E-ISSN:2456-3110

Case Report

Vipadika

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

Management of Vipadika through Shodhana and Shamana: A Case Study

Bhuvaneshwari.1*, Yaseen Hullur M.2, Kulkarni M.3
DOI: http://dx.doi.org/10.21760/jaims.8.3.26

1* Bhuvaneshwari, Post Graduate Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.

2 Md Yaseen Hullur, Assistant Professor, Department of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.

3 Madhusudhan Kulkarni, Associate Professor, Department of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.

All skin diseases in Ayurveda are broadly classified under the heading of Kushta (skin disorders). Vipadika is one among the Kshudra Kushta. It is characterized by Sphutanam (cracking) either in palms or soles or in both with Teevra Vedana (severe pain). Vipadika can be correlated with palmar-plantar psoriasis which is a chronic skin disease which affects palms and sole region. In the present case report a patient with complaint of dryness, scaling, itching and cracking of both palms associated with bleeding and pain since 6 months, was treated with Shodana (Virechana) and Shamana Aushadhi’s, followed by Raktamokshana has shown a significant result. Shodhana helps remove the root cause of the disease, and prevents recurrence.

Keywords: Vipadika, Virechana, Ayurveda, Raktamokshana

Corresponding Author How to Cite this Article To Browse
Bhuvaneshwari, Post Graduate Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya and Hospital, Hubballi, Karnataka, India.
Email: 		Bhuvaneshwari, Md Yaseen Hullur, Madhusudhan Kulkarni, Management of Vipadika through Shodhana and Shamana: A Case Study. J Ayu Int Med Sci. 2023;8(3):139-144.
Available From
https://jaims.in/jaims/article/view/2350

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-02-02 2023-02-04 2023-02-11 2023-02-18 2023-02-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil 19%

© 2023by Bhuvaneshwari, Md Yaseen Hullur, Madhusudhan Kulkarniand 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

Not all skin diseases are responsible for mortality but hampers day-to-day activity and due to its cosmetic issues, it depresses the patients. Researches show that the patient with skin diseases have greater impairment in mental health as compared with patients having systemic disorders like Diabetes mellitus, Hypertension etc. Billions of money is spent on the cosmetical issue every year. Ayurveda includes all the skin disorders under the broad name Kushta. There are 18 types of Kushta described in Ayurveda Samhitas. Out of which 11 are Kshudra Kushta. Vipadika is one of them. Different Acharyas have given different presentations of signs and symptoms of Vipadika. According to Ashtanga Hridaya, Panipadsputana (Cracks over palms and soles), Teevra Vedana (Intense pain), Manda Kandu (Mild itching), and Saraga Pidika (Red-colored macules) are the symptoms of Vipadika.[1] According to Acharya Charaka crack and severe pain are the symptoms of Vipadika.[2] According to Sushtruta Acharya, Itching, burning sensation and pain is present especially on Pada (sole) are the symptoms of Vipadika.[3]

This case is about a patient complaining of dryness, scaling, itching and cracking of both palms associated with bleeding and pain since 6 months. There was no previous history of any systemic disease. The patient reports eating non-vegetarian food on daily basis along with junk food. Patient was treated with Shodana (Virechana) and Shamana Aushadhi’s, followed by Raktamokshana. This has shown a significant result. Total treatment was about 16 days with a follow-up of 15 days.

Case Report

A 26-year-old male patient was admitted at Ayurveda Mahavidyalaya Hospital on 02/11/2022 in Kayachikitsa Dept. bearing IPD No. 347. Reported with dryness, scaling, itching and cracking of both palms associated with bleeding and pain since 6 months.

Chief complaint: Dryness, scaling, itching and cracking of both the palms.

History of present illness: The patient was normal 6 months back. Gradually developed symptoms like dryness, scaling, itching

and cracking in both palms associated with bleeding and pain. On examination, multiple deep fissures were present on both palms with local tenderness. According to the clinical features, the case was diagnosed as Vipadika. Clinical features indicated predominance of Vata and Kapha Dosha.

Personal history

Appetite: Moderate

Bowel: Regular

Micturition: Regular

Sleep: Disturbed

Food: Non-veg and junk food

Vital data

Pulse: 74/Min

BP: 120/80 mmHg

Respiratory Rate: 20 /Min

Weight: 78kg

Skin examination

Site: Plantar aspect of palms

Dryness, scaling, cracking and bleeding from the cracked region is seen.

Cracked skin around the fingers,

Margin: irregular

Samprapti:

Nidana Sevana (Aharaja, Viharaja, Manasika)

↓

Causes Agni Vikruti

↓

Tridosha Vikruti along with Rasa, Rakta, Mamsa, Lasika Dushti

↓

Sanga and Vimargagamana of Doshas

↓

Sthanasamshraya in Pada and Hastha

↓

Causes Vipadika Kushta.



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Nidana Panchaka

Nidana: Katu, Snighdha, Guru, Abhishyandi Ahara, Vataja Ahara.

Poorva-Roopa: Kandu

Roopa: Cracking of palms with Dryness, scaling, itching, bleeding and painful legions.

Upashaya: Application with Mahatiktaka Ghrita.

Treatment given

External application: Lepa with Khadira Aragwadha Guduchi Nimba Haridra Choorna followed by Mahatiktaka Ghrita application for 7 days.

Amapachana: Avipattikara Churna for 7 days.

Snehapana with Mahatiktaka Ghrita

Days Dosage
1st 20ml
2nd 45ml
3rd 60ml
4th 100ml
5th 120ml

Sneha Siddhi Lakshanas were seen on 5th day of Snehapana like Sneha Dwesha, Gatra Mardhava, Snighdha Gatrata, Pureesha Snigdhata etc.

Procedure Medicine Days
1. Sarvanga Abhyanga Bashpa Sweda Kharanja Taila 2 days
2. Vishrama Kala Diet: Pittaprakopakara Ahara 1 day
3. Virechana Manibhadra Guda 60gms + 20gms Total Vegas- 20  
4. Samsarjana   For 7 days
5. Raktamokshana 2 sittings (2 consecutive days) -

Shamana Aushadi (given after Samsarjana): for 15 days

1. Kaishor Guggulu 1-0-1 after food.

2. Gandhaka Rasayana 1-0-1 after food.

3. Sorsiz cream L/A

4. Sorsiz 1-0-1

Table 1: Assessment Criteria for Sphutana.

SN Clinical features Score
1.  Insignificant dryness at the foot/palms 0
2.  Roughness is present when touching 1
3.  Excessive roughness presents and leading to itching 2
4.  Excessive roughness presents and leading to slight cracks 3
5.  Roughness leading to cracks and fissures 4

Table 2: Assessment Criteria for Vedana.

SN Clinical features Score
1. No pain 0
2. Mild pain of easily bearable nature, comes occasionally 1
3. Moderate pain, but no difficulty 2
4. Appears frequently and requires some measures for relief 3
5. Pain requires medication and may remain throughout the day 4

Table 3: Observation table

SN Clinical features Before treatment After treatment After first follow up
1. Scaling of skin + + + + + + + + +
2. Fissures + + + + + + + +  
3. Itching + + + + + + +
4. Pain + + + + +  
5. Discharge (blood) + + + +  

Before Treatment

jaims_2350_01.JPGDate: 9/11/2022
jaims_2350_02.JPGDate: 9/11/2022


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After Treatment


jaims_2350_03.JPG

Date: 15/11/2022


jaims_2350_04.JPG

Date: 15/11/2022





After Follow-Up

jaims_2350_05.JPGDate: 15/12/2022
jaims_2350_06.JPGDate: 15/12/2022

Result

After the treatment symptoms reduced. The patient was advised for follow up medicine and the proper diet was explained.

Discussion

Khadira is having Krimighna, Kushtaghna, Medohara, Raktashodhaka, Kaphapittahara properties. Guduchi acts as Tridosha Shamaka, Raktashodhaka. Haridra is Krimighna, Kushtaghna, Varnya, Vishaghna, Kaphapittanut, Pramehanashaka. Nimba is Kushtaghna, Krimighna, Kandughna, Vranahara, Sula-Shopha Hara.


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The Avipattikar Churna[4] consists of Triphala (best anti-oxidant combination), Pippali, Marica, Sunti, Musta, Patra, Lavanga (anti-oxidant), Ela-patra (relieves pain and inflammation), Trivrt, Vida, Vidanga (anti-microbial drug) and Sarkara. It helps in conditions like Agnimandhya Vibhanda Prameha etc.

Mahatiktaka Ghrita[5] is useful in treating Amlapitta, Rakta Pitta, Vata Rakta, Kushta, Visarpa, Kushta, Asrigdhara. It contains drugs like Saptaparna which detoxifies and cleanses the blood, Aragvadha used for skin diseases and is a mild laxative, Patha used for skin infections, Musta corrects the digestion and metabolism, Usira Dhanvayasa Shweta Chandan does Pitta Shamana, Triphala best anti-oxidant combination, Patola purifies the blood, Varnya and relieves itching, Nimba is a good anti-inflamatory drug useful in allergic skin rashes and wound healing.

Nimbidin, Curcuminoids have Broad spectrum Antibiotic action against both Gram Positive and gram-negative Bacteria thus effectively heal Chronic Skin Ulcers, Diabetic Ulcers, and Anti-Viral action to manage Herpes infections. Nimbidin promote wound healing activity through increased inflammatory response and neovascularization heals the chronic skin ulcers and inflammatory skin lesions making it effective in various skin diseases such as furunculosis, seborrheic dermatitis[6]

Karanja Taila was used because of its Kandughna and Kustaghna properties. It is Kaphaghna and Vataghna due to its Tikta, Katu Rasa and Ushna Virya. It is also having Jantughna Vranaropana and Vedanasthapana properties[7],[8]

As Kushta is the Raktavaha Srotodusti Vikara, Virechana is the main line of treatment adopted in it. Virechana is given with Manibhadra Guda[9] contains Vidanga, Amalaki, Haritaki and Trivrut. Haritaki and Amalaki have Anulomana action and Trivrut has Virechaka Prabhava.

Acharya Charaka considers Rakta Dusti as one of the prime causes of skin diseases[10] By doing Raktamokshana it helps to remove Dushita Rakta which enables proper circulation to the tissues helping in its regeneration, relieves the pain. In case of Padadaha, Harsha, Vipadika, Vatakantaka and Chippa, Siravyadha is advised at two Angula above the site of Kshipra Marma.[11]

Kaishor Guggulu[12] is specifically indicated in Vatarakta, Vrana, and Kushtha. In one study, the anti-allergic, anti-bacterial and blood purifying properties of this Yoga was found.

Gandhaka Rasayana is extensively used in treatment of various skin disorders such as psoriasis, urticaria, eczema and wound healing, gastro-intestinal disorders and sinusitis. It is used effectively in healing of abscesses and chronic non healing wounds.[13]

Conclusion

Vipadika is Vata Kaphaja Kshudra Kushta Roga. The Rooksha Guna of Vata causes pain and severe dryness which leads to the formation of cracks. Kandu is caused by Kapha Dosha. Daha due to Pitta Dosha. The Dharana of Mamsa and Twak leads to Rakthasrava and Sputana as it lies above the Mamsadhara Kala. Mansika Chikitsa and Nidana Parivarjana plays important role in the treatment as it stops the further progression of the disease by restricting Dosha vitiation. In the present case, the patient followed Kushta Nidanas like Viruddhahara Sevana, Adhyashana, Ati Mamsa Sevana etc. This case study shows that Vipadika can be managed through Ayurvedic treatment. Virechana as Shodhana therapy followed by Raktamokshana and Shamana Aushadhi’s are effective in the treating of Vipadika like skin disorders.

Reference

1. Brahmanand Tripathi. Ashtanga Hridayam of Shrimadvagbhata; ‘Nirmala’ Hindi Commentary, Nidana Sthana, 14-23, Chaukhamba Sanskrit Pratishtan; P no. 530.

2. Acharya Vidyadhar Shukla, Ravi Datta Tripathi. Charaka Samhita of Agnivesha; ‘Vaidyamanorama’ Hindi Commentary; Chikitsa Sthana, 7-22, Chaukhamba Sanskrit Pratishthan; Vol II; 184.

3. Anant Ram Sharma. Sushruta Samhita of Maharshi Sushruta; ‘Sushrutavimarshini’ Hindi Commentary; Nidana Sthana, 1/ 5-13 Chaukhamba Surbharati Prakashan, 496.

4. Govind Das. Bhaishajya Ratnavali, Edition Reprint 3rd, Chaukambha Prakashan, Varanasi 2013, chapter 56 verse 25-29 Pg. no. 922.

5. Tripathi B. Ashtang Hriday. ed.2014, Choukhamba sanskrut pratishthan. Chapter 19th, 783p


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6. https://sahasrayogam.com/products/softgel-capsules/mahatiktaka-ghritam-saptavarti/

7. Rao P. Bhaishajya Kalpana Vigyan. Edition-2008, Chaukhambha Sanskrit Sansthan, 13/44,328p

8. Jakhotiya Y, Kuchewar V. Ayurvedic management of palmoplantarpsoriasis. A case study. J of Ayurveda and Hol. Med (JAHM) 2017.5(2); 59-64p

9. N Nitheshwer. Manibadra Guda-Lehya Prakarana Sahasrayogam, Text with English translation Chowkhamba Sanshkrith Series Office Varanasi page no. 256.

10. Aacharya Vaidya Jadavaji Trikamji. editor. Vol. 24. Varanasi: Chaukhamba Sanskrit Sansthan; 1990. Charaka, Charakasamhita, Sutrasthana, Vidhishonitiya Adhyaya; p. 12

11. Lalita Gaonkar, Gururaja H, Jeejo Chandran O. A comparative clinical study of classical and non-classical Siravyadha in Vipadika. J Ayurveda Integr Med Sci 2019; 4:10- 15. http://dx.doi.org/10.21760/jaims.4.4.2

12. Lather A, Gupta V, Bansal P, Sahu M. An ayurvedic polyherbal formulations of kaishor guggula - a review 2011, Journal of IJPBA.28.jan.2018, 2(1), 497- 503p

13. Shetty P, Kedukodi P, Kamath S. et.al. Gandhaka rasayana: possible role as a modulator of fibroblast cell function in wound healing. Int J Health Sci Res. 2020; 10(6):36-45.


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