Vaidya Pramod Kulkarni
Now a day, importance of Ayurveda is on the rise everywhere in the world. In modern era Ayurvedic scientific views and medicines are as useful as, they were in ancient days. In day to day practice we come across many patients whose condition is almost irreversible. Many of these chronic and irreversible conditions are skin conditions, some typical and some atypical. Onset of skin condition is generally gradual and when the disease gets noticed, it is already in chronic stage, requiring many weeks or month for treatment, in these diseases Vicharchikaa i.e. Eczema is a very common disease of the skin. It may be as a separate disease, or as a side effect of one of the symptoms of the any other main disease e.g. Vicharchikaa is very common in Tamaka S`hvaasa. Therefore, unless Tamaka S`hvaasa is treated properly, Vicharchikaa will not come under control. If the same Vicharchikaa is due to some other reason e.g. contact with Pyrethrum Grass (Congress Grass), then we have to concentrate in localized treatment.
Skin conditions as a group are called as Kusht`ha, in Ayurveda science,
Aachaarya Sus`hruta says: xÉÉiÉ: EúŸüiÉ®Éä ®ÉäMÉÉä ªÉlÉÉ EÖú¢Æ |ÉEúÒÌiÉiɨÉÂ*
In practice also, we find that this observation of Aachaarya Sus`hruta is very practical and apt as,it requires many years of treatment, even if there are no symptoms. We are not really sure that patient is definitely cured, because any change in climate or diet, in emotions of the patient may suddenly give rise to relapse.
Etiology
It is said that skin is the first line of defense against any external contact. The deteriorating environment and growing amount of pollutants in air, water etc. means this front line of defense producing many skin manifestations due to the infra red reaction. We can say in short, everything under the sun, including the sun, is causative factor of the skin diseases.
Ayurveda believes that any effect or Kaarya has the same properties as its causative factor or Kaaran`a Hetu. If we know the properties of Kaaran`a, then we can employ the opposite properties to regain equilibrium of Dosha and thus restore health and cure disease.
Though a separate list of etiological factors of Vicharchikaa is not given specifically in any of the classical text, Charakaachaarya has listed following factors as causes of Kusht`ha and at the end of this list he says:
ijnÆ ºÉ´E¢ÊxnxÆ ºÉ¨ºx0404040404nIªÉ¨: *
This means this list is applicable to all types of Kusht`ha and Vicharchikaa is one of the types of Kshudra Kusht`ha. This list is applicable to Vicharchikaa also.
Some typical etiological factors:
- Using hot and cold foods or drinks in alteration
- Sudden change in diet pattern, particularly in relation with the food values
- Consumption of incompatible foods when having indigestion
- Excessive intake of curd, milk, buttermilk, grams etc.
- Excessive anger, fear
- Sudden emersion in cold water
- Caustic food or pungent food
- Forcible stoppage of emetic impulse
- Excessive unctuous food
Bhela Samhitaa has given some more causes
- Nipping
- Milk + lime juice
- Jaggery + raddish
- Diet promoting Kapha Dosha taken by a Kapha predominant person
Prodromal Symptoms:
- Absence of sweating
- Excessive sweating
- Discoloration
- Itching
- Hardened or roughened skin lesions
- Roughness of the skin usually we dont come across many patients in this prodromal condition, because unless the lesion is an exposed part. Patients have a tendency to hide their illness regarding skin.
If the patient does come early with symptoms like itching, particularly itching in inguinal region or all over the body, then it is better to rule out Prameha, because if it is Prameha, then usually treating Prameha appropriately and controlling blood sugar, will usually relieve the symptoms.
Symptoms:
ºEhbÊ0404040404Ê0707070707E ªÉ´ 0b0b0b0b0bºÒEf ÊSÌSE*
- Skin eruption with itching
- Blackish discoloration
- Excess exudation
These are the definite symptoms of Vicharchikaa.
Other symptoms change according to predominance of Dosha. They are as follows:
- Vaata Dosha: Excessive dryness, roughness, dark discoloration or blackening spreads rapidly, irregular.
- Pitta Dosha: Burning, suppuration, exudation, pus formation, foul smelling, skin lesion is thin and hot, reddish or blackish color, exudate is thin, liquid and reddish.
- Kapha Dosha: Excessive itching, sticky, whitish thick exudate, chronic, colours white, dark, well defined margins, invariably but slowly increasing in size.
Mix predominance of two or three Dosha may be seen many times.
Pathogenesis:
Internal causative factors
inªÛª nŸºiOHÆ ÆºÉ¨É¨ S *
x S ÊEÊ0j0j0j0j0jnºi E¢En0h0h0h0h0h0808080808E0404040404ÊxÊkɨ ,0909090909ºi i J0b0b0b0b0b ºÉ¨x0808080808EÞiÒxɨÊ0404040404 E¢xÆ n0h0h0h0h0hÆÆÊE0404040404xÖ¤xvºlxÊɦMx nxÉ´hºÆºlx0808080808ɦɴxɨÊSÊEiºiÊɶ0h0h0h0h0h:* º º1111111111Êv6666666666ŸnÊv66666666660404040404Ê0d0d0d0d0dºÆJªªÊv É´Êi *
Variations in Kusht`ha are innumerable, depending upon the Vikalpanaa of causative factors, Dosha, Dushya, location, colour, pain and potent specific effect.
Differential Diagnosis:
In every case of Vicharchikaa we have to decide, whether it is an independent disease or is it dependent on some other disease. Particularly we should inquire about Tamaka S`hvaasa. Diagnosing Tamaka S`hvaasa is not sufficient to successfully treat Vicharchikaa as a symptom. We have to go into Vikalpa Sampraapti. If the origin of Tamaka S`hvaasa is in Aamaashaya, the treatment is different, as lungs originate from the Prasad part of Rakta Dhaatu
This happens due to internal correlation between Rakta Dhaatu & skin. There are seven main factors, which takes part in the formation of the skin diseases. In that, the Rakta Dhaatu is one of the factors. The formation of lung is – Êhi¡x 0808080808ɦɴ: ¡0404040404¡º: * When Rakta Dhaatu gets affected in Tamaka S`hvaasa, the pathology may extend to skin and skin disease starts.
So here we have to think of Raktamokshan`a and various Raktaprasaadana drugs like Manjisht`haa, Saarivaa etc.
But in case of Aamaas`hayodbhava Tamaka S`hvaasa, we have to think of Vamana & Kaphagna medicines like Pippali, Maricha etc.
We may even prefer Vardhamaana Pippali Rasaayana to get rid of both Tamaka S`hvaasa and Vicharchikaa. In short we have to give tailor-made treatment for every patient and here the skill of physician is most important.
Treatment:
Almost all procedures of Panchkarma therapy and their subtypes are useful in Vicharchikaa e.g. Vamana, Virechana etc. The proper use of all this Panchakarma therapy is to eliminate the offending Dosha. After this is achieved, then we can turn to S`hamana Chikitsaa to pacify the remaining Dosha.
The treatment is in two parts 1. S`hodhana 2. S`hamana
- S`hodhana Vamanaadee. If the patient dose not respond to Panchakarma treatment, then we can be sure that the disease has become incurable
Panchakarma Gun`aateetam Kust`ham| - S`hamana : Palliative medicines Though general principles of treatment of Kusht`ha according to the type, etiology, pathogenesis and Dosha are elaborated in classical texts, the specific treatment of specific Kusht`ha is not described in detail. Due to availability of hundreds of effective remedies (particularly if we include Rasa Aushadhi, the no. of drugs become large) a practitioner becomes easily confessed. Therefore it is better to rely on a small number of tested remedies and remind ourselves of various minute variations and their significance in pathogenesis of Kusht`ha.
External application:
Local or external treatment begins with Lepa, as retention of Lepa is instantly beneficial.
Baahya Lepanam Prayogah Sadyah Siddhidaayakah|
Other local treatment includes use of the Kshaara Prayoga and Visha Pralepa (poison materials) Most important is rubbing treatment of Patrapot`t`alee. The herbs used for this karma are Nimbpatra, Danti, Lataakaranja etc.
Nimbapatrapot`t`alee The most important rubbing treatment, as it is instantly useful, because of digestion of local Saama Dosha, thereby reducing itching, discoloration, thickening etc and improving skin colour. Nowadays various ointments are also available. Various medicines can be used as per determination of Dosha predominance and his treatment accordingly:
e.g. Aarogyavardhini Vat`ee, Rasamaan`ikya, Vanga Bhasma, Trivanga Bhasma, Daaruharidraa Churn`a, Manjsht`haa Churn`a, Khadira Churn`a, Jat`amaamsee, Yast`imadhu, Vid`anga, Nis`hottara, Mahamanjisht`haadi Kad`haa, Khadiraarisht`a, Mahaatiktaka Ghrita etc.
Medicine changes according to disease and condition. There are so many other medicines, which are also available, which can be used in different conditions of the skin problems. I am sure with these tips, I have given you, will be able to enlarge your repertory and successfully treat patients of skin diseases with Ayurvedic way of thinking.
Vaidya Pramod Kulkarni
M.D. (Ayurved)
Last updated on February 22nd, 2021 at 09:05 am