E-ISSN:2456-3110

Research Article

Eczema

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

Study on effectiveness of Siravyadha in comparison with Siravyadha followed by Yashada Lepa in Vicharchika w.s.r. to Eczema

Rakshitha M.1*, Rao S S.2
DOI: http://dx.doi.org/10.21760/jaims.7.10.7

1* M Rakshitha, Post Graduate Scholar, Department of Shalya Tantra, Govt. Ayurveda Medical College & Hospital, Bengaluru, Karnataka, India.

2 Sridhara Rao S, Professor, Department of Shalya Tantra, Govt. Ayurveda Medical College & Hospital, Bengaluru, Karnataka, India.

Vicharchika is one among 11 Kshudra Kushta and it is one among the Astamahagada as said by our Acharyas. This can be co-related to Eczema of contemporary science. Eczema is an inflammatory reaction of skin characterized by dry skin, itching, red to brownish grey patches and painful vesicles. In Ayurveda, management of Kushta includes Shodhana based on Dosha Praadhaanyata followed by Shamanoushadas which include Abhyanga, Parisheka and Lepa. On the other hand, contemporary Medical science, use of oral anti-histamines, oral and topical corticosteroids which reduces local inflammation, itching and lichenification, but show significant adverse effects. It is told that Vicharchika (Kushta) is a Rakta Pradoshaja Vikaara and Siravyadha is an effective modality in treating Rakta Dushti. Yashada Lepa is said to cure Vicharchika in a short duration. The present study, “Study on effectiveness of Siravyadha in comparison with Siravyadha followed by Yashada Lepa in Vicharchika w.s.r. to eczema.” was conducted in SJIIM Hospital, Bengaluru with 40 patients randomly allotted into 2 groups namely - Group A and Group B. Assessment was done based on subjective parameters like (Itching, pain, discharge, discoloration and dryness) and objective parameters like (area and lichenification). Observation was done before and after treatment. Assessment of Itching, Pain, discharge, discoloration, dryness, Area, and intensity of the lesion and lichenification in Group-A showed 80%, 75%, 60%, 68%, 88.89%,65.38% and 80.76% improvement and in Group-B showed 90.9%, 90%, 100%, 81.25%, 85.71%, 80.76% and 100% respectively. Statistical analysis revealed that Siravyadha followed by Yashada Lepa is more effective compared to only Siravyadha.

Keywords: Vicharchika, Siravyadha, Yashada, Lepa, Eczema, Kshipra Marma

Corresponding Author How to Cite this Article To Browse
M Rakshitha, Post Graduate Scholar, Department of Shalya Tantra, Govt. Ayurveda Medical College & Hospital, Bengaluru, Karnataka, India.
Email: 		M Rakshitha, Sridhara Rao S, Study on effectiveness of Siravyadha in comparison with Siravyadha followed by Yashada Lepa in Vicharchika w.s.r. to Eczema. J Ayu Int Med Sci. 2022;7(10):47-59.
Available From
https://www.jaims.in/jaims/article/view/2053

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-09-28 2022-09-30 2022-10-07 2022-10-14 2022-10-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by M Rakshitha, Sridhara Rao Sand 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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Rakshitha M et al: Siravyadha in Siravyadha Yashada Lepa Vicharchika w.s.r. Eczema

Introduction

Skin is the outermost covering of the body that acts as a physical barrier between external and internal environment. The burden of skin disease is a multidimensional concept that encompasses psychological, social and financial consequences of the patients and society due to its high prevalence and associated morbidity over time.[1]

Kushta is broadly classified as Mahakushta and Kshudra Kushta by our Acharyas. Vicharchika is one among the 11 Kshudra Kushta with features of Kandu (itching), Srava (discharge), Pidaka (eruptions), Shyavata (discoloration), Rukshata (dryness) and Raji.[2,3] Vicharchika can be correlated with eczema as per contemporary medicine with similarities of its etiology, symptoms and site of lesions.

Eczema is a common chronic relapsing skin disease characterized by dry skin, itching, red to brownish grey patches and painful vesicles. In acute and sub-acute stage, lesions are often characterized by intensely pruritic, erythematous papules or vesicles with excoriations and a serous exudate.[4] In chronic stage, lesions present with lichenified plaques and papules with excoriations. It affects both the limbs and can be wet or dry in nature.

Though the disease is not life threatening it causes a significant impact on quality of life of an individual both physically and socially.

Acharya charaka quotes Kustham Deergharoganam in sutra sthana[5] considering chronicity of Kushta, it as agrya among deergaanubandhi rogas. Sushruta also opines the same regarding severity and chronicity of the disease.

The existing treatment in contemporary science consists of reassurance, elimination of predisposing causes and palliative measures. Modern dermatology employs systemic and local application of steroids for the management of eczema. Despite an initial response, long term usage of steroids produce ill effects. Long term use of topical steroids causes skin thickening, stretch marks, redness, hypersensitivity and rebound of symptoms on withdrawal. Similarly electrotherapy, Ultraviolet therapy, hydrotherapy, X-ray therapy[6] have their own limitations and are neither popular nor much responding.

Ayurvedic treatment broadly consists of Shodhana Karma based on Dosha Pradhanyata followed by Shamana Chikitsa including different kinds of Taila, Ghrita, Kashayas, Aasava, Arishta and Bahirparimarjana Chikitsa like Pralepa, Pradeha, Abhyanga, Udgharshana. Raktamokshana is specifically mentioned in Kushta which is Pitta Pradhana and Dooshita Rakta.

Siravyadha is indicated when there is extensive vitiation of Rakta. It is said to be the Ardha Chikitsa in Shalya Tantra[7] and is the treatment of choice in Raktapradoshaja Vikaras. It is also said that even the diseases which are not cured by Snehaadi Karma will be cured instantaneously by Siravyadha.[8] Shodhana (Siravyadha) followed by Bahirparimarjana Chikitsa (Lepana) is found to be very efficacious in skin disorders. In Rasa Tarangini, 19th Taranga, while mentioning Amayika Prayogas of Yashada Bhasma, Yashada Lepa is said to be very effective in treating Vicharchika. Yashada Bhasma having Kashaya Tikta Rasa, is Kapha-Pittahara, reduces discharge and helps in healing. Yashada Lepa is said to cure Vicharchika in shorter duration even in chronic stages.[9]

With these background, in this current study an attempt was made to study the comparative effectiveness of Siravyadha followed by Yashada Lepa and only Siravyadha in the management of Vicharchika. The results obtained were statistically analyzed using‘t’ test and compared between the groups.

Objective of the Study

1. To evaluate the efficacy of Siravyadha in the management of

2. To evaluate the efficacy of Siravyadha followed by Yashada Lepa in the management of Vicharchika.

3. To evaluate the comparative efficacy of Siravyadha followed by Yashada Lepa and Siravyadha in the management of Vicharchika.

Materials and Methods

Source of data

Patients were selected from OPD and IPD of Sri Jayachamarajendra Government Ayurveda and Unani Hospital, Bangalore, during the study period from April 2019 - February 2022.



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Method of collection of data: A total number of 40 cases with clinical features of Vicharchika were selected for the present study based on inclusion and exclusion criteria.

Inclusion Criteria

  • Patients with classical clinical features of Vicharchika such as Kandu, Srava, Pidaka, Shyavata, Rookshata and
  • Lesions present only on the Extremities
  • Age: 16yrs to 70yrs

Exclusion Criteria

  • Vicharchika (Eczema) associated with other skin disorders like psoriasis.
  • Systemic disorders such as hypertension, diabetes mellitus and bleeding disorders that would come in the way of disease and treatment
  • Patients under anti-coagulants
  • Pregnant and lactating women

Investigations: Routine blood investigation: CBC, ESR, CT, BT, RBS, HIV, HBSAG

Sampling Design: The 40 cases included were randomly selected and allotted into two groups namely Group-A & Group-B, consisting 20 patients each, by random sampling.

Group A: 20 patients of this group were treated with only Siravyadha in 3 sittings with an interval of 15 days.

Group B: 20 patients of this group were treated with Siravyadha in 3 sittings with an interval of 15 days and application of Yashada Lepa.

Observations were made before treatment, on 15th day, 30th day and 45th day. Changes in clinical features were recorded.

Materials required

Siravyadha

Tila Taila - Quantity sufficient (QS)

Tourniquet - 1

Sterile gloves - 2 pairs

Surgical spirit - QS

Disposable needle no.18 - 2

Measuring jar - 1

Gauze - 3-5

Cotton pads - 1-2

Roller bandage - 1

Lepa

Yashada Lepa - QS (based on area of lesion)

Spatula - 1

Gauze - 2

Study Design

Group A Group B
Siravyadha Siravyadha followed by Yashada Lepa

Selection of Sira

As per classics, Sira which is 2 Angula above Kshipra Marma was selected for Vyadhana, When this is not found any Unnata Sira after Yantrana was selected.

Group A (Siravyadha)

Treatment Procedure in Group A

Poorva Karma

  • Patient was explained about the procedure and written consent taken.
  • Sthanika Abhyanga followed by Swedana was done.
  • A light and liquid diet was advised.
  • Yavagu pepared out of Tila given to the patient.

Pradhana Karma

  • Patient was made to sit in a comfortable position.
  • Yantrana done using a tourniquet over selected area neither too tight nor too loose.
  • Unnata Sira was identified and Siravyadha done using a surgical needle no. 18
  • Blood was collected in measuring jar.

Pashchat Karma

  • Once the bleeding arrest on its own, Bandhana (tight bandaging) was done.
  • Patient advised to rest for some time followed by Hita Aahaara Sevana.
  • Bandage was advised to remove in the evening.
  • Next sittings were done on 15th and 30th



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Group B (Siravyadha followed by Yashada Lepa)
Same procedure as explained in group A followed by Lepa.

Yashada Lepa: Yashada Bhasma of Dhootpaapeshwar pharmacy available in the market was used for the preparation of Lepa.

Preparation of Yashada Lepa

Yashada Bhasma is added with sufficient quantity of Goghrita and Bhavana was done until homogenous mixture.

Based on the size of the lesion, the quantity of Lepa was decided.

Lepa was applied once in a day.

Suitable Pathya and Apathyas were advised to the patients.

Follow Up: A follow up period of 1 month was considered to observe for reoccurrence of signs and symptoms.

Assessment Criteria
Subjective parameters

1. Kandu (itching)

2. Ruja (pain)

3. Sraava (discharge)

4. Shyavata (discoloration)

5. Rookshata (Dryness)

Objective parameters

1. Tenderness

2. Lichenifiaction

3. Area and severity of the lesion

Grading of Parameters
A. Subjective Criteria

1. Itching

Grade 0 – Absent

Grade 1 – Mild Itching (Not disturbing daily activities)

Grade 2 – Moderate Itching (disturbing daily activities)

Grade 3 – Severe Itching (disturbed activities and sleep)

2. Pain

Grade 0 – Absent

Grade 1 -3 – Mild Pain

Grade 4-6 – Moderate pain

Grade 7-9 – Severe pain

Grade 10 – Very severe pain

3. Discharge

Grade 0 – No discharge

Grade 1 – Mild discharge (2*2cm – 1 gauze per day)

Grade 2 – Moderate discharge (2*2cm – 2 gauze per day)

Grade 3 – Severe discharge (2*2cm – 3 gauze per day)

4. Discoloration

Grade 0 – No discoloration

Grade 1 – Reddish

Grade 2 – Blackish Red

Grade 3 – Black

5. Dryness

Grade 0 – Absent (normal skin)

Grade 1 – Mild dryness

Grade 2 – Moderate dryness (dry with scaling)

Grade 3 – Severe dryness (dry with cracking)

B. Objective criteria

1. Tenderness

Grade 0 – No Tenderness

Grade 1 – Mild Tenderness

Grade 2 – Moderate Tenderness

Grade 3 – Severe Tenderness

2. Lichenification

Grade 0 – No Lichenification

Grade 1 – Mild Lichenification

Grade 2 – Moderate Lichenification

Grade 3 – Severe Lichenification


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3. Area and severity of lesion

a. Area –

Grade 0 – No active eczema

Grade 1 – 1-25% of the area of affected limb

Grade 2 – 25 – 50 % of the area

Grade 3 – 50 – 75% of the area

Grade 4 – 75- 100% of the area

b. Severity – (intensity of redness, thickness, scratching and lichenification)

Grade 0 – None, absent

Grade 1 – Mild intensity

Grade 2 – Moderate intensity

Grade 3 – Severe intensity

Assessment of the total effect of the study

Table 1

Unchanged 0-25% relief from the symptoms mentioned above
Mild Response 26-50% relief from the symptoms
Moderate Response 51- 75% relief from the symptoms
Good Response 76- 99% relief from the symptoms
Cured 100% relief from the symptoms

Observations and Results

Total 40 patients were registered in this study. Out of that, all 40 patients were studied in this project. 20 patients were in group A while 20 were in B group. Each patient was observed thoroughly and noted thoroughly.

The observations are recorded and represented in charts.

The results of subjective & objective parameters of clinical study obtained before and after treatment were analyzed statistically

  • Within the group (paired ‘t’ test)
  • In between the group (unpaired ‘t’ test)

Table 2: Effect of Group A on Itching

Parameters Mean % S. D S. E Df t-value p-value Remarks
Itching BT 2.25     0.91 0.20 19
D15 1.75 0.50 22.23 0.55 0.12 4.358 <0.001 HS
D30 1 1.25 55.56 0.56 0.13 7.108 <0.001 HS
AT 0.35 1.90 84.45 0.59 0.13 8.323 <0.001 HS


Effect on Itching in group A
Out of 20 patients studied in Group A, Itching is tabulated in detail in Table 2. Statistical analysis showed that the mean score which was 2.25 before the treatment was reduced to 0.35 after the treatment with 84.45% improvement and there is a statistically highly significant. (P<0.001)

Table 3: Effect of Group B on Itching

Parameters Mean % S. D S. E Df t-value p-value Remarks
Itching BT 1.65     0.75 0.17 19
D15 1.05 0.60 36.37 0.60 0.14 4.485 <0.001 HS
D30 0.30 1.35 81.81 0.47 0.11 12.337 <0.001 HS
AT 0.15 1.50 90.9 0.37 0.08 8.816 <0.001 HS

Out of 20 patients studied in Group-B Itching is tabulated in detail in Table 3. Statistical analysis showed that the mean score which was 1.65 before the treatment was reduced to 0.15 after the treatment with 90.9% improvement and there is a statistically highly significant.

Table 4: Effect of Group A on Pain

Parameters Mean % S. D S. E Df t-value p-value Remarks
  Pain BT 0.50     0.61 0.14 19
D15 0.45 0.05 10 0.60 0.14 1 >0.05 NS
D30 0.15 0.35 70 0.37 0.08 3.198 <0.01 S
AT 0.10 0.40 80 0.31 0.07 3.559 <0.01 S

Out of 20 patients studied in Group-A Pain is tabulated in detail in Table 4. Statistical analysis showed that the mean score which was 0.50 before the treatment was reduced to 0.10 after the treatment with 80% improvement and there is statistically significant. (P<0.01)

Table 5: Effect of Group B on Pain

Parameters Mean % S. D S. E Df t-value p-value Remarks
Pain BT 0.55     0.51 0.11 19
D15 0.35 0.20 36.37 0.49 0.11 2.179 <0.05 S
D30 0.15 0.40 72.72 0.37 0.08 3.559 <0.01 S
AT 0.1 0.45 81.81 0.22 0.05 4.358 <0.001 HS

Out of 20 patients studied in Group-B Pain is tabulated in detail in Table 5. Statistical analysis showed that the mean score which was 0.55 before the treatment was reduced to 0.05 after the treatment with 90.9% improvement and there is statistically highly significant. (P<0.001)

Table 6: Effect of Group A on Discharge

Parameters Mean % S. D S. E Df t-value p-value Remarks
Discharge BT 0.80     1.06 0.24 19
D15 0.55 0.25 31.25 0.83 0.18 2.516 <0.05 S
D30 0.25 0.55 68.75 0.44 0.10 3.240 <0.01 S
AT 0.20 0.60 75 0.41 0.09 3.040 <0.01 S

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Effect on Discharge in group A
Out of 20 patients studied in Group-A Discharge is tabulated in detail in Table 6. Statistical analysis showed that the mean score which was 0.80 before the treatment was reduced to 0.20 after the treatment with 75% improvement and there is statistically significant.

Table 7: Effect of Group B on Discharge

Parameters Mean % S. D S. E Df t-value p-value Remarks
Discharge BT 0.70     0.80 0.18 19
D15 0.50 0.20 28.57 0.61 0.14 2.179 <0.05 S
D30 0.10 0.60 85.71 0.31 0.07 3.942 <0.01 S
AT 0 0.70 100 0 0 3.906 <0.01 S

Out of 20 patients studied in Group-B Discharge is tabulated in detail in Table 7. Statistical analysis showed that the mean score which was 0.70 before the treatment was reduced to 0 after the treatment with 100% improvement and there is statistically significant. (P<0.01)

Table 8: Effect of Group A on Discoloration

Parameters Mean % S. D S. E Df t-value p-value Remarks
Discoloration BT 2     0.79 0.18 19
D15 1.55 0.45 22.5 0.51 0.11 3.942 <0.01 S
D30 0.90 1.10 55 0.64 0.14 7.677 <0.001 HS
AT 0.80 1.20 60 0.52 0.12 7.712 <0.001 HS

Effect on Discoloration in group A
Out of 20 patients studied in Group-A Discoloration is tabulated in detail in Table 8. Statistical analysis showed that the mean score which was 2 before the treatment was reduced to 0.80 after the treatment with 60% improvement and there is statistically highly significant. (P<0.001)

Table 9: Effect of Group B on Discoloration

Parameters Mean % S. D S. E Df t-value p-value Remarks
Discoloration BT 1.60     0.68 0.15 19
D15 1.25 0.35 21.87 0.64 0.14 3.198 <0.01 S
D30 0.45 1.15 71.87 0.51 0.11 10.509 <0.001 HS
AT 0.30 1.30 81.25 0.47 0.11 10.177 <0.001 HS

Out of 20 patients studied in Group-B Discoloration is tabulated in detail in Table 9. Statistical analysis showed that the mean score which was 1.60 before the treatment was reduced to 0.30 after the treatment with 81.25% improvement and there is statistically highly significant. (P<0.001)

Table 10: Effect of Group A on Dryness

Parameters Mean % S. D S. E Df t-value p-value Remarks
Dryness BT 1.25     1.21 0.27 19
D15 0.90 0.35 28 0.85 0.19 3.198 <0.01 S
D30 0.50 0.75 60 0.61 0.14 3.942 <0.01 S
AT 0.40 0.85 68 0.50 0.11 3.847 <0.01 S

Effect on Dryness in group A
Out of 20 patients studied in Group-A Dryness is tabulated in detail in Table 10. Statistical analysis showed that the mean score which was 1.25 before the treatment was reduced to 0.40 after the treatment with 68% improvement and there is statistically significant. (P<0.01)

Table 11: Effect of Group B on Dryness

Parameters Mean % S. D S. E Df t-value p-value Remarks
Dryness BT 1.05     1.10 0.25 19
D15 0.60 0.45 42.85 0.75 0.17 3.942 <0.01 S
D30 0.20 0.85 80.95 0.41 0.09 4.343 <0.001 HS
AT 0.15 0.90 85.71 0.37 0.08 4.722 <0.001 HS

Out of 20 patients studied in Group-B Dryness is tabulated in detail in Table 11. Statistical analysis showed that the mean score which was 1.05 before the treatment was reduced to 0.15 after the treatment with 85.71% improvement and there is statistically highly significant.

Table 12: Effect of Group A on Tenderness

Parameters Mean % S.D S.E Df t-value p-value Remarks
Tenderness BT 0.50     0.61 0.14 19
D15 0.45 0.05 10 0.60 0.14 1 >0.05 NS
D30 0.10 0.40 80 0.31 0.07 3.559 <0.01 S
AT 0.10 0.40 80 0.31 0.07 3.559 <0.01 S

Effect on Tenderness in group A
Out of 20 patients studied in Group-A Tenderness is tabulated in detail in Table 12. Statistical analysis showed that the mean score which was 0.50 before the treatment was reduced to 0.10 after the treatment with 80% improvement and there is statistically significant. (P<0.01)

Table 13: Effect of Group B on Tenderness

Parameters Mean % S.D S.E Df t-value p-value Remarks
Tenderness BT 0.60     0.50 0.11 19
D15 0.30 0.30 50 0.47 0.11 2.853 <0.05 S
D30 0.10 0.50 83.3 0.31 0.07 4.358 <0.001 HS
AT 0.05 0.55 91.67 0.22 0.05 4.818 <0.001 HS

Out of 20 patients studied in Group-B Tenderness is tabulated in detail in Table 13. Statistical analysis showed that the mean score which was 0.60 before the treatment was reduced to 0.05 after the treatment with 91.67% improvement and there is statistically highly significant. (P<0.001)

Table 14: Effect of Group A on Lichenification

Parameters Mean % S. D S. E Df t-value p-value Remarks
Lichenification BT 0.90     0.79 0.18 19
D15 0.60 0.30 33.33 0.60 0.13 2.853 <0.05 S
D30 0.10 0.80 88.89 0.31 0.07 5.811 <0.001 HS
AT 0.10 0.80 88.89 0.31 0.07 5.811 <0.001 HS

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Out of 20 patients studied in Group-A Lichenification is tabulated in detail in Table 14. Statistical analysis showed that the mean score which was 0.90 before the treatment was reduced to 0.10 after the treatment with 88.89% improvement and there is statistically highly significant. (P<0.001)

Table 15: Effect of Group B on Lichenification

Parameters Mean % S.D S.E Df t-value p-value Remarks
Lichenification BT 1.10     0.72 0.16 19
D15 0.55 0.55 50 0.60 0.14 4.818 <0.001 HS
D30 0.05 1.05 95.45 0.22 0.05 7.764 <0.001 HS
AT 0 1.10 100 0 0 6.849 <0.001 HS

Out of 20 patients studied in Group-B Lichenification is tabulated. Statistical analysis showed that the mean score which was 1.10 before the treatment was reduced to 0 after the treatment with 100% improvement and there is statistically highly significant. (P<0.001)

Table 16: Effect of Group A on Area and Intensity of the lesion

Parameters Mean % S. D S. E Df t-value p-value Remarks
Area and Intensity of the lesion BT 1.30     0.47 0.11 19
D15 1 0.30 23.07 0.46 0.10 2.853 <0.05 S
D30 0.50 0.80 61.53 0.61 0.14 8.717 <0.001 HS
AT 0.45 0.85 65.38 0.60 0.14 7.767 <0.001 HS

Out of 20 patients studied in Group-A Area and Intensity of the lesion is tabulated above.

Statistical analysis showed that the mean score which was 1.30 before the treatment was reduced to 0.45 after the treatment with 65.38% improvement and there is statistically highly significant. (P<0.001)

Table 17: Effect of Group B on Area and Intensity of the lesion

Parameters Mean % S. D S. E Df t-value p-value Remarks
Area and Intensity of the lesion BT 1.30     0.57 0.13 19
D15 0.95 0.35 26.92 0.51 0.11 3.198 <0.01 S
D30 0.40 0.90 69.23 0.60 0.13 9 <0.001 HS
AT 0.25 1.05 80.76 0.44 0.10 7.764 <0.001 HS

Out of 20 patients studied in Group-B Area and Intensity of the lesion is tabulated in detail in Table 17. Statistical analysis showed that the mean score which was 1.30 before the treatment was reduced to 0.25 after the treatment with 80.76% improvement and there is statistically highly significant. (P<0.001)


Assessment of total effect of therapy

Table 18: Overall effect of Group-A

Effect of treatment in Group - A
Class Grading No of patients %
1-25% No Improvement 0 0
26-50% Mild Improvement 1 5
51-75% Moderate Improvement 5 25
76-100% Marked Improvement 14 70

Table 19: Overall effect of Group - B

Effect of treatment in Group - B
Class Grading No of patients %
1-25% No Improvement 0 0
26-50% Mild Improvement 0 0
51-75% Moderate Improvement 2 10
76-100% Marked Improvement 18 90

Table 19: Comparative results of Group A and Group B

Group A Group B Difference SE (±) T Value P value
75.21 89.01 13.8 0.0793 5.93 P<0.001

Comparative analysis of the overall effect of the treatments in both the groups was done by statistically with Unpaired T Test.

The test shows that the treatment is statistically Group B is better than Group A. Group A overall result is 75.21% and Group B overall result is 89.01%.

Discussion

Total 40 patients were registered in this study. Out of that, all 40 patients were studied in this study. 20 patients were in group A while 20 were in B group.

Itching: All the 40 patients were presented with the complaints of itching. In group A, after first sitting itching relieved by 22% and 84% relief was found after the treatment while in group B itching was relieved by 90%. Siravyadha helped in removal of Dooshita Rakta in both the groups there by reducing itching which was due to stasis, while application of Yashada Lepa further helped in reducing itching by reducing dryness at the site and promoting healing of the lesion.

Pain: Pain was not found as a major complaint in most of the cases. Of few patients who presented with pain, in group A 80% changes was found whereas in group B 90% relief was noted. The relief in pain is because of the anti-inflammatory action.



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Discharge: Eczema can be dry or wet in nature. Yashada Bhasma has the property of Sankochana of Shleshma Kala which helps in absorbing Kledata and reduces discharge. Hence there was 100% improvement in group B treated with Siravyadha followed by Yashada Lepa.

Discoloration: In both the groups there was no considerable improvement was seen in discoloration. This may be due to shorter duration of treatment i.e., 45 days. Normally the scar healing time is 12-18 months. But the external application of Yashada Lepa has contributed to some extent, so the comparative observation was made between the groups. Group A showed 60% and group B 80% of the improvement.

Dryness: The main pathology of eczema involves dry skin. In eczema the essential fatty acid barrier is reduced which causes epidermal fluid loss resulting in dryness. Vata is the cause for the Rookshata.

Yashada Lepa has Ghrita as major proportion which helps in reducing Rookshata there by relieving itching and other symptoms.

Hence there was better results observed in patients treated with Siravyadha and Yashada Lepa (85%) compared to the patients treated with Siravyadha only (68%).

Tenderness: Tenderness was taken as the objective parameter. As mentioned above pain was not seen as the major complaint in the patients taken for this study and mild tenderness was observed in very few cases. Group A showed 80% relief while group B showed 91% relief.

Lichenification: Cases seen were with mild lichenification which occurs due to deposition of haemosiderin. In Group A, lichenification was relieved by 88.9% and in group B by 100 %

Area and severity: This particular parameter is taken from the scoring called EASI - Eczema Area and Severity Index which is specially designed for eczema. Area is measured percentage and then grading was done.

Severity includes the intensity of redness, scratching, thickness and lichenification. Average of the intensities were measured and graded.

There was no considerable relief seen under this criteria mainly discoloration,

bringing back the affected limb to complete normalcy in both the groups whereas redness, scratching and lichenification were reduced after the treatment, but the comparison was done between both the groups and observation done.

This also may be due to the shorter duration of the study, if the treatment was continued for further duration better results might have been observed.Group A 65% and Group B 80 % result was observed

Treatment of Kushta mainly involves Shodhana based on Dosha Pradhanyata followed by Shamana. As Dooshita Rakta is involved in Vicharchika and Pitta is the Pradhana Dosha, Raktamokshana, Siravyadha is selected for Shodhana of Dusta Rakta. Application of Lepa after removal of vitiated Rakta cures Vicharchika in shorter duration due to its anti-inflammatory action and also reduces burning sensation there by facilitating healing of lesions.

Discussion on mode of action

Mode of action of Siravyadha

Siravyadha is a significant therapeutic tool when judiciously administered. It is said to be half of the therapeutic measure in Shalyatantra like Basti in Kayachikitsa. Acharya Sushruta has explained in detail regarding the Sira and procedure of Siravyadha including the exact site where Vyadhana to be done in different diseases.

According to Acharya Sushruta, in Vicharchika, the vein situated 2 Angula above Kshipra Marma should be punctured using Vrihimukha Shastra. Kshipra Marma is a Snayu Marma which measures Ardha Angula Pramana. Anatomically it is located in the first intermetatarsal space and can be correlated to dorsal arch of the foot. Here the Siravyadha can be done as the veins are superficial and easily visible.

Normally the exchange of gases, nutrients and waste products between blood and tissue takes place at the capillary level. After Siravyadha, the volume loss may affect this exchange mechanism and also decreases the pressure. The low oxygen level at tissues stimulates the development of RBC’s by erythropoiesis and the volume loss will be replaced by the plasma proteins. Hence whenever there is vitiation of blood by any kind of allergens (Dosha and Dushya) that will circulate through veins and finally gets lodged in the tissues at capillary junction where blood exchanges


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its contents with the tissue. So, these allergens deposit and produce symptoms as in case of eczema. Therefore, by Siravyadha Dushta Rakta Nirharana will be done and replaced by Shuddha Rakta which nourishes the affected site thereby reducing the symptoms of Vicharchika.

Mode of action of Lepa

Lepa should be applied against the direction of hair follicles (Pratiloma Gati). This facilitates the absorption of Dravya through Romakoopa and reaches the deeper layers by Swedavaha Sira Mukhas (blood capillaries). Bhrajaka Pitta which is seated at Twak also play a role in metabolization of drugs applied. By all these factors Lepa would get absorbed in the Twak and act on the ailment.

The local application of lotion or ointments include antiseptic, antimicrobial and anti-inflammatory agents. These active principles will enter skin through percutaneous absorption which is mainly through stratum corneum layer of skin.

Yashada Lepa was made by using Yashada Bhasma and Ghrita.,

  • Yashada Bhasma has Kapha Pittahara, Vranasravarodaka, Shleshmakala Sankochaka
  • Yashada Bhasma is Kashaya and Tikta in Rasa which helps in reduction of discharge and healing of ulcer.
  • Ghrita was mixed with Bhasma in preparation of Lepa. Ghrita is both Pitta and Vatahara and is the lipid media which helps to reduce excessive dryness there by curing eczema.
  • Zinc is an anti-microbial, anti-inflammatory, anti-fungal agent.
  • Sustained release of zinc ions stimulates epithelisation of wounds.
  • Zinc oxide effective against aerobic and anaerobic pathogens.
  • Zinc has effective cell penetration, immunomodulation and antimicrobial capacity.

Thus, Yashada Lepa helps in curing the symptoms of eczema.

Comparative analysis of both the groups

Based on the above observation and results obtained, it is evident that, Group B where patients were treated with Siravyadha and Yashada Lepa got better results compared to group A.

jaims_2053_01.JPGBefore Treatment

jaims_2053_02.JPGAfter Treatment

Conclusion

Vicharchika is the disease which can be correlated to Eczema based on similarities in clinical features. Siravyadha helps in Nirharana of Dushta Rakta which reduces the pressure over affected area there by reduces the symptoms and also cures the lesions. Application of Yashada Lepa after Nirharana of Dushta Rakta by Siravyadha has given the significant results in treating Vicharchika due to its anti-inflammatory action. Statistical analysis of treatment in both groups yields results which were significant statistically. Assessment of itching, pain, discharge, discoloration, dryness and area of the lesion in Group A showed 84%, 80%, 76%,60%, 65% and 65% improvement and group B showed 90%, 90%,100%, 80%, 85% and 80% improvement respectively. Overall result of Group A was 75.21% and Group B was 89.01%. Clinically, itching was completely relieved in most of the cases after treatment in both the groups. Dryness was reduced to a marked extent in case of Siravyadha followed by Yashada Lepa application as Ghrita was in major proportion.


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In both the groups, considerable relief of discoloration was not seen which may be due to shorter duration taken for the study. Comparative analysis of the overall effect of both groups shows that Group B where patients were treated with Siravyadha followed by Yashada Lepa was more effective than group A.

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