Ayurvedic management of Vicharchika (Eczema) - A Case Report

Dija T Lawrence; R J Anand; K J Girish; Tapas Brata Tripaty

doi:http://dx.doi.org/10.21760/jaims.8.6.37

Ayurvedic management of Vicharchika (Eczema) - A Case Report

T Lawrence D.^1*, Anand R.², Girish K.³, Brata Tripaty T.⁴

DOI: http://dx.doi.org/10.21760/jaims.8.6.37

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

² R J Anand, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

³ K J Girish, Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

⁴ Tapas Brata Tripaty, Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Eczema is a reaction pattern manifested by variable clinical and histologic findings. Primary lesions may include papules, erythematous macules and vesicles which can coalesce to form patches and plaques. In severe eczema, secondary lesions such as weeping and crusting may predominate. Eczema has quite resemblance with Vicharchika in Ayurveda. Vicharchika is characterized by skin manifestation having the symptoms Kandu (Itching sensation), Pidika (Papule), Shyava Varna (Blackish brown discoloration) and Bahusrava (Excessive exudation). Case summary: A 62 year old male patient approached with chief complaints of diffuse scaly skin lesions over face, upper limbs, lower limbs, abdomen and flanks associated with severe itching and serous discharge since 8 months. The Ayurvedic diagnosis was made as Vicharchika (Eczema) on the basis of signs and symptoms. The patient was given with Raktha Shodhaka and Kushtahara Shamana Aushadis (Oral medications) along with Parisheka (Sudation by shower sprinkling) with Sidharthaka Snana Choorna as Sravahara line of management. Later on Sadyovirechana was administered for Koshta Shudhi. From the 7th day Abhyanga (Oil massage) was started and on 11th day of treatment Siravyadha (Bloodletting) was done. Significant improvement was observed after 14 days of treatment in terms of EASI Score. This case study shows that Ayurvedic treatment is helpful in effective management of Vicharchika and helps in improving the quality of life.

Keywords: Eczema, Vicharchika, Parisheka, Abhyanga, Siravyadha, Case report

Corresponding Author	How to Cite this Article	To Browse
Dija T Lawrence, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India. Email:	Dija T Lawrence, R J Anand, K J Girish, Tapas Brata Tripaty, Ayurvedic management of Vicharchika (Eczema) - A Case Report. J Ayu Int Med Sci. 2023;8(6):240-244. Available From https://jaims.in/jaims/article/view/2440

Introduction

The terms Eczema and Dermatitis are synonymous. The histologic features of dermatitis have been divided into three patterns: acute, sub-acute and chronic. Acute dermatitis shows a mixture of epidermal vesiculation, and a mononuclear cell infiltrate. Chronic dermatitis demonstrates epidermal acanthosis, hyperkeratosis, upper dermal fibrosis, and a predominantly perivascular mononuclear cell infiltrate. Mixtures of these two histologic reaction patterns occur in sub-acute dermatitis.^[1] Allergic contact dermatitis is an immunologic reaction to an allergen which comes into contact with skin. Dermatitis was estimated to affect 245 million people (3.34%) of world population. About 10-20% of the general practice includes the patients suffering from skin disorders and eczema accounts for a very large population of all the skin diseases.^[2]

Vicharchika (Eczema) is one among the Kshudra Kushta (Minor skin disorder). Vicharchika is characterized by skin manifestation having the symptoms Kandu (Itching sensation), Pidika (Papule) Shyava Varna (Blackish brown discoloration) and Bahusrava (Excessive exudation).^[3] There is no specific description available in Samhita regarding the line of management of Vicharchika. Hence the treatment is to be carried out according to the predominance of Dosha. The treatment should be planned on the basis of Roga and Rogi Bala (Strength of disease and patient).

Patient information

A 62 year old male patient visited Kayachikitsa Outpatient department of SDM Hospital, Hassan on 10/9/22 with complaints of diffuse scaly skin lesions over face, upper limbs, lower limbs, abdomen and flanks associated with severe itching, watery discharge, burning sensation and puffiness of face since 8 months. Clinical sign and symptoms like Kandu (Itching sensation), Pidika (Papule) Shyava Varna (Blackish brown discoloration) and Bahusrava (Excessive exudation) were present. He had taken treatment from general physician but found no relief, then he came here for further management.

Associated Complaints

He had disturbed sleep due to itching and burning sensation.

Habits: taking curd, milk (Twice a day), Spicy, oily food, Tea (3 times/day) and smoking (4 beedis/ day).

Past History

No h/o Diabetes mellitus/Hypertension, other major medical and surgical history.

Family History

No relevant family history.

Psychological Evaluation

Patient was in stress due to disturbed sleep, burning sensation and itching.

Clinical Findings: Vital signs were normal. The sleep of the patient was disturbed due to itching. On Integumentary system examination, distribution of the skin lesion was over the face, upper and lower limbs, abdomen and flanks. Type of lesion was papules, vesicles and scaly lesions. The colour was blackish associated with rough surface and serous discharge.

Laboratory parameters

Hb: 14.2 gm%, E.S.R: 20 mm/hr, Eosinophils: 6%, AEC: 625 cells/cmm.

Timeline

Table 1: Timeline

Date	Relevant medical history
January 2022	Acute onset of skin lesion over neck associated with itching
January 2022	Gradual development of skin lesions over other body parts
February 2022	Severe itching and burning sensation started
March 2022	Disturbed sleep due to itching
April 2022	Started allopathic treatment (Corticosteroids and ointment)
August 2022	Symptoms reappeared
September 2022	Consulted in outpatient department of SDM Hospital and admission advised.

Diagnostic Assessment

Sroto Pareeksha : Raktavaha Srotas

Symptoms - Daha (Burning sensation), Panduta (pallor), Vyangha (pigmentation), Kotha (Skin eruptions).^[4]

Diagnosis - Sravi Vicharchika (Eczema Contact )

Kandu (Itching sensation), Pidika (Papule), Shyava Varna (Blackish brown discoloration) and Bahusrava (Excessive exudation)

Therapeutic intervention

Table 2: Intervention

Date	Oral medication and procedure	Dose
10/9/22	1. Punarnava Mandoora Tablet 2. Patola katurohinyadi Kashaya 3. Triphala Tablet 4. Six-C ointment 5. Eladi soap 6. Ganji as diet	2-0-2 Before food 30ml-0-30ml Before food (with warm water) 0-0-1 After food External application External application
11/9/22	1 to 6 and 7. Sarvanga Parisheka with Sidhartaka Snana Choorna Kashaya
12/9/22	7 and 8. Sadyovirechana - Trivrit Lehya + Draksha Kashaya	50 gm + 100ml No of Vegas - 6
13/9/22	2,4,5,7 and 9. Tablet Gandhaka Rasayana DS	1-0-1 After food
14/9/22	2,3,4,5,7,9 and 10.Tablet Arogya Vardhini	2-0-2 Before food
15/9/22	2,3,4,5,7,9,10	-
16/9/22	9,10 11. Sarvanga Abhyanaga with Marichadi Taila + Sarvanga Parisheka by Sidhartakasnanachoorna Kashaya 12. Sidhartaka Snanachoorna Lepa 13. Panchatikta Guggulu Ghrita 14. Mahatiktakalepa	External application 20ml with warm water-empty stomach. External application
17/9/22	9 to 14.
18/9/22	9 to 14 and 15. Aragwadadhi Kashaya 16. Nimbaamritadi Eranda Taila	30ml-0-30ml Before food 10ml bed time with warm water
19/9/22	9 to 16
20/9/22	9 to 16 and 17. Siravyadha	60 ml of blood obtained
21/9/22 to 23/9/22	9 to 16
23/9/22	Discharged the patient with following medicines: 1. Panchatikta Guggulu Ghrita 2. Khadira Arishta 3. Shiva Gutika 4. Marichadi Taila 5. Nalpamaradi Taila 6. Mahatiktaka Lepa	15 ml Before food – Empty stomach 20ml-0-20ml After food 1-0-0 After food External application Before bath External application After bath External application

Outcomes

Table 3: Outcomes

Parameter	Before treatment	In between the treatment (7th day)	After 14 days of treatment
Kandu (Itching sensation)	Present	Reduced	Absent
Pidika (Papule)	Absent	Absent	Absent
Shyavavarna (Blackish brown discoloration)	Present	Present	Reduced
Bahusrava (Excessive exudation)	Present	Reduced	Absent
EASI Score	39.8	36.8	30.8

Figure 1 (a,b&c): Picture showing before the intervention of caseFig. 2 (d,e&f): Picture showing after the intervention of case

Figure 2 (d,e&f): Picture showing after the intervention of case

Discussion

The Ayurvedic diagnosis was made as Vicharchika (Eczema) on the basis of signs and symptoms. The patient was given with Parishekasweda (Sudation by shower sprinkling), Abhyanga (Oil massage), Sadyovirechana (Purgation therapy), Siravyadha (Bloodletting) and Shamana Aushadhis (Oral medications).

The Swedana Karma is a part of Purvakarma of Panchakarma along with the Snehana Karma. Sidarataka Snana Choorna^[5] is Tikta Kashaya Rasa Pradhana.

It possess Sheeta Virya and Vata Kaphahara properties. Sidarataka Snana Choorna Yoga is Varnakara, Kandughna and Twakdoshahara. After proper Swedana, it helps the development of Mriduta (Softness), Laghuta (lightness) and Agnideepti (increase of digestive power) of body. Through Snehana the Dhathus and obstructed Dosha are moistened and on application of Swedana they are mobilized flows towards Koshta and accumulates in Koshta, which are later removed from the body through Shodhana process.^[6]

Marichadi Taila is Kapha Samaka, Ushna Virya, Teekshna, Ruksha, Kushtaghna and Kandughna.

Virechna is useful in in Pitta dominant disorders along with Kapha Sansrista Doshas and Pitta Sthanagata Kapha.^[7]

The Patient was not ready for Snehapana and considering his age also we planned for Sadyovirechna. The Trivrit is Kashaya, Madhura in Rasa, Ruksha and Katu in Vipaka. It is Kapha Pitta Nasaka. When administered along with other Dravya it becomes Tridosha Shamaka and Sarvarogahara.

In Shalyakarma the Siravyadha treatment is considered as the half treatment. Siravyadha is a procedure of Raktamokshana. Vicharchika is a Raktha Pradoshaja Vyadhi. Hence Siravyadha helps in expelling out the Dushta Raktha from the body.

Patola Katurohinyadi Kashaya possess Tikta Rasa, Ruksha Guna, Kapha Pittahara properties. It acts as Kanduhara, Rakta Shodaka, Varnya and Kushtaghna. Gandhaka Rasayana is Katu Tikta Kashya Rasa, Kapha Hara, Kandughna and Kushtaghna. Arogyavardhini Vati is Tikta Kashaya Rasa, Ushna Virya, Tridoshahara, Pachana, Rakta Vardhaka, Rasayana and Kushtahara. Punarnava Mandoora is Tikta Rasa, Katu Vipaka, Sheeta Virya, Kapha Vatahara and Raktavardhaka.

Aragwadhadhi Kashaya is Kaphahara, Dahahara and Kandughna. Pancha Tikta Guggulu Gritha is Tikta Rasa, Vata Pittahara, Katu Vipaka, Kapha Vatashamaka and Kandughna. Mahatiktaka Lepa is Vata Pittahara, Dahaghna and Shyavahara.

Significant improvements were observed after 14 days of treatment in terms of itching, skin lesion and serous discharge.

Conclusion

Vicharchika (Eczema) is relapsing disease. In present study the patient was given with Parisheka Sweda (sudation by shower sprinkling), Abhyanga (Oil massage), Sadyovirechana (Purgation therapy), Siravyadha (Bloodletting) and Shamana Aushadhis (Oral medications) were found to be effective in the management of Eczema. Present observation and approach definitely boost up the new researcher scholar to manage this condition and do further studies.

Patient Perspective: Patient was satisfied with the treatment in terms of reduced itching, burning sensation, exudation and improved sleep.

Patient Consent: Written permission for the publication of this case study has been obtained from the patient.

Reference

1. Robert A Swerlick, Thomas J Lawley. Eczema, Psoriasis, Cutaneous Infections, Acne and other common skin disorders. In: Isselbacher, Wilson, Martin et.al. Harrison’s principles of internal medicine. 13thed. International publication; Mc Graw-Hill;1994;274.

2. Berth Jones J. Eczema, lichenification, prurigo and erythroderma. In Burns T et al., eds. Rook’s textbook of Dermatology. 8th edition. UK: Blackwell Publishing Ltd; 2010. http://dx. doi.org/10.1002/9781444317633. Ch23 PMid:21812829.

3. Sharma RK, Dash Bhagwan. English translation on Cakrapani Datta’s Ayurveda Dipika on Agnivesa’s Caraka Samhita, Chikistasthana, Kushta chikista: Chapter 7, Verse 26, Varanasi: Chowkhamba Sanskrit series office, 2014 :325.

4. Sharma RK, Dash Bhagwan. English translation on Cakrapani Datta’s Ayurveda Dipika on Agnivesa’s Caraka Samhita, Sutrasthana, Vividha ashitapeethiya adhyaya: Chapter 28, Verse 11-12, Varanasi: Chowkhamba Sanskrit series office,2012 :576.

5. Murthy KRS, English translation on Astanga Hrdayam of Vagbhata. Chikitsasthana; Kushta chikitsa: Chapter 19, Verse 59-60. Varanasi: Chowkhamba Krishnadas Academy,2013:482.

6. Murthy KRS, English translation on Astanga Hrdayam of Vagbhata. Sutrasthana; Sveda vidhi: Chapter 17, Verse 30. Varansi: Chowkhamba Krishnadas Academy, 2013:56.

7. Murthy KRS, English translation on Astanga Hrdayam of Vagbhata. Sutrasthana; Vamana Virechanavidhi: Chapter 18, Verse 1. Varanasi: Chowkhamba Krishnadas Academy,2013:58.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2023-04-29	2023-05-02	2023-05-09	2023-05-16	2023-05-23
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Eczema

Journal of Ayurveda and Integrated Medical Sciences

Ayurvedic management of Vicharchika (Eczema) - A Case Report

T Lawrence D.1*, Anand R.2, Girish K.3, Brata Tripaty T.4

Introduction

Patient information

Discussion

Conclusion

Reference

T Lawrence D.^1*, Anand R.², Girish K.³, Brata Tripaty T.⁴