Effect of Parisheka, Rakta Mokshana and Shamanoushadhi in management of Vicharchika (Eczema): A Case Report

Rajouri Joshi; Kalpana Bhamini; Geetismita Boruah; T B Tripaty; Lakshmiprasad L Jadhav

Effect of Parisheka, Rakta Mokshana and Shamanoushadhi in management of Vicharchika (Eczema): A Case Report

Joshi R.^1*, Bhamini K.², Boruah G.³, Tripaty T.⁴, L Jadhav L.⁵

DOI:

^1* Rajouri Joshi, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

² Kalpana Bhamini, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

³ Geetismita Boruah, Post Graduate Scholar, epartment of Panchakarma, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

⁴ T B Tripaty, Professor, Department of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

⁵ Lakshmiprasad L Jadhav, Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Introduction: Vicharchika is one among eleven Kshudra Kushta. Cardinal features of Vicharchika are Kandu, Pidika, Shyava Varna, Bahusravi. Vicharchika is a Kapha Dosha predominant condition as mentioned by Acharya Charaka. Methods: The patient was treated with Siravedha, Sheeta Parisheka with Panchavalkala Qwatha, Gandhaka Rasayana, Triphala Guggulu, Patolakaturohiniyadi Kashaya as Shamana Aushadhi for seven days. Assessment was done on 1st day and 8th day on bases of lakshana, EASI score. Result: After seven days of treatment there was significant reduction in the signs and symptoms, along with EASI score. Discussion: Siravedha was done on first day in order to eliminate Dooshita Rakta, later on Sheeta Parisheka was done to pacify the Daha over lesion for next 6 days. Panchavalkala Qwatha was used for Sheeta Parisheka. Shamanoushadhi prescribed were Gandhaka Rasayana which is Kapha Hara due to its Katu, Tikta Rasa and Ushna Veerya. Triphala Guggulu which acts as Kaphahara due to its Kashaya, Katu, and Tikta Rasa, Rooksha Guna. Patolakaturonhinyadi Kashaya which is Kaphapitta Hara due to its Tikta Rasa and Rooksha Guna. After seven days of treatment patients got significant relief in many cardinal symptoms like Kandu, Srava & Daha. Combined effect of Rakta Mokshana, Parisheka and Shamanoushadhi were considerable improvement seen in this case.

Keywords: Vicharchika Kushta, Eczema, Siravedha, Sheeta Parisheka, Panchavalkala Qwatha, Gandhaka Rasayana, Triphala Guggulu, Patolakaturohinyadi Kashaya

Corresponding Author	How to Cite this Article	To Browse
Rajouri Joshi, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India. Email:	Rajouri Joshi, Kalpana Bhamini, Geetismita Boruah, T B Tripaty, Lakshmiprasad L Jadhav, Effect of Parisheka, Rakta Mokshana and Shamanoushadhi in management of Vicharchika (Eczema): A Case Report. J Ayu Int Med Sci. 2022;7(8):157-161. Available From https://www.jaims.in/jaims/article/view/2040

Introduction

Kushta is manifested by provocation of all three Doshas (Vata, Pitta, Kapha) and derangement of four Dhatus (Twak, Mamsa, Rakta, Lasika). Acharya Charaka opines dominant Dosha of the diseases should be treated first and later the associated Doshas.^[1] Acharya Charaka has classified Kushta Roga as Maha and Kshudra Kushta. Vicharchika is one among Kshudra Kushta.Vicharchika being Kapha predominant Tridosha vyadhi and having specific involvement of Rasa, Rakta, Mamsa and Kleda (Lasika) Dushya (the Sapthakdravya) for the manifestation of disease. Cardinal features of Vicharchika are Kandu (itching), Pidika (eruptions), Shyava Varna (blackish discoloration) and Bahu Srava (excessive oozing).^[2]

Acharya Sushruta explained Vicharchika being Pitta predominant Tridoshaja Vyadhi, presence of symptoms such as Ati Kandu (intense itching), Ati Ruja (Severe pain) and Raaji (marked linings) with Rukshata ( dry appearance).^[3]

According to Ashtanga Hridaya, nature of Srava was explained as ‘Lasikadhya’ whereas Indu, explained Lasikadhya as ‘Jala Pravah’ i.e., watery discharge.^[4] Kushta is disorder of Tvak (skin), affecting a person both cosmetically and mentally because of social stigma faced by the patients due to distorted appearance. Tvak is the Upadhatu of Mamsa, originating from Matruja Bhava, also an Adhisthana of Sparshanendriya, covers the outer part all over the body.

Vicharchika can be correlated with Eczema as it has similar signs and symptoms like non-contageous inflammation of the skin characterized by erythema, scaling, oedema, vesiculation and oozing. There are different types of eczema mentioned; the commonest form encountered is atopic or allergic dermatitis.

Daily visit to general practitioner’s accounts for 10-15% patients with dermatological disorders and of all skin diseases, 30% cases are of eczema. Dermatitis was estimated to affect 245 million people globally in 2015^[5], More prevalent among children (15-20%) and in adults (1-3%) worldwide, the prevalence among age group 6-7 years is 0.9% in India.^[6],[7]

Acharya Charaka states that dominant Doshas should be treated first and associated

Doshas later. An individual with Kapha predominant constitution if exposed to Kapha aggravating Nidana, it results in further aggravation leading to increase strength of Kaphaja Vyadhi.^[8] The vitiated Tridoshas - Vata, Pitta, Kapha along with impaired Tvak, Rakta, Masa and Lasika plays a role in pathogenesis of this Kustha. Kapha and Pitta Dosha are responsible for symptoms like Kandu and Daha,^[9] Vata is responsible for Tvak Shyava Varna and Pitta is responsible for Bahusraava and Daha. As Kushta is known to be a chronic disease for which repetitive Shodhana is indicated.^[10] According to Acharya Sushruta, Vamana can be repeated at interval of every 15 days, Virechana at interval of 30 days and Raktamokshana every 6 months.^[11] In Bahu Dosha condition, Shodhana such as Vamana and Virechana is mainly indicated. Vicharchika is a Raktapradoshaja Vyadhi and the lesion was localized at bilateral distal lower limbs, Siravedha was done in order to eliminate the Dooshita Rakta. Raktamokshana is one of the prime methods of treatment for curing skin disease where all other treatment modalities fail^[12,13]

Case Report

A 65 year female, approached Kayachikitsa OPD with complaints of dark skin lesion over both legs associated with serous and blood discharge, burning, and itching sensation since 15 days.

Patient had a history of Vicharchika (Eczema) every year in between September to march since 8 years, for which after every onset she use to take Ayurveda treatment.

History of presenting illness

Patient was apparently healthy 8 years back. Suddenly 15 days back she develop lesion over bilateral distal lower limbs with itching and serous discharge. Gradually the lesion increased in surface area with serous discharge, itching and burning sensation. For the above complaints she has approached to our hospital.

Clinical findings

On general examination a female patient with moderately nourished having normal blood pressure with normal temperature, pulse and respiratory rate. On examination other parameters like pallor, icterus, central cyanosis, oedema, digital clubbing and local lymphadenopathy were absent.

Systemic examination
Dashavidha Pareeksha (Ten fold examination)

Prakrithi (~body constitution) - Vatapitta; Vikrithi (~abnormal tissues affected) - Tvak, Rakta (~Skin and Blood); Satva (~will power) - Madhyama (~Moderate); Sara (~essence of body tissues) – Madhyama (~Moderate); Samhanana (~Nourishment) – Madhyama (~Moderate); Aharashakthi (~Power of digestion) - Madhyama (~Moderate); Vyayamashakthi (~Power of performing exercises) - Madhyama (~Moderate); Vaya (~Age) - Vridha (~Old).

Ashtavidha Pariksha (Eight fold examination)
Nadi (~pulse) - Vataja; Mutra (~nature of micturition) - Prakritha (~normal); Mala (~Nature of stool) - Prakritha (~normal); Jihva (~Status of tongue) - Alipta (~not coated); Shabdha (~auditory reflexes) - Prakritha (~normal); Sparsha (~tactile) - Prakritha (~normal); Drik (~visual reflexes) - Prakritha (~normal); Aakrithi (~body built) - Krisha (~lean).

Nidana (~Etiology/Causative factor)
Ati Amla, Katu and Lavana Aahara Sevana (~consumption of more sour, spicy and salty food); Divasvapana (~Sleeping in day); Ati Snigdha Aahara Sevana (~consumption of more oily food).

Srotopareekskha (~Examination of circulatory channels involved)
The involved Srotas (~circulatory channels) are Rakta (~Blood) which is having origin from Rasa (~plasma). The Lakshanas (~symptoms) are Kandu (~itching), Pidika (~eruptions), Shyava (~blackish discoloration) and Bahu Srava (~excessive oozing).

Materials and Methods

Day	Intervention	Dose and Anupana
1st day	Siravedha (b/l lower limb)	20 ml blood Visravana from each leg
2nd to 7th day	Sheeta Parisheka - Panchavalkala Qwatha (b/l lower limb)	OD
1st to 7th day	Patolakaturohiniyadi Kashaya	30ml-0-0 (BF) with 30 ml of with luke warm water
1st to 7th day	Triphala Guggulu	2-2-2 (BF) with luke warm water
1st to 7th day	Gandhaka Rasayana	2-0-2 (AF) with luke warm water
1st to 7th day	Gandhaka Malahara (Morning, after Parisheka)	(EA)
1st to 7th day	Shatadhouta Ghrita (At night)	(EA)

b/l - Bilateral, EA - Exernal application, BF - Before food, AF - After food, OD - Once daily.

Result

Parameter	Before treatment	In between treatment (Day 3rd	After 7 days of treatment
Kandu[14]	Present	Reduced	Absent
Pidika	Absent	Absent	Absent
Shyava Varna	Present	Present	Reduced
Bahusraava	Present	Reduced	Absent
EASI score[15]	4.8	2.4	0

Discussion

Gandhaka Rasayana has Katu, Tikta Rasa and Ushna Veerya which pacified Kandu Karma of Pitta and Kapha.^[16]Gandhaka is also Pittakara so, to avoid Pitta aggravation, Sheeta Parisheka of Panchavalkala Qwatha was done. It relieved Daha by its Sheeta Guna and Bahusrava because of its Rooksha Guna. Triphala Guggulu may have helped in reducing Kandu by its Katu, Tikta Rasa and Rooksha Guna.^[17]

Patolakaturonhinyadi Kashaya possesess Tikta Rasa and Rooksha Guna by which acts as Kanduhara, Bahu Sravahara and works as Raktashodhaka.^[18]Gandhaka Malahara is of Ushna Veerya which pacifies Kandu.^[19]

Shatadhouta Ghrita worked as Vata and Pittahara which reduced Daha and Syava Varna.^[20] Therefore, combined effect of Parisheka, Rakta Mokshana and Shamanoushadhi plays a significant role in the treatment of Vicharchika. Assessment was done on follow ups and there was no relapse till six months of treatment.

Before treatment (Day 1st)

In between treatment (Day 3rd)

After treatment (Day 7th)

Conclusion

In this case study combined effect of Parisheka, Rakta Mokshana and Shamanoushadhi in Vicharchika (Eczema) was found to be effective.

Reference

1. Agnivesha, Charaka samhita of Acharya Charaka, Dridhabala krit, edited by Vaidya Jadavaji Trikamji Aacharya. Chikitsasthana. Ch.7, Ver. 32. Varanasi: Chaukhamba Orientalia; 2015. p.451.

2. Agnivesha, Charaka samhita of Acharya Charaka, Dridhabala krit, edited by Vaidya Jadavaji Trikamji Aacharya. Chikitsasthana. Ch.7, Ver. 26. Varanasi: Chaukhamba Orientalia; 2015. p.451.

3. Sri Dalhanacharya, Susruta Samhita of Acharya Susruta, edited by Vaidya Jadavaji Trikamji Aacharya. Nidansthana. Ch. 5, Ver. 13. Varanasi: Chaukhamba Orientalia; 2011. p. 285.

4. Vagbhata, Astangahrdayam, edited by Bhisagacharya Harisastri Paradakara Vaidya. Nidanasthana. Ch. 14, Ver. 17. Varanasi: Chaukhamba Orientalia; 2017. p. 525.

5. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England), 388(10053), 1545–1602. https://doi.org/10.1016/S0140-6736(16)31678-6

6. Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, Williams H: Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicounty cross-sectional surveys. Lancet 2006; 368: 733-743.

7. Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI: Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol 2009; 124: 1251-1258.

8. Shukla V Tripathy R. Charaka Samhita of Agnivesha, Vimanasthana; Maharoga adhyaya: Chapter 6, Verse 15. Delhi: Chaukhamba Sanskrit Pratishthana, 2007

9. Shukla V Tripathy R. Charaka Samhita of Agnivesha, Sutra sthana; Maharoga adhyaya: Chapter 20, Delhi: Chaukhamba Sanskrit Pratishthana, 2007.

10. Dr. Harishchandra Singh Kushwaha, editor. Commentary Agnivesha of Charaka Samhita, Chikitsa Sthana. Kushtachikitsa Adhyaya Chapter 7, Verse 42. Varanasi: Chaukhambha Orientalia, 2018.p.201.

11. Dr. Kewal krishan thakaral, editor. Commentary Dhalana and Gayadas of Sushruta Samhita, Chikitsa Sthana. Kushta chikitsitam vyakhayam chapter 9, Verse 43. Varanasi: Chaukhambha Orientalia, 2019.p.305.

12. Dr. Harishchandra Singh Kushwala, editor. Commentary Agnivesha of Charaka Samhita, Sutra Sthana. Vidhishonitayam Adhyaya Chapter 24, Verse 17. Varanasi: Chaukhambha Orientalia, 2018.p.333.

13. Dr. Brahmanand Tripathi Sarangadhara Samhita of pandit Sarandharacharya, uttarkhanda. Shonitstrav Adhyaya Chapter 12, Verse 1. Varanasi: Chaukhambha Subharti Prakashan 2021.p.272.

14. Shukla V Tripathy R. Charaka Samhita of Agnivesha, Chikitsa sthana; Chikitsa sthana: Chapter 7, Verse 26. Delhi: Chaukhamba Sanskrit Pratishthana, 2007.

15. Leshem YA, Hajar T, Hanifin JM, Simpson EL. What the Eczema Area and Severity Index score tells us about the severity of atopic dermatitis: an interpretability study. Br J Dermatol. 2015;172(5):1353-7. doi: 10.1111/bjd.13662. Epub 2015 Apr 16. PMID: 25580670.

16. Suresh Babu, M., 2005. Yoga Ratnakara. Rasayana adhikara, 1st ed. Varanasi: Chowkhambha Krishnadas Academy.

17. Tripathy Brahmanand. Sharngadhara Samhita By Sharangadharacharya. Madhyama Khanda 8 th chapter Reprint ed. Varanasi (India): Chaukhambha surabharati prakashan;2006.

18. Paradakar Harishastri Vaidya, Astanga Hridayam of Vagbbhata with Arunadatta and Hemadri commentaries, Sutrasthana, 15-chapter, 8th Ed, Varanasi, Chowkambha Orientalia publications 2005

19. Rasa Tarangini 8/63-65

20. Shukla V Tripathy R. Charaka Samhita of Agnivesha, Sharira sthana; Jatisutriya adhyaya: Chapter 8, Verse 24 Delhi: Chaukhamba Sanskrit Pratishthana, 2007

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-08-02	2022-08-04	2022-08-11	2022-08-18	2022-08-25
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	17%

Case Report

Eczema

Journal of Ayurveda and Integrated Medical Sciences