E-ISSN:2456-3110

Case Report

Vipadika

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Ayurvedic management of Vipadika - A Case Report

Sinsha AS1*, Tiga R2, Mallik PP3, Jena S4
DOI:10.21760/jaims.9.8.37

1* Sinsha AS, Final Year Post Graduate Scholar, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

2 Rashmita Tiga, Final Year Post Graduate Scholar, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

3 Pragya Priyadarsini Mallik, Professor, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

4 Sonalika Jena, Associate Professor, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.

Vipadika, categorized as a type of Kshudra Kustha in Ayurveda, presents as a chronic dermatological condition primarily affecting the palms and soles, characterized by symptoms such as Pani-Pada Sphutana (fissures), Teevra Vedana (severe pain), Manda Kandu (itching), and Saraga Pidika (red patches). Vipadika can be correlated to Palmoplantar psoriasis, which is a prevalent chronic inflammatory skin disorder characterized by erythematous plaques affecting the palms and soles significantly impairing daily function and quality of life. Ayurvedic management of Vipadika emphasizes Shamana Oushadhis aimed at pacifying aggravated Doshas, alleviating manifestations of Vipadika. Integral to this approach are Nidana Parivarjana and Pathya Ahara-Vihara Sevana to prevent recurrence. In the present case, a male patient with complaints of dryness, itching, cracking, scaling, and hyperpigmentation of skin of bilateral feet and bleeding from cracks for the last 6 months came to Kayachikitsa OPD and was diagnosed and treated as Vipadika with the Shamana Oushadhis. The patient's condition demonstrated a substantial improvement, with a marked reduction in symptoms evident within 21 days, suggesting effective management of Vipadika through Ayurveda.

Keywords: Vipadika, Kshudra Kustha, Palmoplantar Psoriasis, Shamana Oushadhi

Corresponding Author How to Cite this Article To Browse
Sinsha AS, Final Year Post Graduate Scholar, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India.
Email: 		Sinsha AS, Tiga R, Mallik PP, Jena S, Ayurvedic management of Vipadika - A Case Report. J Ayu Int Med Sci. 2024;9(8):247-252.
Available From
https://jaims.in/jaims/article/view/3743

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-08 2024-07-18 2024-07-28 2024-08-08 2024-08-13
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.32

© 2024by Sinsha AS, Tiga R, Mallik PP, Jena 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].

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Introduction

Vipadika, categorized as a type of Kshudra Kustha in Ayurveda, manifests as a chronic skin disorder primarily affecting the palms and soles, characterized by symptoms such as Pani-Pada Sphutana (fissures in palm and sole), Teevra Vedana (severe pain), Manda Kandu (itching) and Saraga Pidika (red patches).[1] Acharya Sushruta also explained this under Kshudra Kustha in the name of Padadari.[2]

In Ayurveda, skin disorders like Vipadika are attributed to various factors including Viruddha Ahara, Ati-Drava, Ati-Snigdha, Guru Ahara, Vega Dharana, Asatmya Vihara, Papa Karma, Manasika Bhavas, and exposure to adverse environmental conditions. These Nidanas aggravate the Doshas, causing Agnimandya and inducing Dhatu Shaitilyata. Among the three Doshas, Vata and Kapha, are particularly susceptible to disturbance, infiltrating the Rasa-Raktadi Dhatus, disrupting circulation in the Tiryakgata Siras and settling in the Twak, thereby resulting in Vipadika.[3] According to Acharya Charaka, all types of Kustha are Tridoshaja which vitiate the Twak, Rakta, Mamsa, Ambu collectively causing Kustha.[4] with Vipadika correlating with Palmoplantar Psoriasis.

Psoriasis is a common, chronic inflammatory skin disorder that is characterized by the formation of sharply demarcated, scaly, erythematous plaques.[5] Palmoplantar psoriasis is a variant of psoriasis affecting the skin of the palms and soles presenting with hyperkeratotic, pustular, or mixed presentations. These chronic conditions cause significant functional disability and are associated with marked quality-of-life issues.[6] The prevalence of psoriasis in India ranges from 0.44 -2.8% and is commonly affecting individuals in their third or fourth decade, with males being affected twice as frequently as females.[7]The palmoplantar variant of psoriasis constitutes 3 -4% of all psoriasis cases, affecting 2 -5% of the population.[8]

In contemporary medicine, Palmoplantar Psoriasis is typically managed with corticosteroids, topical therapies, vitamins, and immunomodulators, but recurrence remains a persistent issue. Ayurvedic management of Vipadika, involves Shamana Oushadhis aimed at calming aggravated Doshas, alleviating symptoms like itching, pain, and inflammation, promoting skin health,

preventing recurrence, and emphasizing strategies such as Nidana Parivarjana (avoidance of causative factors) and Pathya Ahara-Vihara Sevana (appropriate diet and lifestyle practices) to avoid relapse.

Patient Information

A 42-year-old male patient came to Kayachikitsa Outpatient Department (OPD) of Gopabandhu Ayurveda Mahavidyalaya & Hospital, Puri in February 2024 with complaints of dryness, itching, cracking, scaling, and hyperpigmentation of skin of bilateral feet and bleeding from cracks for the last 6 months. There was itching and pain which was continuous throughout the day. The patient had developed watery discharge in cracks along with bleeding. The lesions were bilaterally symmetrical.

History of the patient

Past History: No specific history was found.

Family history: No family history found.

On general examination the patient is moderately nourished having blood pressure: 110/80 mm/hg with normal temperature, pulse, and respiratory rate. Other parameters like pallor, icterus, central cyanosis, digital clubbing, edema, and local lymphadenopathy were absent on examination.

On physical examination, the patient was found anxious, with a loss of appetite and a constipated bowel with a coated tongue. Micturition was normal and sleep was disturbed. The patient has a height - of 173 cm & weight - of 74 kg. Habits: Spicy, oily food, Tea (2 times/day)

Clinical Findings

Ayurvedic Examination

Table 1: Nidana Panchaka

NidanaPurva RupaRupaSampraptiUpashaya
Katu, Snigdha, Guru, Abhishyandi Ahara, Vatavardhaka Ahara, Divaswapna,KanduPada sphutana,
Teevra Vedana,
Kandu,
Daha		Nidana Sevana (Aharaja, Viharaja, Manasika)
↓
Causes Agnimandya
↓
Tridosha Prakopa along with Rasa, Rakta, Mamsa, Lasika Dushti
↓
Sanga and Vimargagamana of Dosha
↓
Sthanasamshraya in Pada		Symptoms subsided after taking Shamana Oushadhis

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Kushta Samprapti Ghataka

  • Dosha: Vatakaphaja (Vata Pradhana Tridoshaja)
  • Dushya: Rasa, Rakta, Mamsa, Ambu, Twak
  • Srotas: Rasavaha, Raktavaha, Swedavaha
  • Srotas Dusti: Sanga, Vimarga Gamana
  • Adhisthana: Ama Pakwashaya
  • Vyaktasthana: Twak, Dwipadatala
  • Sanchara Sthana: Raktavaha Srotas
  • Rogamarga: Bahya

Table 2: Dashavidha Pareeksha

PrakrutiVata Pittaanubandhi
Vikruti Rasa, Rakta, Mamsa, Twak, Ambu
SaraAvara
SamhananaMadhyama
PramanaMadhyama
SatvaAvara
SatmyaSarva Rasa, Katu Pradhana
AharashaktiMadhyama
VyayamashaktiAvara
VayaMadhyama

Table 3: Ashtavidha Pareeksha

NadiVata Pitta
MalaBadha
MutraPrakrita
JihwaLipta
ShabdaPrakrita
SparshaUshna
DrikPrakrita
AkrutiMadhyama

Modern Examination of Skin

Inspection

Color: Erythema and Hyperpigmentation

Texture: Rough, Dry, Scaly

Lesions Erythmatous Plaques

Distribution: symmetric and localized to dorsal and plantar regions of both feet

Other: Fissures and erosions on the soles of both feet

Palpation:

Moisture: Dry

Temperature: Warmth to touch

Tenderness: Present especially on Pressure

Texture: Rough

Induration: Present

Diagnosis and Assessment

Based on clinical history and examination the condition was diagnosed.

Table 4: Assessment of Subjective Criteria

PadasphutanaNo cracksCracks on heels onlyCracks on heels and plantar aspectCracks on complete foot0123
VedanaNo pain
Pain after pressing
Pain on touch
Pain without touching		0
1
2
3
KanduNo itching
1-2 times a day
Frequent itching
Itching disturbs the sleep		0
1
2
3
Daha (burning sensationNo burning sensation
Burning during itching
Continuous Burning		0
1
2

Therapeutic Intervention

Table 5: Therapeutic administration

SNMedicineDose/ mode of administrationAnupanaSchedule
1.Mahamanjisthadi Kwatha15 ml
Oral		30 ml Lukewarm waterTwice a day before food
2.Panchatiktaka Ghrita Guggulu500 mg 2 tab
Oral		Lukewarm waterTwice a day after food
3.Arogyavardhini Vati500 mg 2 tab
Oral		Lukewarm waterTwice a day before food
4.Gandhaka Rasayana125 mg 1 tab
Oral		Luke warm waterTwice a day after food
5.Jeevanthyadi YamakaSufficient quantity/External--
6.Sidharthaka YogaSufficient Quantity/External washingParisheka-

Follow-up and outcomes

Table 6: Follow up and outcome according to Subjective Criteria

FeaturesBefore treatmentAfter follow-up (1 week)After 2nd follow-up (2 weeks)After 3rd follow-up (3 weeks)
Padasphutana3321
Vedana3210
Kandu3210
Daha (burning sensation2100

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Figures 1: Before Treatment
jaims_3743_01.JPG

Figures 2: After 1 week of treatment
jaims_3743_02.JPG

Figures 3: After 2 weeks of treatment
jaims_3743_03.JPG

Figures 4: After 3 weeks of treatment
jaims_3743_04.JPG

Discussion

Vipadika is a Vata Kaphaja predominant, Kustha Roga characterised by symptoms like Sphutana (cracks or fissures in the skin), Vedana (pain), Kandu (itching,), etc. typically affecting Pani or Pada.[9] In this condition, there is the involvement of mild Pitta Dosha, along with specific Vata and Kapha Dosha. The predominant Lakshanas of Sphutana and Vedana are due to Vata Dushti, Kandu is linked to Kapha Dushti and mild Daha is associated with Pitta Dushti. Acharya Charaka highlights that the treatment of Kustha should be aligned with specific Lakshanas according to the Doshas.[10]

In the conventional medicine, the management of palmoplantar psoriasis is often limited. Research highlights the role of the immune system, inflammatory cascade, cytokines, and keratinocytes in its pathogenesis, with cytokines playing a crucial role in disease progression, resulting in a cytokine storm.[11]

Therefore, a multifaceted Ayurvedic approach is essential to effectively target the complex pathways involved and manage the disease's chronic and relapsing nature. Manjisthadi Kashayam consists of drugs predominantly possessing Laghu, and Ruksha Gunas, promoting Kledashosha (reduction of excess moisture) due to its Tikta and Kashaya Rasa. The formulation balances Pitta and Kapha Doshas, facilitating Ama Pachana, Agnidipana, and Rakthasodhaka, thereby supporting Rakta Prasadana and acts primarily on the Rasa, Rakta, and Mamsa Dhatus.[12]

Panchatikta Ghrita Guggulu contains ingredients with Tikta Rasa, Laghu, and Ruksha Guna, making it effective in Kandu, Kledameda Upashoshana, and Vranashodhaka properties. Guggulu, characterized by its Katu, Tikta, Kashaya, Madhura Rasa, Ushna Veerya, and Katu Vipaka properties, effectively targets Vikruta Kleda, Meda, and Mamsa Dhatu. According to Rasaratnasamucchaya, Arogyavardhini Vati acts as a Rasayana and Kusthanashaka, while also serving as a Pathya, Dipana, Pachana, Medanasaka, Malashuddhikara and Sarvarogaprasamani. Arogyavardhini acts as Srotoshodhahara and helps in the healing of Vipadika by reducing the dryness and pain.[13]


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Gandhaka Rasayana, through its properties as Agnideepaka, Amapachaka, Amanashaka, Vishahara, Soshaka, and Kriminashaka, plays a crucial role in addressing Kustha Nidana and Samprapti alleviating Dushita Kapha and Visha. Gandhaka Rasayana acts as a Dahanashak, Raktaprasadak, enhances Dhatvagni, Rasayana and reduces Kleda with its Ruksha and Laghu properties.[14]

Jivantyadi Yamaka with the Snigdha Guna of Jeevanti, Goghrita, Tila Taila, and Madhucchista balances Vata and prevent Rukshata in Vipadika. Its Vrana Shodhana and Vrana Ropana properties from Daruharidra, Kampillaka, Tilataila, Sarjarasa, and Manjistha reduce Padasphutana, while Go-Dugdha act as Rasayana. Tuttha and Daruharidra alleviate Kandu, and Kampillaka, Tilataila, and Sarjarasa reduce Vedana and Daha through their Pittaghna properties.[15] Parisheka with Siddharthaka Yoga Kashaya[16] is effective as the procedure is suitable for Tridosha especially in Vata Kapha predominant condition and is having Ushna Veerya, Laghu Ruksha Guna, Kusthaghna and Kandughna property which reduces Vipadika.

Pathya Ahara

Laghu Anna, Tikta Shaka, Purana Dhanya, Jangala Mamsa, Mudga, Patola, Purana Shali, Shashtika Shali, Yava, Godhuma, food and ghee prepared by Triphala, Nimba, Khadira Jala Pana and Aushadha Samskruta Takra. Pathya Vihara Abhyanga with Karanja Taila, Parisheka, Avagaha with Khadira Kashaya, Brahmacharya.

Apathya Ahara & Vihara

Guru Anna, Amla Rasa, Dugdha, Dadhi, Matsya, Guda, Tila, Mamsa, Taila, Adhyasana, Ajirnasana, Vidahi - Abhishyandi Ahara, Divasvapna, Maithuna, Vegadharana, Paapa Karma, Tapa Sevana Svedana, Walking bare foot, excessive walking, exposure to mud, dust, water, winter season.

Conclusion

In Ayurveda, Vipadika is categorized under Kshudra Kustha, characterized by Panipada Sphutana / Teevra Vedana, Kandu, Saraga Pidaka and Daha. The pathogenesis involves the disturbance of Vata and Kapha Doshas, leading to the Khavaigunya associated with Twak (skin), Rakta (blood), Mamsa (muscles), Ambu (plasma).

Kustha, a disease of Bahudosha, Bhuridosha and ‘Saptakodravyasangraha’ is to be treated by adopting repeated Shamana Chikitsa i.e., Bahirparimarjana and Antahparimarjana Chikitsa. The case report highlights the effectiveness of Ayurvedic therapies in reducing the severity of symptoms and improving the patient's quality of life with Shamana Chikitsa.

Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has consented to report his images and other clinical information in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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