E-ISSN:2456-3110

Review Article

Shwitra

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 2 FEBRUARY
Publisherwww.maharshicharaka.in

Shwitra - A Pragmatic Clinical Approach

Pandey M1*, Sharma A2, Chaturvedi P3
DOI:10.21760/jaims.10.2.34

1* Manisha Pandey, Post Graduate Scholar, Department of Panchakarma, Pt Khushilal Sharma Govt Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India.

2 Ashish Sharma, Post Graduate Scholar, Department of Dravyaguna, Pt Khushilal Sharma Govt Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India.

3 Preeti Chaturvedi, Reader, Department of Panchakarma, Pt Khushilal Sharma Govt Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India.

Shwitra is a condition characterized by whitish discoloured patches on the body. The word is derived from Sweta in Sanskrit which means white patches. It is caused due to the involve of Saptkodravya. The fourth layer of Twaka that is Tamra. It is mainly considered as a prime location of Shwitra. The disease can be equated with vitiligo and the two terms Leukoderma and vitiligo are used synonymously by most of the physician. But a little bit difference exists between their two terminology the paper reports some classical reference of Shwitra & its various pragmatic treatment.

Keywords: Shwitra, Leukoderma, Kushta, Pragmatic treatment

Corresponding Author How to Cite this Article To Browse
Manisha Pandey, Post Graduate Scholar, Department of Panchakarma, Pt Khushilal Sharma Govt Ayurvedic College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Pandey M, Sharma A, Chaturvedi P, Shwitra - A Pragmatic Clinical Approach. J Ayu Int Med Sci. 2025;10(2):243-248.
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https://jaims.in/jaims/article/view/4327

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-01-13 2025-01-23 2025-02-03 2025-02-13 2025-02-25
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© 2025by Pandey M, Sharma A, Chaturvedi P and 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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Download PDFBack To ArticleIntroductionMaterials and MethodsDiscussionConclusionReferences
Manisha P et al. Shwitra - A Pragmatic Clinical Approach

Introduction

Nowadays, everyone is concerned with their appearance. Skin beauty represents both physical and psychological health. Skin is a mirror that reflects external and internal pathology, aiding in disease diagnosis. Various skin problems affect approximately 20-30% of the world's population.[1] Skin complaints affect people of all ages, from newborns to the elderly, and cause harm in a variety of ways, including discomfort, disfigurement, disability, and so on. Kushtha represents all types of Skin disorders in Ayurveda. Kushtha is divided into two types: Maha Kushtha and Kshudra Kushtha. Sushruta later mentions Shwitra as a different form of Kushtha.[2] Shwitra differs from Kushtha in terms of chronicity and hereditary history, as well as involvement of Twak Only, non-infectious nature of disease, Nidana, Asadhya Lakshana. Shwitra is similar to Vitiligo in terms of signs and symptoms. Vitiligo is a progressive disease marked by hypopigmented white patches. Because of the disease's chronicity and a lack of proper effective treatment, patients become demoralized. In modern science, PUVA (Psoralen + Ultra Violet A exposure) therapy and corticosteroids are primarily used for disease treatment, but these therapies have numerous negative side effects. Patients were treated with an Ayurvedic polyherbal powder mixture containing Psoralia corylifolia (Bakuchi) as the main ingredient supplemented with local application and phototherapy (natural). Most of the patients undergo intermittent Sodhana and Shamana Chikitsa. With these chikitsa sutra, certain local application also gives excellent results in minor skin conditions and also relives the symptoms in severe skin pathologies and restores the disfigurement (Varnyaprasadan Karma) and helps in wound healing (Varnaropan Karma).

In classics, the chikitsa is classified into Antahparimarjan and Bahiparimarjan Chikitsa. The Bahiparimarjan is the local application of medicines in various forms. Lepa is one of them. Application of drugs in the paste form over the concerned body part is a widely acceptable form of Lepa preparation. In Visarpa Chikitsa Charaka has mentioned the method of preparation, utility, duration, thickness, operating procedure and combination of drugs. In Kustha Chikitsa Acharya Charaka has mentioned to use these Lepa after achieving proper Sodhan of Rugna.

Pathogenesis (Samprāpti)

Though Samprapti of Shwitra has not been explained directly in Ayurvedic classics, but all the general Nidana explained under Kushtha Nidan Sthan chapter 5th, here an attempt has been made to formulate and explain the pathogenesis of Shwitra. Due to frequent intake of one or all of the above said Nidanas leads in to formation of toxins (Ama) which further provoke or vitiates all Doshas and which get mixed with digestive juice (Pitta) and then Rasa Dhatu and so on it spreads from one Dhatu to next Dhatu. Thus, the vitiated Doshas spreads from the Koshtha (alimentary tract) to the Shakha (body tissues).

While travelling through all over the body wherever there is Sthanavaigunya (deformity in location) it gets lodged and shows the symptoms of the diseases. Then, these vitiated Doshas move in Triyakgata Siras and get lodged in Tamra layer of Twacha (skin) causing Sanga or obstruction to the local Rasavaha Srotas (lymph or plasma carrying channels) and Raktavaha Srotas (blood carrying channels). The reason behind Dosha Dushya Sammurchana in Tamra layer of Twacha is due to the presence of Khavaigunya (deformity in structural entity) in the respective areas of Twacha.

This leads to the Kshaya (decline) of local Bhrajakapitta and causes Twak Shwetata. Further the Sampapti continues and the deeper Dhatus like Mamsa and Medas are also involved. The involvement of each Dhatu exhibits specific discoloration on the patches. Doshas settled in Rakta Dhatu produces Rakta Varna, Mamsa Dhatu produces Tamra varna and Shweta varna when settled in Medo Dhatu. These altogether involved invariably in different grades and produce white macules all over external surface of the skin causing Shwitra Kushta.

Though all the three Doshas are involved, mainly vitiated Udanavata and Bhrajakapitta are held responsible because these two are responsible for maintenance of color of Twacha. The functioning of Vyanavata cannot be neglected as it is the main motivating force behind the movement of Dushta Dosha along with Rasa. According to Sushrut the pathogenesis of Shwitra is restricted up to level of skin only. It cannot reach further deeper level and also it is devoid of secretions. The elements involved in pathogenesis of disease are listed in table:


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Samprapti Ghatakas of Shwitra

1.  DoshaTridosha (Kapha Pradhana)
2.  DushyaRasa, Rakta, Mamsa and Meda
3.  AmaJatharagni and Dhatwagni
4.  AgniJatharagnimandya and Dhatwagnimandya
5.  SrotasRasavaha, Raktavaha, Mamsavaha and Medovaha
6.  SrotodushtiSanga
7.  AdhishthanaTwak (Rakta, Mamsa and Meda)
8.  Udbhava SthanaAmashaya (Twak)
9.  Roga MargaBahya
10. VyaktasthanaSharira (Twak)

The exact pathogenesis of vitiligo is still not fully elucidated and it remains obscure in spite of all recent findings, genetic, immune and oxidative stress factors etc., However, it is postulated that vitiligo is a multifactorial, polygenic disorder, with a complex pathogenesis. Western science explains it as a condition caused due to improper distribution of the melanin (impaired melanocyte production) beneath the skin surface.

Materials and Methods

Acharya Sushruta and Acharya Sharangadhara has mentioned the different classifications of Lepa in their test, on other hand Acharya Charaka has mentioned the way of its application. In Charaka Visarpa Adhyaya Acharya gave the following rules for Lepa applications.

Synonyms: Llipta, Lepa, Lepana.

Definition: A type of therapy, wherein paste of drug is applied topically to the affected part.

Importance of Lepa Kalpana: By pouring water over a burning house, the fire is extinguished immediately; in the same way the Lepa pacifies the provoked local Dosha by local application. Moreover, it also has actions like Sodhana, Utsadana, Ropana and Pralahdan. (Su. Chi.1/15)

Types of Lepa - According to Acharya Sushruta there are 3 types of Lepa as follow

1. Pralepa: Sita Guna, Tanu(thin), Visoshi or Avisoshi
2. Pradeha: Hot or Cold, thick or thin and
3. Alepa: It is having moderate characters of both Pralepa and Pradeha.

Asthanga Samgraha has given 10 types of Alepa:[3]

1. Snaihika: Used in Vatika Shopha.

2. Nirvapana: Used in Pitta, Visha, Kshara and Agnijanya Vranas.
3. Prasadana: Used to Rakta Dushti.
4. Sthambhana: Used for Raktha Sthambhana.
5. Vilayana: Used in Kapha and Medo vitiated
6. Pachana: Lepa of Sheeta and Ruksha Dravyas in Pakva Shopha.
7. Peedana: Lepa of Ruksha and Pichila Dravyas.
8. Shodhana: Used for the Shodana of
9. Ropana: Used in Shuddha Vrana.
10. Savarnikarana: Used to regain the normal texture of skin.

Acharya Vagbhata has given different types of Mukha Lepa according to seasons. He explained about three types: Doshgna, Vishagna and Varnya.[4] Acharya Sharangadhara has classified the Lepa Kalpana based on their therapeuticuses:[5]

Doshaghna Lepa: This variety of Lepa includes such drugs, which exerts their alleviatory action directly on the aggravated local Doshas. e.g. Punarnavadi Lepa.[6]

Vishaghna Lepa: This kind of Lepa includes the drugs that nullifies poisons directly at local level after their application. The drugs used in this Lepa are potent than those in Doshaghna Lepa. e.g. Dashanga Lepa.[7]

Varnya Lepa: This is cosmetic application over the face, which improves colour and complexion. Chandana, Manjistha, Ushira, Shalmali, Sariva, Masoora etc. are some of the drugs that are attributed with Varnya property. Most of the Varnya drugs are Madhura Rasatmaka and Shita, Guru, Snighdha, Mrudu Gunatmaka; Shita Viryatmaka. They alleviate Pitta and Vata. Milk, Butter, Ghee, Oil and other unctuous stuffs are used as bases to prepare VarnyaLepa. e.g. Mukha KantikaraLepa.[8]

Thickness of Lepa: One fourth, one third and half Anguli is the thickness of the Lepa respectively for Doshaghna, Vishaghna and Varnya Lepa. Wet Lepa pacifies the disease whereas dry Lepa causes vitiation of Dosha. (Sa.Utt.11/2)

Thickness of Lepa application should be equal to the thickness of a buffalo skin (3-5 mm approximately) (Su.Su.18/11)

Method of preparation

Kalka Peshita Aushadi Dravya (paste form) should be applied with the width of 1/3 of thumb width.


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Mode of Application

Overapplication of Lepa one over other should be avoided before the previous one gets absorbed fully. Immediate application of second Lepa as soon as the previous one started to dry down (don’t let the Lepa dry completely). For Vaataj, Pittaj and Raktaj Visarpa - Aghana Lepa (Thin) should be applied. For Kaphaj Visarpa - Ghana Lepa (Thick) should be applied. Width of Lepa - Tribhaga Angushta Matra. Lepa should not be Atisnigdha or Atiruksha (too oily or too dry) also should not be in very Pinda or Drava form (too much liquid or solid in consistency). Stale Lepa is not indicated in any conditions.

Mode of Action

According to Ayurvedic medicine Lepa or the topical formulations, should be softly massaged over the skin in an upward or reverse direction of the hairs to speed up and improve the effectiveness of application. As a result, the medicine penetrates the pores at the hair's root, where it is absorbed into the capillary network, travels to small veins, and eventually enters the systemic circulation. This finally leads to the medication's absorption and the intended outcomes. This rubbing technique raises the skin's warmth, which may hasten the drug's pilosebaceous absorption and skin penetration since heat dilates capillary ends. this rubbing technique raises the skin's warmth, which may hasten the drug's pilosebaceous absorption and skin penetration. Twak is the Sthana of Bhrajak Pitta that is in charge of the texture and integrity of skin, according to our classical literature. Numerous Romkupas originate through the Tiryag Dhamanis, which are dispersed throughout the skin like a mesh and act as a mediator of medication absorption in this manner. Twaksaar is Rasasaar According to Charaka, Rakta is also significant during Varnyaprasadan. Sweat escapes through these Romkupa, and Ras Rakta Dhatu also reaches the Romkupa to provide nourishment.

Pragmatic Treatment

Pragmatic treatment aims to improve outcomes in a way that is both realistic and sustainable In modern medicine, It refers to a realistic, practical approach that prioritizes real-world effectiveness, considering the patient's unique context, limitations, and preferences. The goal is to offer therapies that are not only evidence-based but also accessible, cost-effective, and adaptable to the patient's life.

Lepa Kalpana for Shwitra

In Ayurveda, Lepa Kalpana (topical applications) are often prescribed to address skin conditions like Shwitra. Various herbal pastes are created based on the patient’s constitution and the nature of the skin condition. The goal of Lepa is to bring balance to the skin and help regenerate pigmentation or heal the skin.

Acc. to Charak Samhita

  • Mulakbeej + Avalguj + Gomutra (Ch.Chi.7/169)

Acc. to Shushrut Samhita

  • Lakh, Kutha, Sarso, Biroja, Haldi, Sunthi, Maricha, Pippali, Chakramard Beej, Mulak Beej grind with Butter milk and apply these Lepa (Chi.9/12)
  • Saindhav Lavan, Chakrmard Beej, Gud, Nagkesar, Rasoat these all grind with Kapithya Swaras (Chi.9/13 )
  • Swarna Ksheeri, Amaltas, Shirish, Neem, Raal, Kutaj, Shalvriksha Lepa (Ch.Chi.9/15)

Acc. to Ashtang Hridyam

  • Bhallatak Lepa (Chi.20/11) - Bhallatak, Gomutra, Snuhiksheer
  • 1-Krishna Sarpa Mashi, Bibhitaki oil Lepa 2-Sikhipitta Lepa 3-Netrabala (huiber) Bhasma + Bibhitaki oil Lepa (Chi.20/12)
  • Sawarnkar Lepa (Chi.20/12)- Bakuchi Churna (1 Kudav) + Harital (1 pal) + Gomutra
  • Bhallatakadi Lepa (Chi.20/16) - Bhallatak, Chita (dweepi) root, Snuhi root, Arka root, Gunja Phal seeds, Sunthi, Maricha, Pippali, Sankha Bhasma, Tutha, Kuth, Five salt, Yavkshar, Sajjikshar, Kalihari

Acc. to Chakradatta

  • Amaltas Patra, Chakramard Beej, Karanj Beej, Vasa, Guduchi, Madanphal, Haldi (Kushtha50/8)
  • Gandh Viroja, Devdaru, Khadir Twak, Dhataki Pushpa, Neem Twak, Vayvidang-Kaner Twak(Kushtha Chi.50/8)
  • Bhurj Patra nodule, Lahsun, Sirish Twaka, Kashish, Guggulu, Sahijan Twaka.(Kushtha50/9)
  • Maruva, Kutaj Twaka, Chativan Twaka, Pilu Phal, Kuth leeves, Jati(Kushtha Chi.50/9)
  • Vacha, Harenuka Beej, Nisoth-Danti Mool, Bhilawa Geru and Rasanjan(Kushtha50/10)

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  • Madan Phal, Hartal, Grah Dhoom, Ela, Kashish, Lodhra, Arjun Twaka, Nagarmotha, Sarjagal (Kushtha50/10)

Acc. to Gadnigrah

  • Bakuuchyadi Lepa (Kushthadhikar - 36/242) - Seeds of Bakuchi (250gm) Harital (1kg) + Gomutra
  • Vayasyadi Lepa (Kushthadhikar - 36/243) - Makoy, Chakramard, Kuth, Pipar (each in equal amount) + Aja Mutra
  • Marichyadi Lepa (Kushthadhikar - 36/244) - Maricha, Tambul Patra, Kuth, Madanphal, Kashish, Til Tail
  • Patrakadi Lepa (Kushthadhikar - 36/247) - Tambula Patra, Marich, Kashish, Katu Tail, Swarnamakshik, Madanphal Tila Tail
  • Pootikadi Lepa (Kushthadhikar - 36/248) - Pootikaranja, Madar, Snuhi, Amaltash, Jati (each leaves)
  • Bhadrodudumvarikadi Lepa (Kushthadhikar - 36/249) - Snuhi root, Gular root, Kathgular root,

Acc. to Bhel Samhita

  • Guggulu, Durva, Chitrak root, Kadli root, Tulsi root

Acc to Sharandhar Samhita

  • Shwitranashak Lepa - Swarnapushpi, Kashish, Vayvidanga, Manahshila, Gorochana, Saindha Namak all content in equal quantity and grind with water. (Utt.Khand-11/40)
  • Vayasyedgajadi Lepa - Makoy root, Chakramard root, Kutha, Pippali, all content in equal amount & grind with Aja Dugdha. (Utt.Khand-11/41)

Discussion

The primary advantage of Lepa in managing Shwitra lies in its ability to directly address the skin condition by promoting healing, restoring pigmentation, and balancing the doshas locally. By using natural herbs with properties that support Pitta reduction, enhance Rakta Dhatu (blood tissue), and stimulate melanocyte activity, Lepa provides targeted action on the affected areas. Lepa offers a localized, non-invasive method to support and enhance the healing process, potentially leading to better results in terms of skin pigmentation and overall skin health.

Therefore, combining Lepa with holistic Ayurvedic approaches provides a comprehensive treatment strategy, making it an effective option for managing Shwitra.

Conclusion

Lepa is a highly beneficial and effective topical treatment for Shwitra in Ayurveda, offering targeted relief to those suffering from vitiligo. However, its best results are seen when used in conjunction with a holistic Ayurvedic approach, addressing both internal and external factors contributing to the condition. With consistent use and proper guidance, Lepa can be a valuable tool in managing and potentially reversing the effects of Shwitra.

References

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