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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 11  |  Issue : 1  |  Page : 92-96

Ayurvedic management of vicharchika with special reference to eczema: A case report


Department of Agada Tantra, KLEU Shri BMK Ayurveda Mahavidyalaya, PG Studies and Research Center, Belagavi, Karnataka, India

Date of Web Publication17-Jan-2018

Correspondence Address:
Dr. Mahesh P Savalagimath
Department of Agada Tantra, KLEU Shri BMK Ayurveda Mahavidyalaya, PG Studies and Research Center, Shahapur, Belagavi - 590 003, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_81_17

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  Abstract 


Vicharchika (Eczema) is a type of kshudrakustha often encountered by Ayurvedic Dermatologists characterized with symptoms, namely, kandu (itching), srava (discharge), Pidaka (vesicles), and Shyava varna (discoloration). Vicharchika is often correlated to eczema based on the clinical presentations. No satisfactory treatment is available in contemporary medical practice except antihistamines and topical steroids. Main line of treatment for vicharchika in Ayurveda is Shodhana and shaman oushadhis. A patient approached to outpatient department with chief complaints of discharge, edema, and erythematous skin lesions with intense itching at the ankles and dorsum of both foot, dorsal aspect of the hands, and on cheeks was treated with Virechana and few Agada preparations. A remarkable improvement in the condition was observed in a span of 2 months.

Keywords: Agada, eczema, shodhana, vicharchika


How to cite this article:
Savalagimath MP, Rani J, Patil SF. Ayurvedic management of vicharchika with special reference to eczema: A case report. Indian J Health Sci Biomed Res 2018;11:92-6

How to cite this URL:
Savalagimath MP, Rani J, Patil SF. Ayurvedic management of vicharchika with special reference to eczema: A case report. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2019 Aug 24];11:92-6. Available from: http://www.ijournalhs.org/text.asp?2018/11/1/92/223434




  Introduction Top


Acute eczema occurs after coming in contact with irritant or allergen. Its pathway involves inflammatory mediators, for example, prostaglandins, Helper T cells. Its clinical features are redness, swelling, scaling, weeping, and crusting, and itching. All severe forms of eczema have a huge effect on life quality.[1] Effective therapeutic agents in contemporary medicine are limited in number and may have long-term toxic side effects. The mainstay of treatment in Ayurveda for vicharchika is shodhana, which eliminate the vitiated doshas. Parallel to shodhana, shamanoushadis help to correct the dhatus and bring them to normalcy.


  Case Report Top


An 18-year-young male, farmer by profession, approached to outpatient department with chief complaints of itching, vesicles, blackish discoloration, discharge, edema on the dorsum of both foot, dorsal aspect of hands, and on cheeks since 25 days. The lesions were initially observed over dorsum of both feet in the form of small vesicles associated with itching and later developed itching with oozing. Within couple of days, it spread to both hands and cheeks. There is no previous history (before manifestation of present complaints) of any known allergy in the patient and also there is no family history of any known skin disease for above-said complaints patient consulted to local dermatologist and received oral steroids and anti-inflammatory drugs but found no relief.

On examination, patient presented with [Figure 1] and [Figure 2]:
Figure 1: Before month 1 (feet)

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Figure 2: Before month (hands)

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Figure 3: During treatment (feet)

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Figure 4: During treatment (hands)

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  • Fissured erythematous lesions on both dorsal aspect of the foot and around ankles with thin serous discharge associated with edema
  • At dorsum of hands and at edges of mouth, there were erythematous lesions and blackish discoloration
  • Foul smell and local rise of temperature was also seen
  • General appearance of the body was pale
  • Note: Before developing complaints, the patient walked in the field exposed to chemical fertilizers just 2 days before and his path to home from field was said to be full of grass and parthenium (these could be considered as the main offending factors).



  Laboratory Investigation Top


  • Routine hematology showed hemoglobin - 9.2 g%,
  • Erythrocyte sedimentation rate – 40 ml/h
  • Absolute eosinophil count - 640.


Based on clinical presentation, examination, and laboratory findings, the case was diagnosed as vicharchika (acute eczema) associated with Pandu (anemia).

The condition on thorough evaluation was considered to have Kapha-Pitta as main dosha, rakta and rasa as dhatus, and jataraghni mandya as the source of ama formation. In addition, any poison basically first affects Rakta and then vitiates doshas, this principle is considered in this patient for the selection of medication as there is contact fertilizer poisoning was noticed. The patient was subjected to treatment under two schedules. In the first admission, the swelling, oozing, itching, pain, and anemia were given prime importance and treated accordingly and in the second course treated for shyavatwak (blackish discoloration of skin– result of healed lesion), shareera shodhana (Purificatory process of body) and dhatusamya (homeostasis of tissue element of body).

During first admission, stanika abhyanga, seka, and shaman aushadhi were given as mentioned in [Table 1]. On discharge, the patient was advised to take Patolakaturohinyadi Kashaya 15 ml bid on empty stomach and Bilwadi Agada two bid after food and Nalpamaradi taila external application was given as follow-up medicine for 2 weeks and to wear cotton socks during field works.
Table 1: First admission treatment

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During second admission, the patient was treated with snehapana, abhyanga swedana, and virechana as mentioned in [Table 2]. On discharge, after virechana, Kalyanaka ghrita 10 ml once daily on empty stomach, Arogya vardhini rasa one tid in between food and Ayaskriti 10 ml tid after food and Eladi taila for external application was given as follow-up medicine for 15 days.
Table 2: Second admission treatment

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  Results Top


At the time of discharge after first admission the symptoms such as edema, oozing, and itching, and red scaly patches reduced but blackish discoloration persisted. The lesions over the hand and face completely resolved, and no reoccurrence was observed [Figure 5] and [Figure 6].
Figure 5: After sodhana (feet)

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Figure 6: After sodhana (hands)

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During second admission, he was made to undergo classical virechana karma with arohana karma snehapana with kalyanakaghrita [Figure 7] and [Figure 8]. After that virechana and 15 days follow-up, medication significant change in skin thickness and blackish discoloration were observed.
Figure 7: After shaman (oushadhi feet)

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Figure 8: After shamana oushadhi (hands)

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  Discussion and Conclusion Top


After looking into the signs and symptoms, srava and shotha were to be treated and that was achieved by Triphalakashaya and Lodhra-sevyadi kashaya seka. Ingredients of these two formulations are kashaya and tiktarasa pradhana, which helps in kledashoshana, pitta, and kapha shamana and some are having the property of Krimighna (anti-bacterial) which also helps to combat microbial involvement in the case. Lodra-sevyadi choorna which is explained in the context of Lootavisha chikitsa with shothaghna (anti-inflammatory) and Vishaghna (anti-toxic) properties helps to overcome possibilities of allergens.

Application of Nalpamaradi tail followed by seka would take care of Shotha (inflammation) and daha (burning sensation) as it contains ksheerivriksha daryva which are kashayarasapradhana, pitta and kaphahara and contains tannins as their main chemical constituents which inhibit bacterial growth.[2] The oil given for local application act as physical barrier (emollients type) also.

Arogyavardini vati helps in agnideepana and proper rasa dhatu formation. Katuki helps for elimination of dusta pitta and corrects rakta. Bilwadi Agada and its ingredients have shown antimicrobial, immunomodulatory and anti-inflammatory activity.[3] As there was history of local exposure to fertilizers which act as contact poisoning, is overcome by Bilwadi agada.

Punarnavaasava has proved for anti-inflammatory activity [4] and its ingredient-like Guduchi etc. shown to have immunomodulatory, anti-oxidant, and erythropoietic activity [5] and those of Patolakaturohinyadi kashya takes care of rakthadhatu because of dravyas such as patola, katurohini, and guduchi which have tikta rasa and they are raktashodhak(blood purifactory) and kusthahara. Pippali helps in bio availability of other drugs in formulation.[6]

Kalyanaka Ghritha contains sariva, manjistha, and haridra, etc. which are varnya and kusthaghna helps in reliving shyaavavarnatha (blackish discoloration) and also, this ghrita is Pandu, Kandu, and Garahara which helps in overcoming anemia, itching and any involvement of toxins as there was history of local exposure to fertilizers. In eczema, the essential fatty acids which are required for lipid barrier of skin is reduced and this will cause epidermal fluid loss and making skin susceptible for reaction. Kustha and tagara which have shown antistress activity are also helpful because it is not all about treating skin but a skin patient.[7],[8] The Ayaskriti helps in correcting Pandu (Anemia) and also varnya (correct discoloration) in nature. Eladi taila being vata kaphahara, Varnya, Kandughna and Vishaghna plays important role in vata-kapha pradhana contact poisoning. Thus, Ayurvedic management provides significant relief and improves the quality of life of eczema patient even if the condition is as a result of contact poisoning.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has/have given his consent for his images and other clinical information to be reported 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hunter J, Savin J, Dahl M. Clinical Dermatology. 3rd ed. Reprint. USA: Blackwell Publishing Company; 2003. p. 70.  Back to cited text no. 1
    
2.
Vidhyotini, Yogratnakar. Varanasi: Chaukhambha Sanskrit Sansthan; 2002. p. 114.  Back to cited text no. 2
    
3.
Deepthi SR. A Comparative Clinical Trial to Evaluate the Efficacy of Three Samples of Bilwadi Gullika Prepared in Different Media in Dushivisha with Signs and Symptoms of Kitibha Kustha. Thiruvananthapuram: Government Ayurvedic Medical College; 2010. p. 60-85.  Back to cited text no. 3
    
4.
Gharate M, Kasture V. Evaluation of Anti-Inflammatory, Analgesic, Anti-Pyretic and Anti-Ulcer Activity of Punarnavasava: An Ayurvedic Formulation of Boerhavia Diffuse. Panchavati, Nasik: MGV's Pharmacy College; 2010. p. 60-85.  Back to cited text no. 4
    
5.
Kapil A, Sharma S. Immunopotentiating compounds from Tinospora cordifolia. J Ethnopharmacol 1997;58:89-95.  Back to cited text no. 5
[PUBMED]    
6.
Khushbu C, Roshni S, Anar P, Carol M, Mayuree P. Phytochemical and therapeutic potential of Piper longum: Areview. Int J Res Ayurveda Pharm 2011;2:157-61.  Back to cited text no. 6
    
7.
Bhattacharyya D, Jana U, Debnath PK, Sur TK. Initial exploratory observational pharmacology of Valeriana wallichii on stress management: A clinical report. Nepal Med Coll J 2007;9:36-9.  Back to cited text no. 7
[PUBMED]    
8.
Ambavade SD, Mhetre NA, Patil KM, Desai T, Bodhankar SL. Anxiolytic activity of root extracts of Saussurea lappa Clark. In mice. J Nat Remedies V 2007;6:103-8.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2]



 

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