E-ISSN:2456-3110

Case Report

Management of Sheetapitta

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 5 May
Publisherwww.maharshicharaka.in

A case study on management of Sheetapitta with special reference to Chronic Urticaria

P Nandurkar D1*, R Chavhan K2
DOI:10.21760/jaims.9.5.52

1* Diksha P Nandurkar, Post Graduate Scholar, Department of Agadtantra, Government Ayurved College, Nagpur, Maharashtra, India.

2 Kalpana R Chavhan, Associate Professor, Department of Agadtantra, Government Ayurved College, Nagpur, Maharashtra, India.

Background: Sheetapitta is one of the Twak Vikara mentioned in ancient Ayurvedic Samhita. Sheetapitta is Tridoshaj Vyadhi occurs after exposure to cold breeze. This dominantly leads to the vitiation of Kapha and Vata Dosha associated with Pitta Dosha and circulate all over the body manifesting as maculopapular rash. The symptoms include Varti Damshavat Shotha and Kandu due to dominance of Kapha, Shula due to Vata and Daha caused by vitiation of Pitta Dosha. Sheetapitta can be correlated with urticaria due to resemblance of etiological factors and symptomatology. Aim & Objectives: The aim of the study is to access the efficacy of Ayurvedic management (Shaman Chikitsa) in Sheetapitta. Materials & Methods: It is a single case study. A 44 year old female patient presented with complaints of elevated reddish irregular lesions associated with gradual onset of itching and burning sensation all over the body since 4 months. Itching starts immediately after the consumption of food items like non-veg, spices, citrus fruits, oily food, dry fruits and nuts. The symptoms aggravated more in the night time and gradually subside in the morning. The diagnosis was done as Sheetapitta. Result: Ayurvedic management was done by using Shaman Chikitsa can effectively manage Sheetapitta (urticaria) and improved the quality of life of patient. Conclusion: This case report shows that the classical Sheetapitta treatment was significantly effective in treating urticaria.

Keywords: Sheetapitta, Urticaria, Shamana Chikitsa, Ayurveda

Corresponding Author How to Cite this Article To Browse
Diksha P Nandurkar, Post Graduate Scholar, Department of Agadtantra, Government Ayurved College, Nagpur, Maharashtra, India.
Email: 		P Nandurkar D, R Chavhan K, A case study on management of Sheetapitta with special reference to Chronic Urticaria. J Ayu Int Med Sci. 2024;9(5):307-312.
Available From
https://jaims.in/jaims/article/view/3407

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-03-14 2024-03-25 2024-04-04 2024-04-15 2024-04-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 22.87

© 2024by P Nandurkar D, R Chavhan Kand 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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Diksha P. Nandurkar et al. A case study on management of Sheetapitta

Introduction

In Ayurveda, Sheetapitta is mentioned as one of the Twak Vikara. Sheetapitta is composed of two words, Sheeta and Pitta which are contrary to each other by meaning. The word Sheeta indicates Vata and Kapha Dosha and their association with Pitta Dosha. According to Madhav Nidana, Sheetapitta caused due to exposure to cold breeze which results in vitiation of Vata and Kapha Dosha dominantly in association with Pitta Dosha,[1] Due to the impairment of Doshas, it leads to Rasa and Rakta Dhatu Dushti, then spreads towards the extremities and manifests as maculopapular rash. Sheetapitta, Udarda and Kotha are three different terminologies mentioned in Samhita, having few different characteristics and different causative factors. The specific reference for Sheetapitta is not found in Brihtrayee but these terms are mentioned as Purvarupa,[2] Lakshana[3] and Vyadhi.[4] Madhukosa explained that, though the features of Sheetapitta and Udarda are similar to each other, there is a predominance of Vata Dosha in Sheetapitta while Udarda is dominated by Kapha Dosha.[5] The etiological factors responsible for Sheetapitta appears due to the consumption of Asatmya Ahar or various kinds of allergens. In todays advanced lifestyle, improper and unhealthy food habits leads to lower nutritional value in diet resulting in Dhatu Daurbalya and impaired immune responses. This causes sensitization towards allergens and produce allergic reactions. Sheetapitta can be correlated with urticaria due to the resemblance of etiological factors and symptomatology. Urticaria affects about 20% of population at some point in lifetime.[6] Though it is not life threatening disease, but it makes patient irritable and affects the quality of life. Urticaria is derived from the Latin word ‘Urtica’ means stinging nettle. Urticaria is commonly occurring dermatological disease characterized by erythematous and itchy lesions involving the dermis and mucous membrane and caused by dilatation and increased permeability of capillaries.[7] Urticaria has a variety of etiological factors including IgE antibodies mediated foods, drugs, physical stimuli, infection, autoimmune diseases.[8] Acute and chronic urticaria can occur at any point in the lifespan of third to fifth decade. Acute urticaria is widespread and lasts for less than 6 weeks and may be a manifestation of type 1 allergic reaction.[9]

If it continues for more than 6 weeks then it is said to be chronic urticaria. Upto 45% of the patients with chronic urticaria have an autoimmune cause for their disease.[10] The present study aimed to evaluate the efficacy of Shaman Chikitsa in Sheetapitta.

Aim and Objectives

To study about Sheetapitta Vyadhi (Urticaria) and to assess the competency of Shaman Chikitsa in Sheetapitta Vyadhi.

Case Report

A 44 year old female patient with medium built reported to OPD and presented with chief complaints of elevated reddish irregular lesions with swelling. The above complaints associated with gradual onset of itching and burning sensation all over the body since 4 months. Itching starts immediately after the consumption of food items like non-veg, spices, citrus fruits, oily food, dry fruits and nuts. The symptoms aggravated more in the night and gradually subside in the morning. The diagnosis was done as Sheetapitta on the basis of etiological factors and clinical presentation.

History of present illness

The patient was completely healthy before 4 months and gradually developed reddish irregular lesions all over the body. Initially patient neglected the symptoms but when the symptoms got aggravated, she approached to an allopathic hospital and was on antihistamine medication for 4 months. Patient got symptomatic relief but after withdrawal of medication, recurrence of disease occurs. As a result, she decided to take Ayurvedic treatment.

Past history

Patient had no history of any systemic disease, no medical or surgical history.

Personal history

Occupation - Housewife

Nidana[11]

Due to Sheeta Marutadi Sevan (exposure to cold wind and cold weather), Kapha and Vata Dosha gets vitiated and mixed with Pitta Dosha. All the three vitiated Doshas spreads all over the body


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and manifests as Sheetapitta. 1. Aharaj Hetu - Atiamla Sevan, Atilavan, Atikatu Sevan, Kshara Sevan, Viruddha Ahar Sevan, Dadhi Sevan. 2. Viharaj Hetu - Sheet Maruta Sevan, Bahya Krumi, Keeta Damsga, Chardi Nigrahan, Shishir Ritu, Vastra, Abhushan. 3. Nidanaarthakara Roga - Pittaja and Kaphaja Jwara, Sannipatika Roga, Unmarda, Adhoga Amlapitta

Poorvarup (Premonitory signs)[12]

Pipasa (Thirst), Aruchi (loss of appetite), Hrillasa (Nausea), Dehasaad (Feeling of tiredness), Anga Gaurava (Feeling of heaviness), Rakta Lochanata (Redness of eyes).

Rupa (Signs and Symptoms)[13]

Varti Damshta Samsthana Shotha (Inflammation like an insect bite), Kandu Bahula (Sever itching), Toda Bahula (Excessive pain like pricking), Chardi (Vomiting), Jvara (Fever), Vidaha (Burning Sensation), Ksanikotpatti Vinasha.

Samprapti Ghataka

  • Dosha: Tridosha
  • Agni: Mandagni
  • Vyadhimarga: Bahya
  • Dushya: Rasa, Rakta
  • Srotas: Rasavaha, Raktavaha
  • Srotodushtiprakara: VimargaGamana
  • UdbhavaSthana: Aamashaya
  • VyaktiSthana: Tvak
  • Svabhava: Ashukari

General Examination

  • Pulse : 82/min
  • P. : 110/80 mmHg
  • RR : 20/min
  • Temp : 98.2°F
  • Weight : 67Kg
  • Height : 5.3”
  • Appetite : anorexia
  • Sleep : disturbed

Table 1: Ashtavidha Pariksha of patient

SNNameLakshana
1.Nadi (Pulse)Pitta-Kapha predominant
2.Mala (Stool)Malavrodh
3.Mutra (Urine)Samyak
4.Jivha (Tongue)Alpasama
5.Shabda (Speech)Spashta
6.Sparsha (Touch)Anushnasheeta
7.Druk (Eyes)Samyak
8.Aakruti (Appearance)Madhyam

Assessment Criteria

Assessment of patient was done on the basis of improvement in subjective parameters like Kotha (inflammation), Kandu (itching), Daha (burning sensation).

Table 2: Objective Criteria[14]

Urticaria Activity Score (UAS) as per Indian Journal of Dermatology

ScoreWheals/24 hrsPruritus
0NoneNone
1Mild: < 20 wheals over 24 hrsMild present but not troublesome
2Moderate: 20-50 wheals over 24 hrsModerate: Troublesome but doesn’t interfere with daily routine or sleep
3Severe: > 50 wheals over 24 hrs or large area of whealsSevere pruritus which is sufficiently troublesome to interfere with daily activity or sleep

Table 3: Subjective Criteria

SymptomsMildModerateSevere
Kotha (Raised oedamatous wheals of pink red colour)123
Kandu (itching)123
Toda (pricking sensation)123
Daha (burning sensation)123

Table 4: Treatment Protocol

SNMedicationsDosageAnupanaDuration
1.Haridra Khanda1 tsf BDMilk3 months
2.Dushivishari Agad2 Tab BDLukewarm water1 month
3.Bilwadi Gutika2 Tab BDLukewarm water1 month
4.Avipattikar Churna1 tsf HSLukewarm water15 days
5.Maricha Churna1 tsf BDGhrit1 month

Observations and Results

Following the treatment, improvement in the patient’s signs and symptoms started to visible within 15 days following the treatment. Significant relief was found in Kandu (itching), Daha (burning sensation), Shoth (inflammation) upto second visit. Satisfactory improvement in Kandu were seen.


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jaims_3407_01.JPG
Image 1: Erythematous wheals on the skin
jaims_3407_02.JPG
Image 2: Erythematous wheals on the skin

Table 5: Observation

SNSymptomsObserved Score
Before TreatmentAfter Treatment
1.Kotha (Raised edematous wheals of pink red colour)31
2.Kandu (itching)31
3.Toda (pricking sensation)20
4.Daha (burning sensation)30

Table 6: Pathya-Apathya[21]

Pathya AharaApathya Ahara
1.  Jererna Shali
2.  Jangala Mamsa
3.  Triphala
4.  Madhu
5.  Mudga Yusha
6.  Kulattha Yusha
7.  Ushnodaka
8.  Karkotaka Shaka
9.  Karavellaka Shaka
10. Moolak Yusha
11. Dadima Phala
12. Shigru Shaka
13. Moolaka Shaka
14. Vetragra Phala
15. Potika Shaka
16. Lava Rasa Tittira Rasa		1.  Ksheera Vikarani
2.  Chhardi Nigraha
3.  Ikshu Vikarani
4.  Divaswapna
5.  Matsya
6.  Poorva and Daksheena Disha Pavana
7.  Anupa-Audak Mamsa
8.  Snana
9.  Naveena Madhya
10. Atapa Sevana
11. Virudhahara
12. Vyavaya
13. Snigdha, Amla, Madhura
14. Dravya, Guru Annapana

Discussion

Sheetapitta is commonly encounter Twak Vikara in clinical practices. A variety of etiological factors are responsible for triggering the disease. So, for the treatment of Sheetapitta (urticaria), drugs acting on different causative factors is the key line of treatment. Ayurveda has a vast concept of Pathya and Apathya and it also believes that prevention is always better than cure so the first line of treatment is Nidana Parivarjan as food plays a major role in aggravating the symptoms of urticaria. In modern medicine, there is widespread treatment modalities available but persistent usage of steroids and antihistamines can cause hazardous consequences to the human health. There are higher chances of recurrence rate thus it is essential to find out the effective treatment which will eliminate the disease from its root cause.

Haridra Khanda[15],[16] - Haridra Khanda is the drug of choice for Sheetapitta mentioned by Bhaishajya Ratnavali. It is a potent anti-allergic drug, it has anti-bacterial and anti-microbial properties.

Dushivishari Agada[17] - Most of the ingredients are Katu, Tikta Rasatmaka and Katu Rasa possess Krumihar, Kushthar and Vishaghna properties, it clears Kapha and Kleda from Strotas.

Bilwadi Gutika[18] - Majority of the drugs of Bilwadi Agad are Tikta, Katu Rasa Pradhan and are Ushna Veerya (hot potency) and Katu Vipaki thus, can act as Vishaghna and Keetaghna.

Avipattikar Churna[19] - It causes Raktaprasadana by eliminating Dushta Kapha, Pitta Dosha and Kleda from Rasa and Rakta Dhatu.

Maricha[20] - Maricha contains active principle called piperine because of which it performs anti-inflammatory effect. Ayurveda has a considerable amount of potential in treatment aspect of allergic skin diseases by using various formulations followed by Pathya-Apathya.

Conclusion

Before treatment, assessment and examination of patient was done on the basis of Urticaria Activity Score (UAS). The diagnosis was done that the patient was suffering from grade 3 urticarial phase. After a month of taking continues


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treatment, the grading of Urticaria Activity Score (UAS) and clinical features of a patient were reduced significantly. Remarkable changes were evident after 2 months of treatment with above mentioned medicine. This single case report concludes that Ayurvedic management with Shaman Chikitsa offers excellent result in the treatment of Sheetapitta.

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