Introduction

Herpes zoster is also known as Shingles. It is acute viral infection of the nerve cells and surrounding skin. Characterized by a blister, itching, burning, or tingling sensations, can be very painful but is not life threatening. Caused by the varicella zoster virus that also causes chickenpox, though the virus remains in the body in a dormant state and can reactivate later, often triggered by factors like stress, illness, sun exposure, or a weakened immune system. Shingles usually appears, band of blisters on one side of the chest or back, but it can occur anywhere on the body, including on the face and near the eyes. When VZV reactivates in the trigeminal nerve, which is the fifth cranial nerve, it can affect one or more of its three major branches: the ophthalmic (V1), maxillary (V2), and mandibular (V3) branches. Herpes zoster in the mandibular branch (V3) of the trigeminal nerve^[1] involves the lower part of the face, including the chin, lower lip, teeth, gums, and jaw.^[2] Throughout the world, the incidence rate of herpes zoster every year ranges from 1.2 to 3.4 cases per 1,000 healthy individual, increasing to 3.9-11.8 per year per 1000 individuals among those older than 65 years.^[3] High incidence group is anyone who had chickenpox and people over the age of 50. Incubation period 10- 12 days, it is self-limiting disorder but unlike chicken pox the rash is very painful and even after it disappears, the pain may persist specially in the elderly due to post herpetic neuralgia.

Treatment includes antiviral medications can help reduce the severity, frequency, and duration of outbreaks. These medications, such as acyclovir, famciclovir, or valacyclovir, are often used to manage the infection, and topical treatments can alleviate symptoms. Additionally, lifestyle changes, such as avoiding triggers and boosting immune health, can help prevent outbreaks.

The disease, in which spreading is very rapid in different directions, is known as Visarpa in Ayurveda.^[4] According to Charka Samhita, Tridosha vitiation along with Rakta Dhatu and rapid spreading are the key features of Visarpa.^[5] Susruta Samhita has mentioned that Visarpa in one of the Kshudra Kushta is caused by Twaka (skin), Rasa, Rakta, and Mamsa Dhatu vitiation, resulting in increased inflammation, and eruptions causing other local or systemic symptoms.^[6]

Dashavidha Pareeksha

Process of disease manifestation

Nidana:

Ahara - 10 days prior to the appearance of the lesions, increased consumption of milk, curd, salt, sour food, spices, chicken, fish, oil fried food, consumption of food before digestion of previous meals.
Vihara - Excessive exposure of sunlight, Ativyavaya

Poorva Rupa:

Sensation Crawling of insect in face and light headache.

Lakshana:

Vasical, sever pain, burning sensation, spreading in nature, swelling.

Samprapti Ghataka

General Examination

This ointment is mainly indicated in burning and wound healing.

Follow-up and outcomes

Leech therapy was administered on the first day of rash onset at the site of the blister. The patient experienced relief from the severity of burning pain and other symptoms, and both the rash and blisters subsided.

Changes observed during subsequent follow-ups are shown in the images: Fig. 1 shows the first sitting of Jalouka application, Fig. 2 shows the second sitting, Fig. 3 shows the third sitting, and Fig. 5 shows the patient after completing the treatment.

Fifteen days later, the patient developed right-sided headache, which was treated with Tab. Vatavidwamsa Rasa, 7 days BD after food. The pain gradually subsided.

Intervention

Showing gradual improvement day by day

Right side of mandible and Right Side of temporal

Figure 1: 1st sitting of Jalokavacharana

and Patolakaturohinyadi Kashaya, along with local application of Gairika with Grutha.

Shodhana Chikitsa

Raktamokshana was done through Leech therapy, helps in treating Visarpa by improving circulation, reducing inflammation, and promoting detoxification through the anticoagulant and anti-inflammatory properties of compounds in leech saliva, such as hirudin and hyaluronidase. In modern science, these effects aid in tissue healing, pain relief, and the removal of toxins from the affected area. In Ayurveda, Visarpa is understood as an imbalance of Pitta (fire) and Rakta (blood), and leech therapy is used to draw out excess Pitta and purify the blood, helping to alleviate the infection and inflammation.

Shamanaushadi

Patolakaturohini Kashaya: It contains Patola (Trichosanthes dioica), Katurohini (Picrorhiza kurroa), Chandana (Santalum album), Madhusrava (Marsdenia tenacissima), Guduchi (Tinospora cordifolia), Patha (Cissampelos pareira). Combination of these herbs balance Pitta and Kapha Doshas, with their Tikta (bitter), Kashaya (astringent), and Madhura (sweet) Rasa properties providing cooling, anti-inflammatory, and healing effects. Phytochemically, they contain compounds like alkaloids, flavonoids, glycosides, and saponins, which exhibit strong anti-inflammatory, antimicrobial, and antioxidant properties, reducing swelling, redness, and infection. Additionally, they detoxify the body, support immune function, and promote skin healing.

Kamadugha with Moukthik: It contains Pravala Bhasma 1 part, Shouktik Bhasma 1 part, Kapardika Bhasma 1 part, Shankha Bhasma 1 part, Shuddha Suvarna Gairik 1 part, Guduchi Satva 1 part.

The Ayurvedic formulations for treating Visarpa (skin infections like herpes or shingles) include a combination of mineral - based Bhasmas and plant - based remedies, each offering unique therapeutic benefits to balance the Pitta Dosha, reduce inflammation, detoxify the body, and support the immune system. Pravala Bhasma, rich in calcium, magnesium, and trace minerals, promotes skin healing and immunity by reducing inflammation and detoxifying the body. Shokthik Bhasma, with its zinc and copper content, accelerates recovery by reducing pain, redness, and swelling,

this treatment can help absorb excess moisture, control infection, and balance the Pitta Dosha, aiding in faster recovery and relief from symptoms like swelling, heat, and burning sensations.

Conclusion

In conclusion, the successful management of Visarpa in this case study was achieved through the integration of Jaloukavacharana (leech therapy) and unique formulations. The symptoms of Toda (tingling), Daha (burning sensation), and Pidaka (blisters) pointed to a Pitta-dominant imbalance, with the vitiation of Rakta Dosha playing a key role in the manifestation of the condition. The application of leech therapy helped draw out impure blood, reducing the excess Pitta and alleviating the associated symptoms, while the customized herbal formulations targeted the restoration of imbalanced Dosha. This combined approach not only addressed the symptoms but also focused on correcting the underlying Doshic imbalance, shows the effectiveness of Ayurvedic treatments in managing viral skin diseases like Visarpa.

References