E-ISSN:2456-3110

Case Report

Vidanga Churna

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Management of Charmakeela by Viddha Karma followed by Arka Ksheeradi Lepa externally and Vidanga Churna orally

L Manonmani1*, Arun V2
DOI:10.21760/jaims.9.8.52

1* L Manonmani, Principal and HOD, Shalya Tantra, Tmaes Ayurvedic Medical College, Hospet, Karnataka, India.

2 Veena Arun, Medical Practitioner, Sharma Ayurveda Vaidyashala Jayanagar, Bangalore, Karnataka, India.

Introduction: Charmakeela is one of the most common skin disorders affecting the children and teenage group by and large. It can be correlated to warts according to modern science owing to signs and symptoms. The incidence rate of EGW (extra genital warts) =10% Approx. Globally, 2-25% approx. India. The Incubation period of warts is around 90 days and the high recurrence rate in various modern treatment modalities.

Aim: To evaluate the efficacy of Viddha Karma followed by Teekshna, Lekhana, Ropana, Krimighna properties of Arka Ksheera and Haridra Churna externally and Vidanga Churna Orally.

Objectives: To arrive at a cost effective result oriented medication with least recurrence.

Materials and Methods: A lean built Female patient, presenting with multiple warts on both the palms was selected from T.M.A.E’S AMC Hospital, Hospet. The patient was treated with Vidanga Churna (0-0-5mg) with hot water bed time and with aseptic precautions a 2ml syringe needle was taken and random pricks were made on the surface and surrounding the warts. This was followed by application of Arka Ksheera mixed with Haridra Lepa and was bandaged. The procedure was repeated once a week for 5 weeks.

Results: A significant reduction in the size and other symptoms of warts was seen by 2 weeks and by the end of 5weeks the palms were completely clear and appeared normal. After a regular follow upto 8 weeks with oral medication alone no recurrence was noticed.

Conclusion: The treatment was successful in warding off recurrence and effectively curing all warts with economical, noninvasive technique.

Keywords: Charmakeela, Warts, Arka Ksheera, Haridra, Vidanga Churna, Viddha Karma, Sterile Needle

Corresponding Author How to Cite this Article To Browse
L Manonmani, Principal and HOD, Shalya Tantra, Tmaes Ayurvedic Medical College, Hospet, Karnataka, India.
Email: 		L Manonmani, Arun V, Management of Charmakeela by Viddha Karma followed by Arka Ksheeradi Lepa externally and Vidanga Churna orally. J Ayu Int Med Sci. 2024;9(8):326-330.
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https://jaims.in/jaims/article/view/3453

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-13 2024-07-23 2024-08-03 2024-08-13 2024-08-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.36

© 2024by L Manonmani, Arun Vand 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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L Manonmani et al. Management of Charmakeela by Viddha Karma followed

Introduction

The very purpose of this case study is to reach the indigent category of population through non-invasive, cost-effective treatment mode. Wart being most frequently affecting the teenage population at large an attempt has been made for a remedial measure.

EGW is a most common disorder with most cases reported between ages of 12 to 16 yrs. Among the common types viz. verrucca vulgaris, filiform, verruca plana and condylomatous warts, Verucca Vulgaris (palmar warts) was chosen for this case study, the main symptoms being pain, itching, discomfort with or without discharge.

Depending on the site manifestation of warts shows its impact on life varying from pain to guilt, so also social stigma when it occurs on exposed body parts. Its treatment available at present are: Applications like,

  • Salicylic acid, liq. N2 and Podophyllin[1]
  • Loop electro surgical excision
  • CO2 laser surgery
  • Interferon injection

The Chramakeela falls under the category of Kshudra Rogas mentioned by our Acharyas. Here are the textual references of this skin disorders. The Utpatti of the word Charma Keela is as under Charma, is derived from two words चर् and म, च + सर्वधतुभ्योमनिन्[2] Where चर् is a धातु, म is a प्रत्यय।[3] कील is derived कील्यतेरुद्यतेसौअनेनअत्रावा। from

Definition: चर्मनिगुह्यस्यचर्मानिकीलईवेतिवा।

A nail like growth developed on skin surface or in private parts is called as Charmakeela.

Charma: that means things which shield.

Keela: that means things which bind like pin, bolt or wedge etc.

Charmakeela can be defined as hard nail like growth on the surface of the skin. The Pathogenesis of Charmakeela is due to the aggravations of Vyana Vata which unites with Kapha giving rice to Sprouts like or Nail like eruptions on the surface of the skin which is immovable in nature, there can be involvement of all Tridoshas where in deranged Vayu dislodges Kapha from its site which manifests as rough hard growth on the skin.

It may present itself with symptoms of Vata- Toda, Parushatva and pricking pain with rough surface. Kapha - Savarna (same color as skin) and Grathita (knotty in texture) Pitta - Peeta (Yellowish White), or with Peetaabha Swetha Krishna (Black) Kandu (Srava, Itching and discharge etc. through the entire the lesion.

According to Samprati, Lakshana and Chikitsa described by Acharya Shusrutha, Charmakeela can be compared with warts.[4]

According to modern science

Definition: A benign lesion occurring in the mucosa of the skin commonly caused by HPV which can spread from one location to other and person to other by contact[5] is called was warts.

The treatment modalities in Ayurveda being

  • Agni Karma [6]
  • Kshara Karma[7]
  • Chedana Karma[8]

Viddha Karma was adopted as one of the treatment modalities followed by Lepana and oral medicine in this case study.

Case Report

A lean built female patient presenting with multiple warts on both the palms and digitals was selected from TMAE‘S AMC Hospital and research Centre Hospete.

History of present illness

The patient was complaining of pain, discomfort and itching, whitish yellow coloured multiple rough eruptions on both the palms since 4 to 5 months which was hampering her household chores.

Previous history: Nil

Personal history: Nil

General Examination

Appetite: Low

Habit: Wearing others clothes and using public washrooms

Bowel: Once daily

Micturition: 4 to 5 times per day

Sleep: Disturbed


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L Manonmani et al. Management of Charmakeela by Viddha Karma followed

Occupation: Laborer, housemaid

Icterus: Pallor

Clubbing: Absent

Cyanosis: Absent

Lymphadenopathy: Absent

Height: 135cm

Gait: NAD

Tongue: Slightly Coated

Systemic Examination

Per Abdomen: Soft

CVS: NAD

CNS: NAD

RS: NAD

Local Examination

O/E Inspection

Site: Palmar aspect

Size: Multiple lesions varying from 2 to 10mm

Shape: Varied from round to spherical

Numbers: Multiple

Surface: Rough, spherical

Discharge: Absent

Color: Pale Yellow and Whitish

Surrounding Area: No Redness

On palpation

Tenderness: present

Sensation: intact

Reducibility: irreducible

Compressibility: Non compressible

Bleeding on touch: Absent

Consistency: Firm and hard

Temperature: NAD

Investigations

Before the treatment

Hb: 11.5 %

BT: 1.4 Sec

CT: 3.5o Sec

RBS: 104 Mg/Dl

HIV: Negative

HBSAg: Negative

Aim

To evaluate the efficacy of


  • Viddha Karma
  • Tikshna, Lekhana, Ropana, Krimigna properties of Arka Ksheera, Haridra Churna externally
  • Vidanga Churna internally

Objectives

To arrive at:


  • Cost effective Management
  • Non invasive technique
  • Result oriented medicines
  • Least recurrence

Materials


  • 2 Ml Sterile Syringe Needle
  • Containers with
  • Triphala Kashaya,
  • Latex of Arka
  • Haridra Churna
  • Vidanga Churna
  • Johnsons ear buds

Method

Fresh latex of Arka was collected from TMAE’S Herbal Garden and all the above materials were kept ready to follow the procedure as under -

Purva Karma

The patient’s hands were first washed with soap and hot running water and then washed with Luke warm Triphala Kashaya. The patient was made to lie down on supine position on the bed.


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Pradhana Karma

Random pricks were made with needle on the surface and surrounding areas of warts. Care was taken to prick superficially to avoid bleeding. Later Lepa was applied with Johnson ear bud dipped in Arka Ksheera, and covered the entire surface area including periphery and lesions. Once the latex became sticky Haridra Churna was sprinkled on the entire surface of the wound.

Paschat Karma

After the latex completely dried the wound was covered with gauze and bandaged. The patient was kept under observation for 3 hours and was advised to take Vidanga Churna (0-0-5mg) with hot water at bed time throughout the course of the treatment. The above procedure was repeated once a week for five weeks. Follow up was done till eight weeks.

Assessment criteria

Observation

Subject criteria1st day1st week2nd week3rd week4th week5th week6th week7th week8th week
Pain865310000
Burning sensation431000000
Itching532100000

Grading

For pain - VAS Scale was used
jaims_3453_01.JPG

For Burning Sensation

Cat-1: Mild - 0 to 3

Cat-2: Moderate - 4 to 5

Cat-3: Severe - more than 5

For Itching

Cat-1: Mild - 0 to 3

Cat-2: Moderate - 4 to 5

Cat-3: Severe - more than 5

No of Weeks

Y Axis: 1 Week = 0 to 1

X Axis: one category = 1 column

Burning Sensation
jaims_3453_02.JPG

Itching Sensation
jaims_3453_03.JPG

Y Axis: No of weeks

X- Axis: Itching Sensation

Green Bar = Timings 4 to 5 Min in a day per week

Red Bar = Frequency 15 to 20 Times in a day per week

Results

A significant reduction in the size of warts along with symptoms like Itching, pain & discomfort consistently on 1st, 2nd, 3rd & 4th Week subsequently and palms appeared normal by 5th week. After regular follow up till 8 weeks with oral medication throughout the course of the study, no recurrence was noticed.

Rasa Panchaka[10]

SNDrugRasaGunaVeeryaVipaka
1.Arka KsheeraTikta, Lavana Ushna, Snigdha Ushna Katu
2.VidangaKatu, KashayaLaghu, Ruksha, Tikshna Ushna Katu
3.Haridra Tikta, Katu Laghu, Ruksha Ushna Katu

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Chemical composition[11,12]

Pharmacological ActionsArkaVidangaHaridra
Anti- inflammatoryHexane, dichloromethane, ethylacetate-n-butanolTanninCurcumin
AnalgesicEthanol-Alpha phellandrene
Anti ulcerHydro-alcoholic--
Anti keloidalLatex--
Wound healingAqueous extract, ethanolic extractEthanol extract, Embela-
Anti-bacterial--Curcumin
Anti-cancer--Alpha phellandrene
  • Hexane, dichloromethane, ethylacetate-n-butanol in Arka, Tannin in Vidanga and Curcumin Haridra which are anti-inflammatory act on the warts to reduce the size and inflammation.
  • Ethanol and Embela in Vidanga helps in faster the epithelization, It also helps in high rate of wound contraction through collagenation.
  • Ethanol and Alpha phellandrene have analgesic effect.
  • Hydro-alcoholic, Aqueous extract, ethanolic extract and Latex helps in anti-ulcer, anti-keloidal, wound healing effect.
  • Curcumin acts as antibacterial and Alpha phellandrene acts as anti-cancerous activity.

Conclusion

The combined effect of all the above mentioned drugs has helped in destroying the HPV and curing the warts. Viddha Karma has helped in removal of clogging of the warts surface to channelize the medicine to enter into deeper tissue there by facilitating and hastening the healing process.

The latex of Arka has worked by disseminating into all the warts to reach deeper tissues there by producing the medicinal effect to the entire warts from the surface to the base.

Haridra being antiseptic, anti-inflammatory has helped to prevent the spread of infection. Even though above study has given successful results and proved efficient, a prospective study regarding the above drugs is required to obtain a complete analysis of drug.

References

1. Manthappa M. Manual of Medicine, 3rd ed, CBS Publishers, 2021

2. Mahamahopadhyaya Pandita Shivadatta dadimatha, Amarakosha Delhi, Choukhambha Sanskrit Pratishtana 1915.
3. ShabdaKalpadruma by Raja Radhakanta Deva 3rd Edition 1976, Choukhambha Sanskrit Series, Varanasi.
4. Shusruta Samhita, with Dulhana Commentary edited by Priyavrat Sharma Varanasi, Choukhambha Orientalia 1st Edition-2000, Nidana Sthana Chapter2 Shloka 18-20.
5. K Rajagopal Shenoy, Anitha Nileshwar, Manipal Manual of Surgery, 6th Edi, New Delhi. CBS Publishers and distribution, Satishkumar Jain-2023 Vol-01
6. Vagbhata Ashtanga Sangraha, Edited and commented Vaidya Yadunandan Upadhyaya, 14th Edition 1979, Nidana Sthana Chapter-57
7. Shusruta Samhita, with Dulhana Commentary edited by Priyavrat Sharma Varanasi, Choukamba Orientalia 1st Edition-2000, NidanaSthana Chapter 13 Shloka 03.
8. Vagbhata Ashtanga Sangraha, Edited and commented Vaidya Yadunandan Upadhyaya, 14th Edition 1979, Nidana Sthana Chapter-57, Shloka 47 to 48.
9. Shusruta Samhita, with Dulhana Commentary edited by Priyavrat Sharma Varanasi, ChoukambaOrientalia 1st Edition-1999 Sutra SthanaChapter 12 Shloka 10.
10. Neelakanteshwar, Ayurvedic Remedies for common skin diseases Delhi. Choukhambha Sanskrit Pratishtan 2009.
11. Acharya Priyavat Sharma, Dravyaguna Vijnana, Varanasi, Choukhambha Bharati Academy 2018, Haridra Vol-2 Pg -694, Arka Vol- 2 Pg -433, Vidanga Vol-2 Pg -503
12. Vinayaka, Bhavamishra, Bhavaprakash Nighantu Varanasi, Choukhambha Orientalia Academy.


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