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Table of Contents
CASE REPORTS
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 141-145

Management of Vicharchika through Panchakarma: a case study


Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India

Date of Submission07-Nov-2021
Date of Acceptance22-May-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Kumari Kavita
Department of Panchakarma, All India Institute of Ayurveda, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jism.jism_86_21

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  Abstract 

Background: Vicharchika is a type of skin disorder; as per our ancient Acharyas, all skin disorders are described under Kushtha, which is further divided into two subcategories MahaKushtha and KshudraKushtha. Vicharchika is one of the types of KshudraKushtha as mentioned in Ayurveda texts. The clinical presentation of Vicharchika is similar to that of atopic dermatitis. Aim: As modern system of medicines is no safe and permanent solution, Ayurveda provides a wide range of treatment protocols such as Shamana (medication of disease), Shodhana (purification), and Rasayana (rejuvenation) therapies. In this single case study, Ayurveda Panchakarma treatment was used to understand its effectiveness and safety. Materials and Methods: The patient was given treatment for a period of 15 days along with a follow-up period of 15 days. The treatment protocol included DeepanaPachana, Snehpana, Sarvanga Abhyanga, SarvangaBaspaSwedana followed by Virechana (purgation therapy) through NimbamruthadiErandaTaila, Triphala, and TrivrutChurna.Results: A significant improvement was seen in all assessment criteria, i.e., Eczema Area and Severity Scale, Scoring Atopic Dermatitis, and Ayurveda Signs and Symptoms. An average improvement of 86.87%was recorded in all assessment criteria. Conclusion: Ayurveda Panchakarma procedures have immense potential even in chronic cases and can be used as a treatment plan for skin disorders. Considering the chronicity of the case and substantial improvement found, this case was worth sharing with scientific domain for betterment of science.

Keywords: Atopic dermatitis, Panchakarma, Vicharchika, Virechana


How to cite this article:
Kavita K, Meher AK, Bhatted SK. Management of Vicharchika through Panchakarma: a case study. J Indian Sys Medicine 2022;10:141-5

How to cite this URL:
Kavita K, Meher AK, Bhatted SK. Management of Vicharchika through Panchakarma: a case study. J Indian Sys Medicine [serial online] 2022 [cited 2022 Aug 13];10:141-5. Available from: https://www.joinsysmed.com/text.asp?2022/10/2/141/348478




  Introduction Top


Vicharchika is a skin disorder explained by our Acharyas under Kushtha; Kushtha is further divided into MahaKushta and KshudraKushta.[1] According to our Acharyas, Vicharchika has key signs of Kandu (extreme itching), Pidika (vesicle/boil/pustule), Shyavata (discoloration), Bahusrava (copious discharge),[2]Raji (lichenification),[3]Ruja (pain), and Rukshata (excessive dryness). Vicharchika is fundamentally a KaphaPradhanaTridoshaja Vyadhi,[4] and Rasa, Twak, Rakta, Mamsa, and Kleda[5] are Dushya of it. The clinical presentation of Vicharchika is similar to that of eczema [atopic dermatitis (AD)], which is an inflammatory, frequently reverting, non-transmissible, and pruritic skin disease. Basic symptoms of AD are erythematous and eczematous skin lesions, flexural lichenification or papules along with strong pruritus, and cutaneous hyper-reactivity.[6] AD can happen at any age and has a high occurrence in children. In the current era, various types of contaminations, absence of appropriate regime, and maladministration of numerous beautifying chemicals have amplified the prevalence of skin diseases day by day. An escalating predisposition in AD has been detected in India in the last four decades. The incidence of eczema is 0.42–0.55%in India.[7] The contemporary discipline is significantly advanced predominantly in dermatology, but there is no accurate and safe medication for complete remedy of eczema. The abundant use of medications such as steroids generates serious side effects such as nephrotoxicity, osteoporosis, skin cancer, and so on.[8] In Ayurveda texts, there are various lines of treatment for KushthaRoga, i.e., Shodhana (purification) and ShamanaChikitsa (medication of disease). ShodhanaChikitsa includes Vamana (emesis), Virechana (purgation), and Raktamokshana (bloodletting). In dominancy of Vata, Ghrita must be given; similarly where the Kapha is dominant, VamanaKarma should be used; and in the dominancy of Pitta, Virechana Karma and Raktamokshana should be done.[9] Along with purification treatment, ShamanaChikitsa with medicines having Tikta (bitter) and KatuRasa (pungent) should be used. In this case, Virechana Karma was given as per the Prakriti and symptoms of the patient. A noteworthy improvement was found in all the symptoms of the patient. Observing into the chronicity, it can be acknowledged that AyurvedaSodhana therapy has enormous possibilities to cure skin disorders and can be used as a therapeutic combination with Rasayana and Shamana therapies to yield good results.

Case report

A 54-year-old male patient came to Panchakarma OPD of All India Institute of Ayurveda, Saritavihar, New Delhi on September 16, 2019.

UHID No.: 334486.

IP No.: 3252.

Address: Paharganj, New Delhi, India.

Chief complaints with duration

Chief complaints and the duration of the illness are mentioned in [Table 1].
Table 1: Chief complaints with duration

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History of present illness

The patient was asymptomatic 30 years back, he then gradually developed black patches on hands. He progressively developed itching and oozing of blood along with pain. He took allopathic medicines for it but could not get any comfort, and then he came to the OPD of AIIA and got admitted for Panchakarma treatment.

History of past illness

There was no significant history found with the patient.


  General examination Top




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  Ashtavidha Pariksha Top




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  Dashavidha Pariksha Top




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  Samprapti Top




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Diagnosis

Vicharchika/eczema (AD)

Treatment protocol

Details of treatment are explained in [Table 2].
Table 2: Treatment protocol

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Methodology

The patient was admitted in the IPD of AIIA on September 16, 2019 for 14 days and was given Virechana treatment.

He was assessed by the Eczema Area and Severity Scale (EASI), Scoring Atopic Dermatitis (SCORAD), and Ayurveda Sign and Symptoms on 0th day, 14th day, and 30th day [Table 3].
Table 3: Scoring pattern of Ayurveda signs and symptoms

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  Observation and Results Top


Observation and results of all the assessment parameters are mentioned in [Table 4].
Table 4: Observations in all the assessment parameters

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  Discussion Top


In the above case study, an average improvement of 86.87% was found [Table 4]. All the assessment parameters showed a significant improvement [Graph 1][Graph 2][Graph 3] and [Figure 1][Figure 2][Figure 3]. As the main line of treatment described for Kushtha is repeated Sodhana (biopurification), the disease can be eradicated completely. As in this case of Vicharchika, as per the symptoms, the main involvement was that of Pitta and Rakta (blood), so here Virechana (systemic purification by giving purgative drug) was given.[9] In the case described, DeepanaPachana (increase in digestive and metabolic fire) was done by MustaChoorna (Cyperus rotandus), which has digestive and carminative action.[10]Panchanimba Choorna has Triphala (Embellica officinale, Teminalia bellarica, T. chebula), Trikatu (Zingiber officinale, Piper nigrum, P. longum), Vidanga (Embelia ribes), Haridra (Curcuma longa), Daruharidra (Berberis aristata), Khadira (Acacia catechu), Indrayava (Holarhena antidysentrica) as its main ingredients which balance the Pitta and Rakta Dosha as it is mainly TiktaRasatmaka.[11]SudarshanaChoorna has Musta, Haritaki (T. chebula), Pushkarmoola (Inula racemosa); its main action is to balance Tridosha as it is Tikta Rasa, UshanVirya, Madhura Vipaka.[12] After SamyakaDeepanaPachanaLakshana (proper digestion of undigested metabolite) like increase in digestive fire and lightness in body, the patient was administered Snehapana (administration of medicated ghee through oral route) with MahatiktakGhrita, which is mainly Tikta Rasa (bitter), UshnaVeerya (hot), Madhura Vipaka (sweet), hence works best for KushthaRoga.[13] After SamyakaSnigdhaLakshana (proper oiling), the patient was administered Abhyanga (massage) and Swedana (proper fomentation). All the above therapies bring Dosha into the Koshta of patient[14] after which Virechana was given, as it is considered the best treatment for morbid and increased Pitta Dosha. NimbamrutaadiEranda was given as SnigdhaVirechana has symptoms such as dryness and blackish discoloration. TriphalaChoorna has properties of MriduRechaka (soft potency),[15] and TrivrutChoorna is MadhayamaRechaka (moderate potency)[16] and was chosen as both alleviate Tridosha.[17] As Vicharchika is a KaphaPradhanaTridoshaja Vyaadi, Trivrut and Triphalachurna were chosen. Looking into the chronicity of the patient, it has marked improvement in all the symptoms without any complications.
Figure 1: Before treatment

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Figure 2: Before treatment

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Figure 3: After treatment

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Figure 4: After treatment

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Graph 1: Changes in EASI

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Graph 2: Changes in Ayurveda Signs and Symptoms

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Graph 3: Changes in SCORAD

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  Conclusion Top


Virechana is a potent Panchakarma therapy for the treatment of Vicharchika even in chronic cases as the patient was having symptoms for 30 years, and got significant relief within 30 days. Hence, it can be concluded that Virechana therapy along with Rasayana and Shamana therapy can be used as a treatment protocol for Vicharchika for safe and effective management with minimum or no remission. As this is a case of single patient, it needs more contributions from all the corners regarding reproducibility of its effect and safety.

Future scope

This case report can be used as a base to bring out additional research on a larger number of individuals in addition to produce a treatment protocol for skin disorders with maximum efficacy and safety.

Acknowledgement

We acknowledge the patient for providing all his medical history and for supporting us in his treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their 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.
Sushruta. Nidanasthana, Chapter 5, Verse 16. In: Shastri K, editor. Sushrutasamhita, Dalhanacharya, Tika. Varanasi: ChaukhambhaSurbharti Publisher; 2012. p. 320.  Back to cited text no. 1
    
2.
Agnivesha. Chikitsasthana, Chapter 7, Verse 26. In: Kashinnath P, Gorakhnath C, editors. Charaka Samhita. Varanasi: ChaukhambhaSanskrita Series Office; 2013. p. 451.  Back to cited text no. 2
    
3.
Sushruta. Nidanasthana, Chapter 5, Verse 13. In: Shastri K, editor. Sushrutasamhita, Dalhanacharya, Tika. Varanasi: ChaukhambhaSurbharti Publisher; 2012. p. 285.  Back to cited text no. 3
    
4.
Agnivesha. Sutra sthana, Grahnichikitsa, Chapter 7, Verse 10, 30. In: Kashinnath P, Gorakhnath C, editors. Charaka Samhita. Varanasi: ChaukhambhaSanskrita Series Office; 2013. p. 450-1.  Back to cited text no. 4
    
5.
Agnivesha. Chikitsasthana, Chapter 7, Verse 9. In: Kashinnath P, Gorakhnath C, editors. Charaka Samhita. Varanasi: ChaukhambhaSanskrita Series Office; 2013. p. 450.  Back to cited text no. 5
    
6.
Kay AB Allergy and allergic diseases. N Engl J Med 2001;344: 109-13.  Back to cited text no. 6
    
7.
Kanwar AJ, De D Epidemiology and clinical features of atopic dermatitis in India. Indian J Dermatol 2011;56:471-5.  Back to cited text no. 7
    
8.
Ericson-Neilsen W, Kaye AD Steroids: Pharmacology, complications, and practice delivery issues. Ochsner J 2014;14:203-7.  Back to cited text no. 8
    
9.
Agnivesha. Chikitsasthana, Chapter 9, Verse 39–40. In: Kashinnath P, Gorakhnath C, editors. Charaka Samhita. Varanasi: ChaukhambhaSanskrita Series Office; 2013. p. 201.  Back to cited text no. 9
    
10.
Makbul S The incredible benefits of Nagarmotha (Cyperus rotundus). Int J Nutr Pharmacol Neurol Dis 2018;4:23-7. Doi:10.4103/2231-0738.12461.  Back to cited text no. 10
    
11.
Chapter 50, Verse 158. In: Sharma P, editor. Cakradatta. Chhaukhambha Orientalia Publication; 2008. p. 408.  Back to cited text no. 11
    
12.
Sahasrayogam , Niteshwar K, Vidyanath R, editors. Chapter 4. In: ChoornaPrakrana. Varanas: ChaukhambaSurbhartiPrakashana; 2017. p. 160.  Back to cited text no. 12
    
13.
Madhyama Khanda, Chapter 9, Verse 50–54. In: Brahmanand Tripathi, editor with Hindi Commentary, Sharangdhara Samhita of Sharandharachrya. Varanasi: ChaukhambaSurbhartiPrakashana; 2009. p. 120.  Back to cited text no. 13
    
14.
Agnivesha. CharakaSamhita, YadavajiTrikamji Acharya Vd. , editor, revised by Charaka&Dridhabala with Ayurveda Deepika commentary of Chakrapanidatta, Prakashan, Sutra Sthana chapter 28, verse 33. Varanasi: Chaukhambha Prakashan; reprint 2007. p. 479.  Back to cited text no. 14
    
15.
Uttarkhand, chapter 4, verse 13–14. In: Sharangdhara Samhita of Sharandharachrya. Tripathi Brahmanand editor with Hindi commentary, Varanasi: ChaukhambaSurbhartiPrakashana; 2006. p. 344.  Back to cited text no. 15
    
16.
Sutra Sthana, chapter 13, verse 66–67. In: Sharangdhara Samhita of Sharandharachrya. Tripathi Brahmanand editor with Hindi commentary, Varanasi: ChaukhambaSurbhartiPrakashana; 2009. p. 85.  Back to cited text no. 16
    
17.
Agnivesha. Charaka Samhita. YadavajiTrikamji Acharya Vd editor, revised by Charaka and Dridhabala with Ayurveda Deepika commentary of Chakrapanidatta. Kalpasthana chapter 7, verse 5–11. Varanasi: Chaukhambha Prakashan; 2007. p. 886.  Back to cited text no. 17
    


    Figures

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

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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Abstract
Introduction
General examination
Ashtavidha Pariksha
Dashavidha Pariksha
Samprapti
Observation and ...
Discussion
Conclusion
References
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