Management of Skin Diseases in
Ayurveda with Special Reference to Vicharchika
Dr.Aswathy S.
PG Scholar, Dept. of
Agadatantra, Govt.Ayurveda Colllege, Tvpm
Vicharchika Lakshanam
Vicharchika is characterized
with itching, boil, syaava twak (blakish discolouration) and profuse oozing.
Nidanam
Virudhahara and Dushivisha
are the two major factors responsible for Vicharchika.
Virudhahara
Virudh
(Vi+rudh+ktha) is virodha visishta, distinguished incompatibility.
Dravyas (In short all the
drugs and diet) that which causes uthklesa (agitates, enrages, move
doshas from their normal place) and do not expel it out is termed as virudha.
Types of virudha in samanya kushta nidana
Intake of cilcima
with payas (samyoga virudha), use of santharpana & apatharpana
without sequence (karma virudha), excessive intake of drava snigdha
guru aahaara(mathra virudha), intake of food during ajeerna (vidhi
virudha) Improper administration of panchakarma or apathya in panchakarma.vidhi,ahara
without emesis of vidagdham.(undigested food). Divaswapna soon
after lunch. Sudden diving in cold water or drinking cold water after srama (avastha
virudha)
Important srothas affected by virudha
Mathra virudha
Atimathra sevanam,
guru seetha atisnigdha atimathra sevanam, vidaahi annapanam & snigdhoshna
dravya, medyanam cha athi bhakshanam and atimathra ajirnam will vitiate the
following srotas respectively annavaha, rasa vaha, raktha
vaha,medovaha and purisha vaha srothas.
Vidhi Virudha
Sushkanna sevanam,
abhishyandhi & guru, vaathalaanam cha sevanam, athyabhishandhi and
athyasana ajeerna will vitiate udaka vaha, mamsa vaha, asthivaha,
majjavaha and purisha vaha srotas respectively.
Akaala bhojanam vitiates annavaha
srotas due to Kala virudha and Sithoshna akrama sevanam
vitiates swedavaha srotas due to Karma virudha.
Dushivisha
Dushivisha is defined as any
kind of poison originating from inanimate(stavara) or animate(Jangama)
sources or any artificial poison (Kritrima visha) retained in the body
after partial expulsion or which has provisionally undergone detoxification, by
the anti-poisonous drugs, forest fire, the wind or the sun. The skin
manifestations of the dushivisha also increase due to the same
aggravating factors of dushi visha like dushitha desha, kala, anna, diwaswapna,
ajeerna etc.
Samprapti
Exposure to
etiological factors like Sthavara visha, Jangama visha, Virudhahara,
occupational pollutants etc. undergoes metabolism in the body. In the next step
the toxins undergoes accumulation at the ashaya or dhatu level (Chaya
and prakopa avastha). These toxins get kapha avarana in
due course of time. Up to this level no signs and symptoms are seen. Hence, it
is a subclinical condition. After exposure to secondary like dushitha desha,
Kala, anna, divaswapna, ajeerna etc. vitiation of doshas and dhatus
cause dosha dushya Sammurchana (Prasara avastha). In the next
stage, poorvaroopa (premonitory symptoms) are seen like Angagourava,
jwara, atisara etc. (Sthanasamsraya Avastha)
Subsequently, onset of signs and symptoms are
seen depending on the tissues involved, if rasa dhatu is involved rasa
dushti lakshanas are seen (Vyakti avastha), if raktha dhatu
is involved kushta, visarpa, Kota, raktapitta etc.(Bheda avastha) will occur.
Diagnosis
Diagnosis is on
symptomatic basis. Kandu, Syava, Pidaka, Bahusrava/Lasika
are the main and important symptoms. According to Susrutha samhitha Ruja, Rooksha and Raji are also
present along with the above symptoms.
Comparison
Vicharchika is symptomatically
almost similar to acute eczematous dermatitis. Sub acute eczema also shows some
similarity with Vicharchika. Eczema can be defined as a catarrhal
inflammation of the sensitive skin. The term Eczema literally means ‘boil out’
(ec = out, zema = boil) Eczema clinically represents pruritus, erythema,
oedema, papules, vesicles, scaling and lichenification. Vesicles, through
secondary infection may turn in to pustules. There are three stages of
evolution of eczema, viz acute, subacute and chronic. Acute eczema shows
erythema, oedema, vesicles, oozing, crusts and sometime blisters. Subacute
eczema shows diffuse erythema, oedema, scabbing and scaling of skin. Chronic
eczema depicts moderate erythema, scaling and eventually lichenification. For
practical purposes eczema has been grossly divided in to two main groups:
endogenous and Exogenous. In exogenous eczema the causative factor is one
coming from outside the body, where as in endogenous eczema the factor is an
internal one. Atopic dermatitis, Seborrhoeic dermatistis, Asteatotic
dermatitis, nummular dermatitis, Stasis dermatitis, Autoeczematization etc are
coming under Endogenous Eczema. Exogenous eczema includes contact dermatitis,
infective eczema, photodermatitis, radiational eczema etc.
Sl No.
|
Vicharchika
|
Acute Eczema
|
1.
|
Kandu
|
Pruritus
|
2.
|
Pidaka
|
Papules, vesicles
|
3.
|
Syava
|
Erythema
|
4.
|
Bahusrava/lasika
|
Oozing
|
Role of Agadatantra in the management of Vicharchika
A study conducted
in Kerala state by Dermatology department of Kasturba Medical
College
Treatment Protocol
According to the
amount of aggravated dosha and rogibala treatment is divided into
Sodhana and samana. In prabhootha dosha, Sodhana is
indicated. If dosha kopa is less Samana Chikithsa is enough. If the
patient is very weak only Samana Chikithsa can be used even in prabhootha
dosha condition.
Sodhana
In Sodhana
Chikithsa Snehanam and Swedanam should be done as poorvakarma.
After proper snehanam and Swedanam sodhana procedures such
as Vamanam, virechana, rakthamoksha etc should be done according
to the dosha predominance and Peyadikrama should be followed
after sodhana along with Samana medicines.
Snehanam- Vicharchika
is a Kapha predominant skin disease so Nimbadi ghrutham is
suitable for Snehapana. In some cases other doshas also vitiates
along with Kapha so we can use the following medicines according to the dosha
predominance.
Sl.No
|
Dosha
predominance
|
Medicine for
Snehapana
|
1.
|
Thridoshajam
|
Aragwadha
Mahathikthaka ghrutam, mahavajrakam ghrutham/thailam Gugguluthikthakam
ghrutam
|
2.
|
Vathapaithikam
|
Thikthakam
Ghrutam
|
3.
|
Kaphavathajam
|
Vajraka
ghrutam/vajrakam thailam
|
4.
|
Vathikam
|
Nisothamadi
ghrutham.
|
5.
|
paithikam
|
Patoladi ghrutam
|
6.
|
Kaphajam
|
Nimbadi ghrutham
|
Swedanam- After Snehana
Ushnaambu Snanam or Ooshma swedam (Aragwadha patram, Karanja
patram, Neelini patram, Haridra, Thulasi patram and Nimba patram) should be
followed for swedana.
Vamanam- for vamana
Mustadi Choornam (Sidharthaka snana yogam) is indicated.
Virechanam- Thrivruthadi
Kashayam (Thrivruth, Thriphala and Danti), Mustadi Choornam, and
avipathi choorna are indicated for virechana.
Vasthi- Asthaapana-daarvyaadi
yogam for Vasthi.
Nasyam-saindhavaadi
nasyam.
Rakthamoksham- Jaloukavacharana & prachaana are
very effective in Vicharchika especially in the case of Stasis Eczema,
it is done at the site of lesion. In other vicharchika cases Siravyadha
is indicated with Vreehimukha sasthra at 2 angula above Kshipra
marma.
The patients suffering
from Kushta(skin diseases) have to undergo subsequently Nasya Karma
once in every 3 days, Vamana once in every 15 days, virechana
once in every month and Rakthamoksha in every 6 monts.
Lepanam
Lepana is indicated only if vitiated doshas
take aasraya in twak.
Ø
Sidharthaka /Musthaadi
choornam for Blackish discolouration
Ø
Nimba haridradi
choorna wth butter milk for sopha and pidaka,
Ø
Thriphala choorna for the purpose of sodhana & ropana,
Ø
Eladi gana choorna with buttermilk/hot water if kandu & pidaka,
Ø
for discolouration
/ lichenification Eladi gana choorna with milk /coconut milk, Nimbapathradi
choorna in butter milk, Guloochyadi choorna with hot water,
Ø
if pain &
oozing Guggulu Panchapala choorna for dhoopana,
Ø
karanja mula
swaras + kalka of nimb pathra
& nirgundi pathra for non healing puss filled vranas
Ø
application of a
paste of Thila cooked in milk if sopha with pain
Dhaara:
Ø
If more pus &
oozing persists Thriphala + CuSO4 (Thutham) is used for dhara, after oozing
subside plain thriphala kashaya is used for kshalana,
Ø
ksheera vriksha
twak kashaya dhara / ksheera vriksha ksheera
kashaya dhaara if more pain & burning sensation,
Ø
Guloochyaadi
kashaya dhaara if burning sensation,
Ø
aaragwadha twak
kashaya if oozing is present,
Ø
karanja pathra
kashaya for kapha vathaja condition with kandu,
Ø
Gairika+Harithaki+Kupeelu
pathra kashaya dhara, and Paaranthy pushpa
dhaara for oozing with burning sensation
Samana Chikitsa
After completing
the Shodhana karma, shamana chikitsa is indicated to subside the
residual doshas. Shamana Chikitsa is also very useful in those
patients who are unable to undergo or contraindicated for Sodhana Chikitsa. For
Samana therapies following medicines are used in clinical practice
Kashayas- Manjishtadi
Kashaya is effective in Vicharchika because it is indicated in kaphaja
kushta with kand and sraava. Other medicines used according to the
dosha predominance of the disesase are listed below.
Sl.No.
|
Dosha
predominance/ indication
|
Medicine
|
1.
|
kapha vathaja
|
vajrakam kashayam
|
2.
|
Pitta kapha
|
Nimbanilavaakdi kwatham,
Patolakaturohinyadi kwatham, Patolamoolaadi kwatham, Guluchyadi kwatham
|
3.
|
Kapha pitha
|
Nisothamadi
Kashayam, Aaragwadhaadi kashaya
|
4.
|
Vatha kaphajam
|
Chitraka
sobhanjanam kashayam
|
5.
|
Thridosha
|
Mahavajrakam
kashayam
|
6.
|
Vatha paithikam with Vedana
pidaka syaavatha
|
Thikthakam
Kashayam
|
7.
|
vesicle formation
with burning sensation
|
Guloochyaadi
kashaayam
|
Gutika Yogas- visha vilwadi
gutika, vilwadi Gutika, Dooshi vishari gutika with madhu in all condition
especially with fever and infection, kaisora guggulu can be used with hot water
for Kaphaja condition with manjishtaadi kashaya for pithaja condition and with
milk for vathaja condition, Amrutha guggulu, Panchanimbadi gutika Thriphala
guggulu,etc can also be used with Khadira Kashaya. Mukkamukkadukaadi gutika and
Gopichandanadi gutika can be used if infection and fever is present.
Choorna Yogas- Haridra khandam,Vyoshadi
vatakam, Thaaleesadi choornam can be used if itching is more, Guduchi satwam with
milk if burning sensation is more, Guggulu panchapalam choornam and thriphala
choornam for kapha pitha condition. Brihath panchanimbadi choornam with kashayas
of khadira&asana sara is used for itching and oozing, Naraaayana
choornam –after snehana for virechana
Arishta and Asava
Yogas- pippalyasavam can be used in all conditions, amrutharishtam+punarnnavasavam
if infection is present. Abhayarishtam, Khadirarishtam, Dasamoolarishtam, in Pithaja
condition Duralabhaarishtam and Useerasavam, & in Kaphapithaja condition- madhookasavam
and moolakaadyarisham can be used.
Lehya Yogas- in kaphaja
condition Manibhadra gulam, Dasamoola Hareethaki and Dasamula
lehyam, & in pithaja condition Danthee harithaki and madhusnuhi rasayana
can be used. In Thridosha condition-Gandhaka Rasayana can be used
for 41 days with strict pathya.
Taila Yogas – in kapha
pithaja condition Guggulumareechaadi thailam, in raktha pithaja condition
Panchavalkalaadi tailam and in kaphaja condition kachooradi thailam & Dinesa
valyadi Keram can be used. In paithika sopha with ruja Paaranthyadi
keram can be used.
Pathya
- Rakthasali, Sastika, and Priyangu, Yusha (Soup
made by pulses mudga and harenuka), mamsarasa of
Ena, sikhi, Svavit Lava, Tititri, prasata, Yusha and Rasa
should be prepared by using antitoxic drugs and diets which do not produce
Vidaha
- Saindhava, tanduliyaka (amaranthus
spinosus), Jivanti (Lepatadenia reticulate), Varthaka
(Solanum melongena), Sunisannaka (marselia minuta) etc. Amalaki
(Emblica officinalis), Dadima (Punica granatum) as amla dravyas
Apathya
- Navadhanya (freshly harvested grains), Kulatha
(Dolichos biflorus), Tila (gingelly), Souvira, Phanitham (a kind of Jaggery), Sura(alcoholic
drink), Foods and drugs which are Tikshna, Ushna Vidahi,
particularly tikshna Dravyas
- Ajeerna, Adhyasana, divaswapna, Vyavaya(Sexual
intercourse), Krodha, athapa (Sun rays)
- Tailam, tamboolam, lavana, guda, amla, sarsapa,
narikela, takra, Kshara dravyas, mamsa dravyas, sura, dadhi, shaka,
athya-atapa, panasa, athya-adhwana, dhooma, Vyapath chintha etc
Follow-up :Vicharana
Snehapanam, Sapthasamaadi gulika(act
as a Rasayana),Paadaadi choornam with hot water for one month,
Clinical Data
A randomized
control study to evaluate the efficacy of Vishavilwadi agada in the
management of Dooshivishajanya Vicharchika conducted in the Dept. of
Agadatantra, Govt.Ayurveda
College
can i have the references of all above
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