E-ISSN:2456-3110

Review Article

Pracchana in Vicharchika

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 6 JUNE
Publisherwww.maharshicharaka.in

A conceptual study on role of Pracchana in Vicharchika with special reference to Dry Eczema

Madhushree K V1*, Duragappa H2
DOI:10.21760/jaims.9.6.15

1* Madhushree K V, Post Graduate Scholar, Department of Shalyatantra, Government Ayurveda Medical College, Bangalore, Karnataka, India.

2 Duragappa H, Professor, Department of Shalyatantra, Government Ayurveda Medical College, Bangalore, Karnataka, India.

Vicharchika (Eczema) has been considered one among 11 Kshudra Kushtas by Brihattrayees. It is also enumerated under Kshudra Rogas by Sushruta.[1] Features like Raji (Excoriations), Ati Kandu (Excessive itching), Ruja (Pain), Ruksha (Dryness), Arati (Uneasiness) are said by Sushruta which can be clinically corelated to dry eczema. Eczema is not contagious inflammation of the skin characterised by erythema, scaling, dry skin, itching, red to brownish grey patches.[2] In Brihattrayees, Rakta Dushti (Vitiation of blood) has been told as the prime reason for skin diseases for which letting out the vitiated blood gives better relief in symptoms. In Vicharchika, there is localized vitiation of blood. Hence Rakthamokshana (bloodletting) by Pracchana is an effective method of treatment, as Pracchana is a mode of Shastrakrita Raktamokshana indicated for Eka Deshastha (localised) Twak Vikaras (Skin disorders).[3]

Keywords: Vicharchika, Pracchana, Dry Eczema, skin disorder.

Corresponding Author How to Cite this Article To Browse
Madhushree K V, Post Graduate Scholar, Department of Shalyatantra, Government Ayurveda Medical College, Bangalore, Karnataka, India.
Email: 		Madhushree K V, Duragappa H, A conceptual study on role of Pracchana in Vicharchika with special reference to Dry Eczema. J Ayu Int Med Sci. 2024;9(6):104-110.
Available From
https://jaims.in/jaims/article/view/3247

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-04-15 2024-04-24 2024-05-03 2024-05-13 2024-05-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Authors state no conflict of interest. Non Funded. The conducted research is not related to either human or animals use. 13.65 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Madhushree K V, Duragappa Hand 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

Vicharchika, also known as eczematous skin lesions, is considered as Kshudrakushta or minor skin disease in Ayurveda. It falls under the category of Raktapradoshaja Vikara[4], indicating a condition caused by vitiation of blood, with the dominance of Kapha dosha as per Charaka. However, according to Susrutha, it is predominantly Pitta in nature and involves features like Kandu, Arti, Ruja, Rukshata and Raji which is more similar to dry eczema. Eczema, is a non-contagious inflammation of the skin characterized by inflammation, redness, itching, scaling, oedema, dry skin, red to brownish grey patches. It can manifest as localized lesions on the skin. The contemporary strategies for managing eczema includes usage of emollients, topical corticosteroids, anti-histamines and immunomodulatory agents.

In Ayurveda, management of Kushta includes Shodhana (Bio purification) based on predominant Dosha followed by Shamanoushadhas which include Abhyanga, Parisheka, and Lepa. Rakta Dushti is one of the prime reasons for skin disease. Hence patients may get relief after letting out the Dushita Rakta. Among the various methods of Raktamokshana, Pracchana comes under Shastrakrita Raktamokshana. Pracchana is a technique of letting the vitiated blood out of the body from a localised lesion, where blood is in Pindita Avastha in the superficial layer of the skin.[5] This is done through the artificially made cut wounds in the skin with the help of a sharp, pointed surgical instrument. The indication of Pracchana are Alpa Kushta[6] i.e., mild congregation of vitiated Doshas, with Dushta Rakta in Pindita Avasatha (lump form), Eka Deshastha (localised region of the skin), Grathita (stagnated and coagulated in the layers of skin) etc. In Pracchana blood is drained along with the stagnated fluids (Rasa and Laseeka) rich with the deranged Doshas. Every cut that is made on the skin drains the area of about one Angula i.e. 3/4" around it.[7] By removing the vitiated blood through bloodletting, the body's natural balance can be restored, thus alleviating the symptoms of Vicharchika.

Disease Review
In Ayurveda, all types of skin diseases have been discussed under the broad heading Kustha which is further divided as Maha Kustha and Kshudra Kustha.

Vicharchika is one among the Kshudra Kustha. According to Acharya Charaka, the skin disease where eruptions over the skin appear with dark pigmentation, itching with profuse discharge from lesion is Vicharchika[8], whereas as per Acharya Sushruta severe itching, severe pain and dryness is seen is Vicharchika.[9]

Vicharchika is defined as Visheshena Charchyate Panipadasya Twak Vidaryate Anayaiti Roga Vishesha. A disease typically characterised with intense itch and breaking of skin specially of hands and feet.[10]

Dosha Pradhanyata in Vicharchika
According to different authors the disease Vicharchika is manifested by predominance of different Doshas, as explained in the table below.

Table 1: Dosha Pradhanyata of Vicharchika according to different Aacharyas.

AuthorPradhana Dosha
SushrutaPitta
CharakaKapha
VagbhataKapha
MadhavaKapha
KashyapaKapha
HareetaKapha
BhelaKapha

Nidana

  • Mithya Ahara - Ahita Ahara, Viruddha Ahara, Asatmya Ahara, Ajeernashana.
  • Mithya Vihara - Excessive exposure to heat and cold, suppression of natural urges, Increases mental stress etc.
  • Visha - Toxic substances
  • Krimi - microorganisms
  • Beeja Dosha - Genetic factors etc.

Purvarupa

  • Asweda or Ati Sweda (loss or excessive sweating at the site of localization of vitiated Doshas)
  • Kandu (Itching)
  • Vaivarnya (Discoloration)
  • Nistoda (Pricking pain)
  • Ati Shlakshnata
  • or Ati Parushya (excess rough or excess smooth skin)

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  • Paridaha (Burning sensation)
  • Suptata (Numbness)
  • Loma Harsha (Horripilations) etc.

Rupa

Features of both Shuska Vicharchika (Dry eczema) and Sravi Vicharchika (Wet eczema) are explained in our classics. Acharya Charaka and Vagbhata have described Sravi type of Vicharchika whereas Sushruta has explained Shushka Vicharchika which are summarized in the below table.

Table 2: Lakshanas of Vicharchika as per different authors.

LakshanasSushrutaCharakaVagbhataBhelaHaritaKashyapa
Kandu+++++-
Pidaka-++-+-
Shyava-+++++
Srava-+++++
Ati Raji+-----
Arati+-----
Ruja+----+
Rookshata+-----
Raktata---+-+
Praklinnata---+--
Vrana-----+
Paridaha-----+

Lakshanas of Vicharchika with special reference to dry eczema

Features said by Sushruta more likely can be correlated to dry eczema

  • Raji (crackings / excoriations)
  • Ati Kandu (severe itching)
  • Ati Ruja (severe pain)
  • Ruksha (dryness)
  • Arati (uneasiness)

Samprapti

The Vata, Pitta and Kapha provoked and vitiated by the etiological factors cause Agnimandya and enter the Tiryaggamani Sira and reach the Twak, Laseeka, Rakta and Mamsa where they cause the Shithilata (softening) of them, rendering finally incapable of their functions. Later these Doshas exhibit the Lakshana (symptomatology) of the disease on the Twak by ruining its healthy structure and colour. The three Doshas and the four Dhatus which are the basic important factors i.e., Twak Laseeka,

Rakta and Mamsa these entire together make the material for the production of any Kushta including Vicharchika. Hence this combination of seven factors is called as Saptadravya Sangraha.

Samprapti Ghataka

Table 3: Samprapti Ghatakas of Vicharchika

DoshaTridosha
DushyaRasa, Rakta, Mamasa, Laseeka
SrotasRasavaha, Raktavaha, Mamsavaha, Swedavaha
Sroto DushtiSanga, Vimarga Gamana
AgniMandagni
Udbhava SthanaKoshta
Sanchara SthanaTiryaggami Sira
Vyakta SthanaTwak
RogamargaBahya

Dosha and Lakshanas of Vicharchika
Though Vicharchika is manifested by the combined effect of all the three Dosha Kapha is considered as main causative Dosha. The symptoms are produced as the disease progresses through its different stages (Shatkriyakala of Sushruta). Based on these Lakshana, the Dosha behind them can be understood as follows:

Table 4: Involvement of Doshas in particular Lakshanas of Vicharchika.

DoshaLakshanas
VataShyava Varna, Atiraji, Ruja, Rukshata
PittaRakta Varna, Arati
KaphaKandu, Praklinnata

Chikitsa
Acharya Sushruta in the context of Kshudra Roga Chikitsa has mentioned Vicharchika to be treated in the line of Kushta Chikitsa. Based on the stages of Kushta specific treatment options are also told for the same.

Table 5: Treatment modalities based on stages of Kushta

Purvarupa AvasthaVamana, Virechana
Twak SampraptaShodhana Lepas
Shonita SampraptaRaktamokshana, Lepas, Kashaya Pana
Mamsa SampraptaLepas, Arishta, Mantha
Meda Samprapta (Yapya)Shodhana, Rakta Mokshana, Bhallataka, Shilajatu, Ayaskriti, Tuvaraka Pana
Asthi Samprapta
(Asadhya)		Naivopakramet

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Sushruta also indicated Pracchana in skin lesions having Mandala and Utsanna pattern. The raised circular patches should be scraped repeatedly or incised superficially[11]

Eczema

Eczema or eczematous dermatitis is a condition in which a series of highly characteristic changes develop in the epidermis of skin, when some external agent inflames the skin. However, frequently this type of reaction occurs in the absence of external factors also, when the condition is called as Constitutional Eczema.

The first sign of eczema is erythema, caused by the dilatation of the dermal blood vessels. Next stage consists of invasion of epidermis by lymphocytes and an increase in its cellular and intercellular fluid. The later collects into minute vesicles appearing on the surface of the skin. The vesicles soon rupture leading to exudation of serum, which after sometime dries up to form crusts. Sometimes the epidermal oedema resolves before vesication and weeping occur. In either case as a result of these changes the normal function of epidermis is disturbed. Firstly, the healthy horn cells will not be formed, and then the surface of the skin becomes scaly. Secondly the cellular division may be increased leading to a general thickening of the epidermis which when extreme, results in lichenification. These physical changes need not be necessarily seen in an orderly sequence in every case.

The cardinal sign of eczema is vesication and the essential symptom is itching. The intensity of this depends both on the cause and individual affected and varies from almost nothing to uncontrollable paroxysms of scratching. Further, the degree of itching varies with the site, being on the whole worse in those areas rich in itch points like bend of the elbow, knee, anus, groin, sides of the neck etc.

The constitutional eczema is of five types mainly. Eczema due to external agents varies widely depending upon the causative agent (Contact dermatitis)

The five constitutional eczemas are:

1. Atopic eczema2. Nummular eczema
3. Pompholyx
4. Seborrheic dermatitis
5. Varicose eczema / Stasis dermatitis

Procedure Review

Pracchana is one among Ashta Vidha Shastra Karma, as it comes under the heading of Rakta Visravana (bloodletting).

The derivation of the word Pracchana is from the root Ch' to mean as to cut, to cut off or cut as under. Often it is pronounced as Pracchana also and these words are from the root 'Cchad' to mean a private door or a loop-hole or a window. However, the literal meaning of the word Pracchana is, to bleed by making incisions or cuts in the skin.[12]

The synonyms of Pracchana are (1) Pada (2) Shastra Pada (3) Kuttana

Indications

General Indications:

  • Ekadeshastha (localized) Twak Vikara
  • In Pindita Rakta (When vitiated blood has formed a lump)
  • Dushita Rakta present in Uthaana Sthana
  • In Asukumara persons
  • As Purva Karma (pre procedure) for Shrunga and Alabu type of Raktamokshana

Specific Indications:
A physician should apply scarification therapy for the following:

  • Vātāsṛk (nodes developed as a result of rheumatoid arthritis and gout,
  • Granthi (enlarged lymph glands)
  • Pidaka (pimples)
  • Kotha (urticarial patches)
  • Rakta-Mandala (red and circular patches in the skin)
  • Kustha (lepromatous growths)
  • Shotha (oedematous parts)
  • Apakva Vidarika (Unripen Vidarika)
  • Indralupta (Alopecia areata)
  • In undeveloped ears Pracchana
  • should be done on the anterior aspect after Sthanika Snehana and Swedana
  • Pre procedure of Lekhana Karma in Vartmagata Rogas

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  • Post procedure of Bhedana (incision) in Shleshmopanaha

Procedure of Pracchana is described in Sushruta Samhita Sutra Sthana[13] and Ashtanga Hridaya Sutra Sthana[14]

Purvakarma

On a day when the weather is neither too cold not too hot, when the sky is free of clouds, when the patient has digested the food taken in the morning, he should be applied with luke warm oil over and around the lesion and sudation is done over this. Patient is advised not to withhold his natural urges. A tourniquet is then applied, firmly about 3-4 Angula i.e., 2-3" above or superior to the region of the lesions.

jaims_3247_01.jpg
Figure 1: Sthanika Abhyanga

jaims_3247_02.jpg
Figure 2: Sthanika Sweda

Pradhana Karma

With a sharp pointed instrument said for the 'Visravana' purpose, i.e., Koorcha/Soochi (or any other similar instrument found convenient) Pracchana is carried out. It is done briskly without causing any damage to the underlying tissue like veins, arteries, or any vital parts. The process should be started from the lower end of the lesion and carried towards the upper or superior end. The operation should be done gently, and the cutting of the skin should be done at an equal distance. It should be neither very superficial nor too deep but should just allow a normal flow of blood. No repetition of cutting is made on a single point.

jaims_3247_03.jpg
Figure 3: Procedure of Pracchana

jaims_3247_04.jpg
Figure 4: Procedure of Pracchana

Pashchat Karma

When bleeding stops spontaneously the tourniquet is to be released. The skin should then be examined for any extensiveness by which oozing of blood still continues.


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In such case the measures told for the management of the conditions are to be adopted. Panchavalkala Kwatha wash followed by sterile dressing should be done.

Instruments for Pracchana Karma

As per classics:

As Pracchana comes under type of Visravana, following Shastras (surgical instruments) are told as per Sushruta[15]

  • Suchi
  • Kusha Patra
  • Aati Mukha
  • Shrari Mukha
  • Antarmukha
  • Trikurchaka

Acharya Vagbhata has told Nakha Shastra along with the above mentioned Shastras for Pracchana.[16]

As per Conventional Method:

  • Surgical blade No.11 is used to make multiple superficial parallel incisions.
  • Sterile surgical needle is used to make multiple superficial punctures.
  • Modified instruments like Derma roller, Derma stamp and Derma pen are also used for Pracchana Karma

Discussion

Probable mode of action:

According to Ayurveda concept, after Prachhana Karma i.e., taking superficial parallel incisions or multiple superficial punctures in skin, vitiated Rakta is drawn out from the lesion along with the vitiated Dosha, stimulating the natural physiology of Prakruta Dosha and Dhatu. Thus, reducing the Vyadhi and the Lakshanas. Prachhanna Karma enhances the drug delivery system across the skin as it bypasses the stratum corneum and deposit the drug directly to the vascularized dermis. As well as after taking the superficial parallel incisions stimulates the wound healing cascade to start. In the manner to heal the wound, body releases few growth factors like PGF, TGF- alpha and Beta, connective tissue growth factor etc.

which promotes to form the neovascularization and angiogenesis which removes the toxic blood from the site and promotes the healthy tissue to regrow thus disease reduces.[17]Pracchana removes the vitiated Doshas and improves perifollicular vascularization. This helps in the better absorption of Lepa, Taila which are applied later.[18]

In Pracchana, pricking wounds are created over the skin of the affected area. Hence, we are inducing an acute physiological inflammatory response in that area which will promote the healing of the wound as well as the skin disease.[19]Pracchana karma helps to reduce itching, ESR and AEC due to improved microcirculation, removal of dead RBC’s, hemosiderin and histamines, inflammatory mediators and stasis.[20]

Conclusion

Prachhana Karma can be described as an easy, OPD based, effective method for performing Raktamokshana. It is particularly effective for accumulated vitiated Rakta and for localized skin conditions. Vicharchika with special reference to dry eczema is notable for its chronicity, dryness, discoloration and lichenification which gets cured hardly with internal medications. By creating superficial incisions, Pracchana stimulates local blood flow, releases stagnant Doshas. Thus, adopting Pracchana in Shushka Vicharchika helps to let out Sthanika Doshas and Dushyas viz, Rakta and Lasika, thus aid to relieve the symptoms.

References

1. Acharya Sushruta. Sushruta samhita with Nibandha Sangraha commentary of Sri Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya, Chaukambha Sanskrit Sansthan Publication, reprint edition 2015, Ni.Ch.13, Verse 3, p no 318

2. N. Behl, A. Aggarwal, Govind Srivastava, practice of dermatology, 10th edition, New delhi, CBS Publishers & Distributors, 2005, Dermatitis & Eczema, pg. no. 126

3. Acharya Vagbhata, Ashtanga Hridaya with Sarvanga sundara and Ayurveda rasayana commentary, Chaukambha Surbharati Prakashan, 2017 edition, Sutra sthana, Ch 26, verse 51-52, p no 325


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4. Acharya Sushruta. Sushruta samhita with Nibandha Sangraha commenatry of Sri Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya, Chaukambha Sanskrit Sansthan Publication, reprint edition 2015, Sutra sthana Ch 24, Verse 10

5. Acharya Sushruta. Sushruta samhita with Nibandha Sangraha commenatry of Sri Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya, Chaukambha Sanskrit Sansthan Publication, reprint edition 2015, Sha.Ch 8, verse 26, p no 383

6. Acharya Charaka, Charaka Samhita by Agnivesha revised by charaka and Dridabala with Ayurvedadipika commentary of chakrapanidatta, Chaukambha publications, reprint 2016, chi.7. verse 40, p no 452

7. Prabhakar Rao, Sarngadhara Samhita of Sarngadharacarya Sanskrit Text with English Translation

8. Acharya Charaka. Charaka Samhita by Agnivesha revised by charaka and Dridabala with Ayurvedadipika commentary of chakrapanidatta, Chaukambha publications, reprint 2016, chi.7. verse 26,

9. Acharya Sushruta. Sushruta samhita with Nibandha Sangraha commenatry of Sri Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya, Chaukambha Sanskrit Sansthan Publication, reprint edition 2015, Ni.Ch.13, Verse 3, p no 318.

10. Raja Radha Kanta Deva, Shadakalpadruma 3rd edition, Chaukambha publications,1967

11. Acharya Sushruta. Sushruta samhita with Nibandha Sangraha commenatry of Sri Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya, Chaukambha Sanskrit Sansthan Publication, reprint edition 2015, Chikitsa Ch 9, Verse 10.

12. Apte, Y.G. Joshi, Sanskrit English Dictionary, Prasad Prakashana Poona,1957

13. Acharya Sushruta. Sushruta samhita with Nibandha Sangraha commenatry of Sri Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya, Chaukambha Sanskrit Sansthan Publication, reprint edition 2015, Sutrasthana, Ch 14, verse 26, p no

14. Achaya Vagbhata, Ashtanga Hridaya with Sarvanga sundara and Ayurveda rasayana commentary, Chaukambha Surbharati Prakashan, 2017 edition, Sutra sthana, Ch 26, verse 51-52, p no 325

15. D. Singhal, Sushruta Samhita, Sutra sthana, Chapter 8, Verse 4, Page no 72

16. Vagbhata, Ashtanga Hridaya with Sarvanga sundara and Ayurveda rasayana commentary, Chaukambha Surbharati Prakashan, 2017 edition, Sutra sthana, Ch 26, verse 18, p no 320

17. Soni, B., Shirode, P.R. Critical review of Prachhannakarma and instruments for Prachhannakarma mentioned in Bruhattrayi. Bull. Env. Pharmacol. Life Sci., Vol 12[2] Jan 2023: 56-66.

18. Dr Girish Desai, Dr Vishwanath Sharma, Dr S.V. Shailaja, Critical analysis on role of raktamokshana in shalya tantra vyadhis. WJPLS, 2021, Volume 7, Issue 4, Page 77,78

19. Muhammed Safeeque E.K et al: Effect of Pracchana in Vicharchika – A Case Study International Ayurvedic Medical Journal {online} 2022 {cited November 2022}

20. Tikole Yogesh, Emmi S V, Mathew S, Killedar Ramesh. Standardization of Prachchana karma in stasis dermatitis. Int. J. Res. Ayurveda Pharm. 2014;5(3):315-317 http://dx.doi.org/10.7897/2277 4343.05364


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