E-ISSN:2456-3110

Case Report

Shitapitta

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 8 August
Publisherwww.maharshicharaka.in

Ayurvedic management of Shitapitta with special reference to Urticaria - A Case Study

Pawar N1*, Khandekar V2, Jain S3
DOI: http://dx.doi.org/10.21760/jaims.8.8.45

1* Neha Pawar, Post Graduate Scholar, Department of Swasthavritta And Yoga, Government Ayurveda College, Nagpur, Maharashtra, India.

2 Vrushali Khandekar, Associate Professor, Department of Swasthavritta And Yoga, Government Ayurveda College, Nagpur, Maharashtra, India.

3 Sumeeta Jain, Professor and HOD, Department of Swasthavritta And Yoga, Government Ayurveda College, Nagpur, Maharashtra, India.

Urticaria is a dermatological condition which is characterized by itchy wheals which suddenly appear on any skin region or mucous membrane. These lesions usually last few minutes to few hours and then go away without leaving any trace. These symptoms can be linked with Shitapitta. This study aim to assess the efficacy of Ayruvedic management in Shitapitta based on Ayruvedic Shaman and Shodhan Chikista. This patient used Dhauti Karma and Nitya Virechan for adequate control.

Keywords: Shitapitta, Urticaria, Tvak Vikar, Shaman, Shodhan Chikista

Corresponding Author How to Cite this Article To Browse
Neha Pawar, Post Graduate Scholar, Department of Swasthavritta And Yoga, Government Ayurveda College, Nagpur, Maharashtra, India.
Email: 		Pawar N, Khandekar V, Jain S, Ayurvedic management of Shitapitta with special reference to Urticaria - A Case Study. J Ayu Int Med Sci. 2023;8(8):279-282.
Available From
https://jaims.in/jaims/article/view/2716

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-06-14 2023-06-20 2023-07-01 2023-07-12 2023-07-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Pawar N, Khandekar V, Jain 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].

J Ayu Int Med Sci 2023;8(8)279
Pawar N et al: Ayurvedic management of Shitapitta with special reference to Urticaria

Introduction

Urticaria is a dermatological conditioned which is characterized by itchy wheals which suddenly appear on skin or mucous membrane. They are commonly known as hives, wheals, welts and nettle rash.

It usually occurs due to an allergic reaction trigged by food seasonal or external factors or medication.[1]

In urticaria the individual lesion typically last for few minutes to few hours then subside without leaving any trace.[2]

Urticaria is divided into two categories based on how long it lasts 1) acute urticaria which stay less than six weeks 2) chronic urticaria which stay longer than six weeks.[3]

As Shitapitta is Tvak Vikar i.e., skin diseases in which wheels or hives appear all over the body with itching, burning sensation and pain these all are the symptoms of Shitapitta[4] and this can be related with urticaria. This condition occurs due to the dominance of Shita (cold) over Pitta Dosha, when someone is exposed to cold weather, Kapha and Vata Dosha aggravates and combine with Pitta Dosha, they spread all over the body and creates rashes on the surface of the skin. Varati Damstavat Shotha and Kandu caused by Kapha Dosha vitiation, Shul caused by Vata Dosha vitiation and Daha caused by Pitta Dosha.

In modern science, antihistamines and steroids are used to treat urticaria and their long term uses can cause adverse effects on the human body.[5] In Ayurveda, Shitapitta Chikista can be divided into three phases they namely are Langhana for Alpadosha, Langhana with Pachan for Madhya Dosha Avastha, Shodhan for Bahudosha Avastha.[6]

In Shitapitta Shodhan like Vamana , Virechan and Raktamokshan are the ideal treatment and they are very effective, as they eliminates vitiated Dosha from the body, and the recurrence can be avoided.[7]

As in this case due to Shodhan Chikista all symptoms are gone completely and it can be considered as main Chikista (Apunarbhav Chikista) as this Shodhan Chikista helps to remove the obstructed Kapha and Pitta Dosha. As in this case Jala Dhauti, Virechana are planned to treat Shitapitta.


Case Report

Detail of the case

Here by presenting a case of 42 year female patient who visited Government Ayurved College and Hospital, Nagpur with presenting complaints of Varati Damshavat Shotha and Kandu all over the body as the symptoms more aggravates in the evening time. She was diagnosed with urticaria by the physician and adviced to take tablet cetirizine 5mg od daily.

Personal history

No history of HTN / DM / Thyroid dysfunction / any other allergic illness

Family history

Not any significant

Medical history

Tab Cetirizine 5mg once a day (Antihistamine drug)

General examination

  • Pulse: 72/min
  • Blood Pressure: 120/70mmHg
  • Respiratory Rate: 16/min
  • Temperature: 97 F
  • Weight: 55kg
  • Height: 145cm
  • BMI: 26.2

Systemic examination

  • CNS: NAD
  • CVS:- NAD
  • RS:-NAD

Asthavidha Pariksha

  • Nadi - Vata-pittaja
  • Mala - Asamyak
  • Mutra - Samyak
  • Jiva - Sama
  • Shabda - Spashta
  • Sparsha - Anushnasheeta
  • Drik - Samyak
  • Akruti- Madhyam

J Ayu Int Med Sci 2023;8(8)280
Pawar N et al: Ayurvedic management of Shitapitta with special reference to Urticaria

Table 1: Urticaria activity score (UAS7) used to examine Shitapitta[5]

Patient score was 3

WhealsPruritusScore
NoneNone0
Mild <20 wheals over 24 hoursMild : present but not annoying1
Moderate 20 to 50 wheals over 24 hoursModerate : troublesome but doesn’t interfere with normal daily activity or sleep2
Intense >50 wheals over 24 hours or a large area of wheal that blend into oneIntense : severe itching which is sufficiently troublesome to interfere with normal daily activities or sleep3

Therapeutic Intervention

Table 2: Schedule of Shodhan Chikitsa

SNProcedureDrug usedDuration
1.DhautiLukewarm water + LavanOne day
2.Nitya VirechanAvipattikar Churna 10gm HsFor 15 days

Shaman Chikista

Table 3: Schedule of Shaman Chikitsa

SNMedicineDose and frequencyTime of administrationAnupanDuration
1.Trikatu Churna Kwath20ml twice a dayAfter mealLukewarm water15 days
2.Krimikuthar Rasa2 tablet twice a dayAfter mealLukewarm water15 days
3.HaridrakhandapakaOne table spoon twice a dayBefore mealLukewarm water15 days

Observation and Result

Table 4: Symptoms before and after treatment

SNSymptoms Before treatmentAfter treatment
1.Varati Damsha Samsthana Shotha10
2.Kandu (itching)30
3.Vidaha (burning sensation)PresentAbsent

The above table shows the result obtained before and after treatment. In this condition mainly three symptoms are observed like rashes, itching and burning sensation, these three symptoms are marked with the help of Urticaria activity scale, as shown in table no 4. The result and observation obtained after treatment i.e., at the 25th day assessed by using subjective and objective criteria, all the symptoms reduced completely.

Discussion

Shitapitta is a Tridoshaja Vyadhi, according to Nidaan Sevana (Etiological factor)[10] there is a vitiation of Kapha and Vata, which spreads throughout the body, both externally and internally, by mixing with Pitta.

The Tridoshas spreading internally cause Dushti (pathogenesis) of Rasa and Rakta Dhatus and their Dushti appear causing symptoms such as Varati Damstavat Sotha (rash), Kandu (itching), Shul (pain) and Daha (burning sensation), respectively caused by Vata, Pitta and Kapha, which reached to Twaka.[11] This all symptoms can be correlated to urticaria i.e., hives which are red, raised, itchy spots and rash caused by allergens.[12]

In Ayurveda the presentations and prognosis of the diseases depends upon multiple factors, As Shitipitta is a condition found in Bahudosha Avastha or Lakshana as mentioned in Charak Sutra Sthan chapter 16 like Pitaka, Kota, Kandu, and it’s treatment being mentioned as Shodhana Chikista depend upon the predominance of Dosha.[13] These Shodhan therapies are mostly, adopted due to their specialty, when there is aggravation of Doshas, Shodhana modality treatment helps in the nonoccurrence of the disease,[14] therefore Shodhan Chikista are praised as first choice of treatment. Jala Dhautikarma, Nitya Virechan are also planned for Shodhana.

Jala Dhauti: Hathayoga Pradipika, an ancient Yoga scripture describes voluntarily induced vomiting as one of the six cleansing techniques to clean the body and regulate the mind.[15] Voluntarily induced vomiting was planned for one day. Akanthapana of warm water facilitates the vomiting process by gag reflex. In this procedure Doshas (~waste products or toxins) are eliminated through upper channels such as mouth. Specially the Kapha and Pitta Dosha brought to Amashaya (~stomach and duodenum) from all over the body by the specific preoperative procedures and then eliminated out by inducing the vomiting as it also helps by removing Kleda from the body i.e., through Amashaya.

Nitya Virechan removes toxins from the body by working on gross level where the various organs and system of the body, as well as Gastrointestinal tract which cleansed thoroughly and also by acting on the cellular level where body is cleansed and purified at the level of cell membrane and molecules. Absorption in the intestine is greatly improved and metabolism is also improved. Avipaithikar Churna eliminate Kleda and Doshas from Rasa, Rakta and Meda. It improved complexion by purifying blood and by absorbing Kleda from Rakta. As Shitipitta is a Pittasthana Samudbhava Vikar where there is Avarodha to Apana


J Ayu Int Med Sci 2023;8(8)281
Pawar N et al: Ayurvedic management of Shitapitta with special reference to Urticaria

Vyau due to morbid Kapha, the principle pathology involved and Vimargaman of Vyanvayu, Nitya Virechana for short period with Avipattikar Churna helps in Vimargamana of Vyan Vayu by Srotoshodhana and also reduce vitiated Pitta. Trikatu Churna also help in removal of Kleda. Rakta Krimikuthar Rasa has Kapha and Vatahara properties Haridradi Khanda Paka is Kandughana, Dadru Nashaka, Krimihar, Jirnajwara Nashaka, Shothahara. In this way the given Shodhana and Shaman Chikista helps in breaking pathogenesis, resulting in controlling the symptoms in Shitapitta.

Conclusion

As Shitapitta is mainly due to Kapha and Vata Doshas aggravation and combining with Pitta Doshas So Jala Dhauti, and Nitya Virechan pacify Kapha and Vata Pitta Dosha respectively. Hence in this study Dhauti and Virechan shows significant result.

jaims_2716_01.JPG

Reference

1. https://www.webmed.com/skin-problems and treatment /giude.

2. Sharma SK, Munjal YP, Agarwal AK. API Textbook of Medicine, Association of physician of India, 9th edition 2012, pg- 479,491.

3. https://researchgate.net/deref/https%3A%2F%2Fwww.dermentnz.org

4. Vijayarakshita S Madhavanidana Chaukhamba Surbharti Prakashana, Sheetapittodkothanidanam/ reprinted, 2010, pg-200

5. Flynn CA, Griffin G, Tudiver F Decongestants and antihistamines for acute otitis media in children 2002.

6. Agnivesh, Charak Samhita commentary by Brahma Nand Tripathi, Chaukhamba Surbharti Sansthan, Varanasi. sutra 4/17, 43:24.

7. Elman S, Hynan LS,et al.The 5-D itch scale , a new measure of pruritus . Br J Dermatol. 2010; I62 (3)/pg 587-93.

8. Yogaratnakar

9. Flynn CA, Griffin G, Tudiver F. Decongestants and antihistamines for acute otitis media in children 2002

10. Prof Sharma A, Orientalia Delhi C. Edition, 2017, kayachikista Vol- 2, chapter no.60, pg no- 864

11. Prof Sharma A, Orientalia Delhi C. Edition, 2017, kayachikista Vol- 2, chapter no.60, pg no- 865

12. Principles and practice of panchakarma by Dr. Vasant C Patil. 5th edition Chaukamba publication, pg no 404,

13. Charak Samhita, Shukla AV, Chaukhamba Prakashan Siddhi Sthana vol 1 reprint edition 2015.

14. Prof Sharma A, Orientalia Delhi C. Edition, 2017, kayachikista Vol- 2, chapter no.1, pg no- 17.

15. Agrawal S, editor (reprint edition) Hatayogpradipika of Swatmaram Yogi, Dvitiyaupadesh, chapter 2 Verse 25. Varanasi: Chaukhamba Orentalia 2018;34.


J Ayu Int Med Sci 2023;8(8)282