E-ISSN:2456-3110

Case Report

Vicharchika

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 5 May
Publisherwww.maharshicharaka.in

Effect of Virechana and Raktamokshan in Vicharchika: A Single Case Study

S. Khandalikar S.1*, R. Murade H.2, G. Kengale P.3
DOI: http://dx.doi.org/10.21760/jaims.8.5.47

1* Sandeep S. Khandalikar, Associate Professor, Department of Sanskrit Samhita, Government Ayurved College, Baramati, Pune, Maharashtra, India.

2 Harshali R. Murade, Professor & HOD, Department of Sanskrit Samhita, Government Ayurved College, Baramati, Pune, Maharashtra, India.

3 Priyanka G. Kengale, Assistant Professor, Department of Sanskrit Samhita, Government Ayurved College, Baramati, Pune, Maharashtra, India.

Skin protects us from various external invasions. Skin is largest organ and is exposed to disease and injury. Kushtha in Ayurveda represent all skin diseases. It is one among the Ashtaumahagad. There are two main types of Kushtha i.e., Mahakushtha and Kshudra Kushtha. Vicharchika (Kshudra Kushtha) is characterized by symptoms like Pidika, Kandu, Raktavarna or Shyavata, Vedana, Strava or Rukshta etc. All Kushtha are Tridoshaj the Pradhan Dosha involved in Vicharchika is Pitta. Virechana and Raktamokshana is indicated in treatment of Pittaja and Raktaja Vyadhi. A case study of patient of Vicharchika treated by Virechana and Raktmokshan along with Shamana Chikitsa is presented.

Keywords: Skin, Raktamokshan, Virechana, Panchakarma, Jalaukavacharan, Eczema

Corresponding Author How to Cite this Article To Browse
Sandeep S. Khandalikar, Associate Professor, Department of Sanskrit Samhita, Government Ayurved College, Baramati, Pune, Maharashtra, India.
Email: 		Sandeep S. Khandalikar, Harshali R. Murade, Priyanka G. Kengale, Effect of Virechana and Raktamokshan in Vicharchika: A Single Case Study. J Ayu Int Med Sci. 2023;8(5):271-274.
Available From
https://jaims.in/jaims/article/view/2372

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-01 2023-04-04 2023-04-11 2023-04-18 2023-04-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2023by Sandeep S. Khandalikar, Harshali R. Murade, Priyanka G. Kengaleand 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].

Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)271
Khandalikar S et al: Effect of Virechana and Raktamokshan in Vicharchika

Introduction

Skin is the outer covering of our whole body. In Ayurveda skin is known as Sparshanendriya. It protects the surface of the body from heat cold and external infection. Vicharchika is a type of Kshudra Kustha with symptoms Kandu (Itching), Srava (discharge), Pidika (vesicle) and Shyav Varna (discoloration). All skin diseases are included under the Kushtha and are classified into Mahakushta and Kshudrakushta. Vicharchika is described under Kshudrakushta. The clinical presentation of Vicharchika is similar to Eczema in modern dermatology. Eczema (atopic dermatitis) is characterized by dry, itchy skin with areas of poorly demarcated erythema and scale. In the acute phase, Eczema may be vesicular and oozing; in the chronic phase, it may become hyperpigmented and thickened.

Causes of Vicharchika

  • Viruddha Aahar (incompatible diet)
  • Drava, Snighdha, Guru Aahar (liquid, oily and heavy food intake)
  • Chardi Vega Dharan
  • Vyayam immediately after having food
  • Intake of cold water after fear, hard work and after sitting in
  • Eating even having indigestion
  • Improperly following Panchakarma
  • Daily intake of freshly cultivated grains, curd, fish, salt and
  • Intake of Kapha Vardhak Ahara in excess like Urad, Mooli, Guda, Milk
  • Sexual intercourse during indigestion
  • Divaswap (Sleeping during day)
  • Disrespect of the respectable (Brahmin, Guru )
  • Atisweda (excessive sweating)
  • Aswedan (no sweating)

Purva Rupa (prodromal symptoms) of Vicharchika

  • Atisweda (excessive sweating)
  • Aswedan (no sweating)
  • Twakparushya (hard and dry skin)
  • Akasmat Romharsha (tingling sensation)
  • Vaivarnya (discolouration)
  • Kandu (itching)
  • Suptata (numbness)
  • Sparshgyananash (no sensation)
  • Kotha (eruptive rashes)
  • Twak Shotha (inflammation in the skin)
  • Shrama (easy fatigue)
  • Klama (fatigue)
  • Wound healing delayed
  • Discoloration of blood

Differential diagnosis of Eczema

  • Chronic inflammatory skin diseases (Chronic inflammatory skin diseases, contact dermatitis, Seborrhoeic dermatitis, Psoriasis, Lichen simplex chronicus)
  • Infectious agents (Candida, Dermatophytes, Herpes simplex, Staphylococcus aureus, Sarcoptes scabiei)
  • Immunologic disorders (Dermatitis herpetiformis, Pemphigus foliaceus, dermatomyositis)
  • Congenital disorders
  • Nonallergic reaction to medication
  • Metabolic Diseases (Phenylketonuria, Tyrosinemia, Zinc deficiency, Pyridoxine (Vitamin B6) and niacin
  • In Ayurvedic aspect Vicharchika is to be differentiated from Kapal, Audambar, Mandal, Rishyajeeva, Pundreek, Sidham, Kaknaka, Ekkushtha, Charmakhya, Kitibh, Dadrumandal, Charmdal, Pama, Visphotak Kushtha.

Lakshana (Symptoms of Vicharchika)
Sa Kandu Pidika Syava Bahu Srava Vicharchika || (Cha.Chi.7/26)

Rajyo Atikandu Atiruja Sa Ruksa Bhavanti Gatresu Vicharcikayam || (Su.Ni.5/13)

The classical symptoms of Vicharchika are Rakta and Shayav Varna (Red and Black discoloration), Pain, Kandu (itching), Bahusrava (Secretions).

Case Report

Clinical findings & History

Name - ABC


Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)272
Khandalikar S et al: Effect of Virechana and Raktamokshan in Vicharchika

Age - 48 years, Male

Occupation - Officer in a Bank

Complaints - Itching, oozing, pain, and redness in both legs for 6 months

Pulse - 84/min

BP - 116/80 mmHg, Nondiabetic.

Family history - No significant illness

Assessment Criteria
The symptoms of Vicharchika were categorized according to intensity

Symptoms - Rakta Varna, Kandu, Vedana, Strava

Assessment - Atyadhik - 3, Madhyam - 2, Alpa - 1, Normal - 0

Timeline chart of treatment

Symptom BT 2 mths 4 mths 6 mths 9 mths 1 yr 2 yrs 3 yrs
Rakta Varna 3 3 3 3 2 1 0 0
Kandu 3 3 3 2 2 1 1 0
Strava 3 2 2 1 0 0 0 0
Vedana 3 2 2 2 1 0 0 0

Internal Medicine

  1. Kaishor Guggulu - 2 tablets thrice a day after meal (for 2 years)
  2. Haridrakhand Churna - 3 gm twice a day (for 2 years)
  3. Arogyavardhini Vati - 2 tablets after meal twice a day (for 1 month)

External Medicine
Triphala Kwatha for Dhavana (cleaning the lesion)

Shatdhaut Ghrut for local Application and alternatively Karanj Tailam for local application

Shodhan Chikitsa

Vamana - Sneha-Sweda Purvak Vaman was given followed by Sansarjan Krama. Samyak Vamana Lakshan were observed.

Virechana - Sneha-Sweda Purvak Virechana was given followed by Sansarjan Krama.

Virechana was given every month for six months.

When the symptoms of disease showed improvement then Virechana was given once a year in Sharad Ritu.

Raktamokshana - Jalaujavacharana was performed every month for 3 months.

Vitiated Dosha and Dushya of Vicharchika

Vicharchika has the involvement of Tridosha, with Kapha predominant Dosha.

Twak, Rakta, Mansa and Lasika are the four Dushyas of Vicharchika (mainly Rakta)

It is also included in Raktapradoshaja Vikaras.

Discussion

Kushtha is Tridoshaj Vyadhi with Twak, Rakta, Mansa, Lasika as four Dushyas. So, the treatment in Vicharchika was planned to target Kapha Dosha by Vaman. Virechan every month for 6 months and then once a year in Sharad Ritu was performed to remove vitiated Pitta and Kapha Dosha. Raktamokshan was performed to achieve Raktashuddhi as Rakta is one of main Dushya. Externally washing with Triphala Kashaya helps in Kledashoshana, reduces Srava & Shotha from local area. After washing, local application of Shata Dhaut Ghrut and Karanj Tailam was administered. Lepa provides highest drug concentration at the site of action so it is essential. Shatdhaut Ghrita is used as externally for Daha Shamana, and to reduce infection. Kaishor Guggul cures Medodusthi, it helps to improving digestion & removing toxins. It has anti-bacterial, anti-inflammatory, anti-oxidant, anti-microbial property which helps in treating wounds. Haridra Khanda is useful in allergic skin manifestations especially in urticaria, eczema. Aaragwadhadi Varga is useful skin disorders, itches & ulcers.

jaims_2372_01.JPG

Before Treatment


Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)273
Khandalikar S et al: Effect of Virechana and Raktamokshan in Vicharchika

jaims_2372_02.JPG
Jalaukavacharanajaims_2372_03.JPGAfter Treatment

Conclusion

Shodhan Chikitsa (Panchakarma) as described in classic text plays significant role in disease management and Apunarbhava of disease. Shamana Chikitsa (Internal and External) in Vicharchika is found effective. Pathya plays important role in speed of recovery and Apunarbhava of disease. Ayurvedic management provides significant relief & improves the quality of life of Vicharchika patient.

Reference

1. Shastri Kashinatha, Chaturvedi Gorakhanath ed. Charaka Samhita-2, Chikitsasthana, 7/26, chaukhambha bharti academy, Varanasi, reprint. 2012, 252

2. Shastri Ambikadatta. Sushruta samhita, Nidanasthan, 05/13, Chaukhamba Sanskrit Sansthan, Varanasi, reprint, 2008, 322

3. Tripathi Brahmanand. Astanga Hridaya. Nidanasthana 14/7-10, Chaukhamba Sanskrit Pratishthan, Varanasi, reprint. 2011, 528

4. Tripathi Brahmanand. Astanga Hridaya, Nidanasthana 14/3, Chaukhamba Sanskrit Pratishthan, Varanasi, reprint. 2011, 527

5. Shastri Kashinatha, Chaturvedi Dr. Gorakhanath ed. Charaka Samhita-2, Chikitsasthana, 7/09-10, Chaukhambha Bharti Academy, Varanasi. reprint. 2012, 248

6. Mahadevan L. Ayurvedic Dermatology & Venereology, Chapter-8, Analysis of Vicharcika, Sarada Mahadeva Iyer Ayurvedic Educational & Charitable Trust, Kanyakumari, Second Edition, June 2018, ISBN978-81-922529-3-3, Page no. 121.

7. Differential Diagnosis of Atopic Eczema, B. Wedi, A. Kapphttp://eknygos.lsmuni.lt


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