Virechana Karma in Eczema (Kshudra Kushtha) : A Case Study

Pallavi Bhagwat Rathod; Seema D. Bahatkar

Virechana Karma in Eczema (Kshudra Kushtha) : A Case Study

Bhagwat Rathod P.^1*, D. Bahatkar S.²

DOI:

^1* Pallavi Bhagwat Rathod, Final Year PG Scholar, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.

² Seema D. Bahatkar, Professor and HOD, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.

Panchakarma therapy aims at the elimination of excessive Doshas from the body to maintain the state of health for a longer duration, while the Shamana therapy is for suppression of vitiated Doshas within the body. Virechana is one of the Panchakarma therapy. Virechana is the bio-purification procedure of Ayurveda when Doshas are expelled out from the body through the anal route then it is called Virechana. Normally, after Virechana Karma, patient does not complain of having any untoward like those present after diarrhea due to dehydration. Thus, Virechana Karma is one of the important bio-purificative method which is indicated for complete elimination of Doshas and thus result in eradication of diseases. Patient was treated with Shodhana in the form of Virechana Karma followed by oral medication. The patient reported symptomatic improvement.

Keywords: Panchakarma, Shodhana, Shaman

Corresponding Author	How to Cite this Article	To Browse
Pallavi Bhagwat Rathod, Final Year PG Scholar, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India. Email:	Pallavi Bhagwat Rathod, Seema D. Bahatkar, Virechana Karma in Eczema (Kshudra Kushtha) : A Case Study. J Ayu Int Med Sci. 2022;7(10):276-279. Available From https://www.jaims.in/jaims/article/view/2054

Introduction

Skin is the largest organ of the body which acts as barrier between the internal tissue and the external environment. In Ayurveda, Panchakarma Chikitsa which has satisfactory treatment for various chronic autoimmune metabolic disorders. On one side and other hand it is gaining global recognition for its preventive and promising effect. To study the treatment of Kushtha systematically it is necessary to look at three principles of treatment which are described in Krimi Chikitsa i.e., Samshodhana, Samshamana and Nidana Parivarjana^[1] separately. All Acharya’s have emphasized Shodhana therapy in the management of Kushtha. The therapy which expels out morbid Doshas from the body is known as Shodhana. By the nature, Kushtha is difficult to cure disease so it is Called ‘Duschikitsya’.^[2] But the application of Shodhana therapy; cure of the disease become easier due to removal of root cause hence, Shodhana has great importance. Shodhana may be administered based on predominance of vitiated Dosha. In Ayurveda skin diseases are considered under the entity of Kushta. Kushtha is also Rakta-Pitta Pratoshaj Vikara.^[3] Virechana karma is indicated in Kushtha.^[4] Hence, patient was treated with classical Virechana Karma followed by oral administration of Shamana Aushadhi such as Kaishor Guggulu, Arogyavardhini Vati, Panchatikta Ghrita, Mahamanjishtadi Kwatha, Sukshma Triphala.

Single Case Study

A male patient aged 55 years came to OPD No. 15 of Panchakarma department of M. A. Podar Hospital, Mumbai having complaints of Ubhaya Hasta Pada Twaka Krushna Vaivarnya, Kandu, dryness on affected area, skin eruption on both palms in the last 3 years. Patient gets depressed due to difficulty in doing routine work. Patient taking allopathic medicines since 6 moths but again there is a relapse of symptoms.

History of present illness

Ubhaya Hasta-Pada Twaka Krushna Vaivarnya,
Kandu,
Dryness on affected area,
Skin eruption on both palms.

Patient gets depressed due to difficulty in doing routine work.

Patient taking allopathy medicines since 6 moths but again there is a relapse of symptoms.

Occupational history - Nil

Family History - Not significant.

General Examination

Pulse - 78/min

Blood Pressure - 120/80mm of hg

Examination

Cardiovascular System - Normal

Respiratory System - Normal

Per Abdomen- Normal

In Ayurveda

Dosha - Pitta-Kapha

Dushya - Rasa-Rakta, Mamsa, Twaka

Agni - Mandagni

Adhisthana - Twaka, Rakta, Mamsa, Lasika

Vyaktasthana -Twaka

Srotas Dushti Lakshana

Rasavaha - Aruchi, Asyavairasya, Krishangata

Raktavaha - kustha, Pidaka.

Udakavaha -Trishna, Mukhashosha.

Annavaha - Anaannaabhilashnama, Arochaka.

Swedavaha - Twakaparushya.

Examination of Lesion

Shape - Irregular

Distribution area - Exposed area

Border - Diffused

Spreading pattern - Symmetrical

As per Ayurveda Krushna Varna, Khara Sparsha.

Management

Virechana Karma

Preparation of the Patient includes Dipana, Pachana, Snehapana Sarvanga Snehana, Swedana, administration of Virechana Yoga.

a. Dipana and Pachana: Dipana Pachana was done with Aampachaka Vati 500 mg BD and Triphala + Mushta + Shunthi Kwatha for 5 days, till the Niramalakshana appear.

b. Abhyantar Snehapana: Snehapana was done with Panchatikta Ghrita, after complete digestion of previous day diet it was administered in higher dose every day in early morning depending upon Agni and Koshtha for a period 7 days, till the Samyak Snigdha Lakshana appears.

Table 1

Days	Dose
1	30 ml
2	60ml
3	90ml
4	120ml
5	150ml
6	180ml
7	210ml

Patient is advised to take warm water for drinking and to avoid exposure to excessive wind, sunlight, emotional exacerbation etc.

c. Sarvanga Snehana and Swedana
After Samyak Snigdha Lakshana appears a gap of three days was given prior to administration of Virechana Yoga and during these days Sarvanga Snehana followed by Swedana was carried out.

d. Diet during Vishramakala
Diet containing Jangala Mamsa Rasa. Yusha with Snigdha, Laghu, Ushna quality and Kapha Avriddhikara Ahara. According to Sushruta, on the previous day of Virechana Laghu Ahara, Phalamla, Ushnodaka^[5] should be given.

Virechana Yoga
Trivritta Avaleha^[6] 70 gm

Virechanopaga Dravya - Manuka Phanta Muhurmuha.

Total 17 Vega on administration of Virechana Yoga, it was Kaphant Virechana, patient felt lightness in the body, Kshudhapravritti.

Paschat Karma: Samsarjana Krama specific diet schedule was followed for 5 days according to Shuddhi.

Shamana Aushadhi
1. Kaishor Guggulu^[7] 500mg BD

2. Arogyavardhini Vati ^[8] 500mg BD

3. Haridra Khanda 5 gm

4. Mahamangisthadi Kwatha 20ml

5. Gndhak Rasayana 250mg BD

Discussion

Kushtha is always originating due to provocation of all three Doshas and Dushit Twaka, Rakta Dhatu, Mamsa Dhatu, and Sharirastha Jaliya Ansha.^[9] Charaka opines at this context that most dominant symptoms of the Dosha should be tackled first and later the associated symptoms and their causative dosha should be treated.^[10] Kushtha has specific Nidana hence Nidanparivarjan is the first step of Chikitsa, the patient is master mason, had regular contact with different chemicals, during treatment patient strictly avoid contact with such chemicals, which are Agantuj Hetu may help to restrict basic pathogenesis of the diseases. On the basis of symptomatology, the present case is considered as Kshudra Kushtha with Pitta Dosha Pradhanya and Kapha Dosha Anubandha, Virechana Karma is indicated in Kushtha, Virechana pacify vitiated Pitta Dosha and also help in eliminating vitiated Kapha Dosha, also corrects Dushit Rakta Dhatu, causes Valanulomana, Srotoshodhana, thus burning sensation, pus formation itching, pian were reduced. Oral administration of Shamana Aushadhi which are Raktapitta Shamaka Varnaprasadak and also work as Rasayana which help to cure disease and also restrict relapse of symptoms.

Eczema or dermatitis is inflammation with spongiosis. Spongiosis is intercellular oedema in the epidermis. This is accompanied by perivascular lymphatic infiltrate.^[11] Virechana is basically cleansing in nature it clears channels of transportation. Lots of fluid will be excreted which may help to reduce oedema by eliminating inflammatory mediator thus symptoms get reduced.

Fig.1: Before treatment

Fig. 2: After treatment

Result

1. Lesions were completely resolved

2. Marked Relief found in burning sensation and itching.

3. No pain in affected area.

4. No relapse of skin eruption on both palm and other symptoms.

5. Redness, dryness and itching on both upper limb and face was completely corrected.

Conclusion

It can be concluded from present case study that Virechana Karma followed by Shamana Aushadhi is highly effective in the management of chronic eczema (Kshudra Kushta).

Reference

1. Agnivesha, Charaka Samhita Ayurveda Dipika commentary of chakrapanidatta, by kashinath Shastri, vimanasthana 7/15. chaukhambha prakashan, Varanasi, p- 700

2. Sushruta samhita, by Ambika Datta Shastri, chikitsasthana, 9/63 chaukhambha prakashan, Varanasi, p-70

3. Agnivesha, Charaka Samhita Ayurveda Dipika commentary of chakrapanidatta, by kashinath Shastri, sutrasthana 24/18. chaukhambha prakashan, Varanasi, p- 550

4. Agnivesha, Charaka Samhita Ayurveda Dipika commentary of chakrapanidatta, by kashinath Shastri, chikitsasthana 7/40. chaukhambha prakashan, Varanasi, p- 376

5. Sushruta Samhita, by Ambika Datta Shastri, chikitsasthana, 33/19 chaukhambha prakashan, Varanasi, p-245

6. Vagbhat Samhita, Ashtanga Hrudaya, kalpasiddhisthana; virechana kalpa adhyaya.

7. Trivritshyama kalpa 2/9 edited by Brahmanand Tripathi, chaukhambha sanskrit prakashan, Delhi.

8. Sharangdharacharyavirchita, Sharangdhar Samhita, vatak- kalpana 7” addhaya (shloka No 70-81) Madhyamkhanda annoted with Dipika Hindi Commentary by Brahmananda Tripathi, Chaukhambha Surbharti Prakashana, Varanasi.

9. Sharangdharacharyavirchita, Sharangdhar Samhita, Asavarishtakalpana 10 addhaya (shloka no 62-67) Madhyamkhanda annoted with Dipika Hindi Commentary by Brahmananda Tripathi, Chaukhambha Surbharti Prakashana, Varanasi.

10. Agniveshapranita Charaka Samhita Chikitsasthana kusthachikitsa addhyaya 7/97/31-32 edited by Rajeshwardatta Shastri, Chaukhambha Bharti Academy. Varanasi.

11. Concise pathology by Geetika khanna, section First. The Skin chapter no.22. Elsevier private Limited.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-09-29	2022-10-01	2022-10-08	2022-10-15	2022-10-22
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Eczema

Journal of Ayurveda and Integrated Medical Sciences