurveda, all skin diseases are considered under the broad heading of Kushtha. Vicharchika is a type of Kshudrakushtha, now-a-days very commonly found in many people. It is presented with symptoms as Shyava Vaivarnya, Pidaka, Kandu, Srava and Shoola. In this case study, a 57 years old male patient working as bus conductor visited to OPD of Panchakarma of our hospital with symptoms of Vicharchika. He was treated with Jalaukavacharana every 7 days for 1.5 month (5 sittings) along with internal Ayurvedic medications for 3 months and regular follow-up was taken every 7 days. Remarkable results were observed in patient with reduction of symptoms. Assessment was performed with Eczema Area and Severity Index Score (EASI) and Eczema area score. The study proved efficacy of Jalaukavacharana in the management of Vicharchika within short duration and marked improvement.

Keywords: Kushtha, Vicharchika, Jalaukavacharana

Corresponding Author	How to Cite this Article	To Browse
Tanvi Sunil Joshi, Final Year PG Scholar, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India. Email:	Seema D. Bahatkar, Tanvi Sunil Joshi, Role of Raktamokshana by Jalaukavacharana in management of Vicharchika - A Case Study. J Ayu Int Med Sci. 2022;7(10):245-251. Available From https://www.jaims.in/jaims/article/view/2015

Introduction

In Ayurveda, Acharyas have explained Kushtha as - Kushnati Vapuh Iti. It describes Kushtha as the Vyadhi that gradually destroys healthy body tissues; mainly sin and then further tissues.^[1] All types of Kushtha have symptoms like Vaivarnya, Kandu, Raga, Srava, Pidaka, Mandal Utpatti, Shoola, Raukshya, Vrana etc.

Vicharchika, a type of Kshudra Kushtha is most commonly diagnosed in clinical practice. Its incidence is alarmingly rising and is quite a concern on healthcare of public. It is a Raktapradoshaja Vyadhi, involving Tridoshawith dominance of Kapha^[2] and Pitta.^[3]

The characteristic features of Vicharchika are - Pidaka, Shyava Varna, Kandu and Srava.^[4] Pidaka or Mandala are of varying size with Alpa Shotha, Ati Kandu, Shyava or Krishna Vaivarnya and Alpa Pichhil Jala or Raktasrava in some cases.

According to modern science, Vicharchika can be correlated with Eczema. It is found in patients in two types- 1) Dry and 2) Wet. Most commonly it has symptoms like- rashes with redness, thickness/ inflammation, scratching and lichenification. These symptoms can affect the cosmetic look of individual and can be stressful. Recurrence of symptoms is the most common complaint in patients of Vicharchika and hence, there is need for permanent cure of Vicharchika which can be achieved with the help of Ayurveda.

Case Report

A 57 years old male patient visited in OPD of Panchakarma of M. A. Podar Ayurveda Hospital, Worli, Mumbai with the complaints of - Raukshya, Kandu, Vranavat Utpatti, Alpa Raktasrava and Kandupashchat Pichhil Jalasrava and Shoola over both hands and foot for 2 years with gradual increase in the intensity. He worked as BEST bus conductor for more than 25-30 years. Patient had also taken allopathic treatment with antifungal drugs and local applications but got mild relief in symptoms only for short period. So, he visited to our hospital at Panchakarma OPD for ayurvedic management.

Clinical Findings: When the patient visited to OPD of Panchakarma of our hospital, he was thoroughly examined.

The findings observed are as below:

Table 1: Samanya Parikshan

Parikshya Bhava	Parikshana	Parikshya Bhava	Parikshana
Naadi	Vatapradhan, Kaphanubandhi Guru, Saama.	Shabda	Prakrit
Mala	Kathin, Grathita Asamadhankarak	Sparsha	Twak Dushti Sthani Kharata, Raukshya
Mutra	5-6 Vega/din; 1-2 Vega/Ratra Samadhankarak	Druk	Prakrut
Jivha	Alpa Saama	Aakruti	Madhyam

Table 2: Srotas Parikshan

Srotas Naam	Parikshan
Pranavaha	S1S2 Normal, AEBE Clear
Udakvaha	Avishesh
Annavaha	Avipaka, Amlodgar, Hrullas, Chhardi
Rasavaha	Angamarda, Ubhay Hasta-Pada Twakdushti, Hrullas, Raukshya, Kandu, Shoola
Raktavaha	Ubhay Hasta-Pada Twakdushti, Raukshya, Kandu, Srava, Shoola, Raktasrav
Mamsavaha	Avishesh
Medovaha	Avishesh
Asthivaha	Avishesh
Majjavaha	Avishesh
Mutravaha	5-6 Vega/Dina 1-2 Vega/Ratra
Purishvaha	Udar Aadhmaan, Udar Gaurav, Asamadhankarak, Grathit Malapravrutti
Swedavaha	Ati Sweda, Sarvaang Kandu

Dashavidha Pariksha
1. Prakruti : Vatapradhan Pittanubandhi

2. Vikruti : Rasa, Rakta,

3. Sara : Madhyam

4. Samhanan : Madhyam

5. Satva : Madhyam

6. Saatmya : Ushah paan

7. Aharshakti : Abhyavaharan: Madhyam; Jaran: Madhyam

8. Vyayamshakti : Alpa

9. Vaya : Madhyam

10. Praman : Madhyam

Sthanik Parikshan

Darshan: Ubhaya Hasta Pada Anguli Sthani Raukshya, Kharata, Mandal Utpatti, Vranavat Darshan, Alpa Aarakta Varna, Alpa Rakta Srav.

Sparshan: Ruksha, Khara Sparsha, Alpa Aardra.

Prashna:

1. Twak Dushti Sthani Shoola, Kandu

2. Kandu Vruddhi After Sheeta Vata or Jala Samparka.

3. Lakshanvruddhi after Amla Rasa Sevan.

All Routine Investigations

All basic routine blood and urine check-up was performed.
As Raktamokshan as Panchakarma Chikitsa was planned, the patient was investigated for BSL- F and PP.
Haemogram to examine basic blood parameters and BT, CT.
Also, patients were tested for HBsAg, VDRL etc.

Table 3

Test	Result
Hb%	13.9
RBCs	4.12 milli/cmm
WBCs	9600/cmm
Platlets	2.3 lakhs/cmm
ESR	13 at the end of 1 hr
BSL	FBS - 112 mg/dl PP - 219mg/dl
BT	2mins 15 sec
CT	5mins 35 sec
VDRL	Negative
HBsAg	Negative
LFT	WNL
RFT	WNL
Lipid Profile	WNL
Sr. Uric Acid	WNL
Urine – R & M	WNL; PC- 4-5/hpf

Nidan Panchak

Hetu

Aahar

Katu, Amla Rasa Sevan, Atyambupaan, Ateetakalashan, Vishamashan,
Abhishyandi (Sandhanjanya, Matsya, Odana) Viruddha Ahar Sevan.

Vihar

Yanayan, Sheeta Vata Sevan, Aatapsevan, Chhardi Vega Udiran.

Manas

Atichintan, Krodh

Vyasan

Tea: 5-6 times/day
Tobacco: 6 times/day
Alcohol: 2-3 times /week

Poorvarupa

Sarvaang Kandu
Ati Swedan
Ubhay Hasta-Pada Pradeshi Mandal Utpatti, Vranvat Utpatti, Raukshya.

Roopa

Ubhay Hasta-Pada Pradeshi Mandal Utpatti, Vranvat Utpatti
Raukshya, Kharata, Kandu, Shoola
Twak Dushti Sthani Alpa Raktasrav, Kandu Paschat Picchil Jalasrava.

Figure 1: Samprapti

Rasa Raktavaha Srotodushti

↓

Dosha - Shakha Gati

↓

Twak Sthani – Sthanasamshraya

↓

Ubhaya Hasta Pada Pradeshi- Raukshya, Kandu, Vranava Utpatti

↓

Alpa Raktasrav, Kandupashat Picchil Jalsrav and Shoola

↓

Vicharchika

Differential Diagnosis

Vyadhi Nidana: Vicharchika

Sadhya-Asadhyata

As Vicharchika is Kapha dominant and only one Dosha dominant type of Kushtha; it is considered as Sadhya.^[5]

Management

Patient was diagnosed with Vicharchika as Sadhya and Nava Avastha.

The treatment was planned as Jalaukavacharana along with Ayurvedic internal medicines.

Aushadhi	Matra & Anupana	Sevan Kala	Kala	Guna
Arogyavardhini Vati	500 mg Koshna Jala	Apana	1 month	Pachan, Deepan, Malashodhan, Kushthaghna
Nisha + Amalaki Choorna	2 gm+ 1gm Koshna Jala	Apana	2 months	Pachan, Anuloman, Rasa-Rakta shodhan, Pramehanashan
Bhoonimbadi Kwatha	20 ml	Apana	1.5 months	Pachan

Internal Ayurvedic medicines and their mode of action are given as below:

Triphala Guggul	500 mg Koshna Jala	Vyana Udana	15 Days	Shoolaghna, Shothahara, Kledanashan
Gandhaka Rasayan	250 mg Koshna Jala	Vyana Udana	1.5 months	Kledanashan, Dahanashan, Kushthaghna
Khadiradi Vati	500 mg Koshna Jala	Vyana Udana	1.5 months	Kledanashan, Kushtanghna
Panchatikta Ghrita Guggul	500mg Koshna Jala	Vyana Udana	1 month	Raktaprasadan, Kanduhara, Raukshnashan
Aragwadha Kapila Vati	500 mg Koshna Jala	Ratrau	1 month	Sramsan, virechan, Kushtha-Kandu Nashan.

Panchakarma Upakrama
Panchakarma Upakrama as Raktamokshana in the form of Jalaukavacharana was performed in this patient.

Jalaukavacharana at both hands and feet was done every 7 days for 1.5 month (5 sittings) and observations, assessment was recorded.

Figure: 2
Figure: 3

Figure: 4

Figure: 5

Figure: 6

Assessment of the Patient:

1. Scoring of signs and symptoms of Vicharchika.

Score	Kandu	Vaivarnya	Daha
0	No Itching	Normal colour	No burning
1	Occasional itching	Abnormal but near to normal colour	Occasional burning
2	Mild itching	Reddish discoloration	Mild burning
3	Mild to Moderate itching	Slight black reddish discoloration	Mild to Moderate burning
4	Severe itching	Deep black reddish discoloration	Severe burning

Score	Vedana	Pidaka	Rukshata
0	No pain	No eruption of skin	No line on scrubbing with nail
1	Occasional pain	Starting of eruption	Faint line on scrubbing with nail
2	Mild pain on touch	Moderately developed eruption	Marked line on scrubbing with nail
3	Mild to moderate pain	Spread over extremities	Excessive dryness leading to itching
4	Severe pain	Severely spread on overall body	Excessive dryness leading to cracks and bleeding

2. Area Score

3. Severity score

4. EASI score

Assessment of the Patient

Before Treatment

Signs and Symptoms	Score
Kandu	3
Vaivarnya	3
Daha	2
Vedana	3
Pidika	2
Raukshya	2

After Treatment

Signs and Symptoms	Score
Kandu	2
Vaivarnya	1
Daha	1
Vedana	1
Pidika	0
Raukshya	0

Before Treatment

1. Area score:

Upper limb- 2

Lower limb-2

2. Severity score

Region	Redness	Thickness	Scratching	Lichenification
Upper Limb	1	2	1	0
Lower Limb	1	2	1	0

3. Easi Score:

Upper Limb = 1+2+1+0=4*2*0.2= 1.6

Lower Limb = 1+2+1+0=4*2*0.4= 3.2

After Treatment

1. Area score

Upper limb: 1

Lower limb: 1

2. Severity score

Region	Redness	Thickness	Scratching	Lichenification
Upper Limb	0	1	0	0
Lower Limb	0	1	1	0

3. Easi Score

Upper Limb = 0+1+0+0=1*1*0.2= 0.5

Lower Limb = 0+1+1+0=2*1*0.4=0.5

Discussion

While understanding pathology of Kushta and Vicharchika, all Tridoshas are vitiated along with Rasa, Rakta, Mamsa an Lasika.^[6]

Vicharchika is one of the Kshudrakushtha with Kapha Dosha predominance but it represents symptoms of Tridosha Dushti, as Kandu due to Kapha; Srava due to Pitta; and Shyava Varna, Raukshya due to Vata.^[7]

Acharya Dalhana in the commentary of Sushrut Samhita has specifically mentioned that most common site of Vicharchika is Hasta and Pada.^[8]

As per the Chikitsasutra of Kushta, one should perform Shodhana Karma according to Dosha dominance.^[9] Also, in Raktamokshana Chikitsa, Alpa Kushtha needs Prachhan or Jalaukavacharana.^[10] Considering Raktadushti and local Raktamokshana Chikitsa, Jalaukavacharana proves very effective in reducing signs and symptoms of Vicharchika.

Ayurvedic internal medications given act as Pachan, Deepan, Tridosha Shaman, Kleda Nashan, Kandu-Kushtha Nashan, and Rasa Rakta Prasadana along with Jalaukavacharana.

Here, in this case, Area score has reduced from 2 to 1, Severity score also has reduced in each symptom.

EASI score for upper limb is reduced from 1.6 to 0.5 and for lower limb from 3.2 to 0.5.

Thus, Jalaukavacharana and internal medicines both show marked results in management of Vicharchika.

Conclusion

This case study proves that Jalaukavacharana and Ayurvedic internal medicines can not only cure Vicharchika but also prevents recurrence of the Vyadhi. Raktamokshana and medicines along with Nidan Parivarjan and Pathya Ahar Vihar Sevan is very effective in the management of Vicharchika.

Consent of the Patient: Informed written consent of the patient has been obtained before treatment and for the publication of the case study.

Reference

1. H.S. Paradkar, Ashtanga Hridaya of Acharya Vagbhata with Sarvang sundara teeka by Hemadri, Nidansthan, adhyay 14, verse 4, Chaukhamba Surabharti publications, Varanasi, reprint ed.2015.

2. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Chikitsasthan, adhyay 7, verse 30, Vaidyamitra publication, Pune, reprint ed. 2018.

3. Acharya Yadavji Trikamji, Sushrut Samhita with Nibandhsangraha teeka of Dalhana, Nidansthan, adhyay 5, verse 16, Chaukhamba Surabharti publications, Varanasi, reprint ed.2015.

4. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Chikitsasthan, adhyay 7, verse 26, Vaidyamitra publication, Pune, reprint ed. 2018.

5. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Chikitsasthan, adhyay 7, verse 38, Vaidyamitra publication, Pune, reprint ed. 2018.

6. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Chikitsasthan, adhyay 7, verse 9, Vaidyamitra publication, Pune, reprint ed. 2018.

7. Acharya Yadavji Trikamji, Sushrut Samhita with Nibandhsangraha teeka of Dalhana, Nidansthan, adhyay 5, verse 13- Dalhana teeka, Chaukhamba Surabharti publications, Varanasi, reprint ed.2015.

8. Acharya Yadavji Trikamji, Sushrut Samhita with nibanhsangraha teeka of Dalhana, Nidansthan, adhyay 5, verse 13- Dalhana teeka, Chaukhamba Surabharti publications, Varanasi, reprint ed.2015.

9. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Chikitsasthan, adhyay 7, verse 39, Vaidyamitra publication, Pune, reprint ed. 2018.

10. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Chikitsasthan, adhyay 7, verse 40, Vaidyamitra publication, Pune, reprint ed. 2018.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-09-26	2022-09-28	2022-10-05	2022-10-12	2022-10-19
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Raktamokshana

Journal of Ayurveda and Integrated Medical Sciences