Case Series Showing Efficacy of Virechana Therapy for Hives or Urticaria
Total years in practice: 5
Ayurveda can safely be applied to heal many difficult conditions . Shitapitta (Urticaria) is a type I hypersensitivity reaction which is manifested because of exposure to such allergens. Epidemiology of Urticaria is increasing nowadays due to industrialization and agriculture. Skin diseases are a major health problem among all the age groups and are associated with significant morbidity. Two cases were studied in the present paper—males 16 years & 19 years having recurrent Urticaria for 7 years & 3 years, respectively. Both received Shodhana treatment with Virechana procedure, followed by Shamana (palliative management). Urticaria is palliable only in most cases when managed with the western chemical medicine. Ayurveda could eradicate it for good.
Two cases (males, 16 years and 19 years) having recurrent Urticaria from 7 years and 3 years, respectively were taken for the study. Major symptoms were itching and inflammation like insect bite. The history of present condition was idiopathic and both the patient could not pinpoint any direct etiological agent from food or environment.
Ayurveda is a science which deals with healthy life by Nidan Parivarjana (Preventive medicine), Shodhana (Purification), Shamana (Internal medication) therapies. Panchakarma is the Shodhana (Purification) modality in Ayurveda that provides effective cure in most of the diseases . Vitiated Dosha impurities are eliminated from the body and a lasting relief takes place. Shitapitta (Urticaria) is a disease in which an imbalance among Tridosha takes place . Signs and symptoms of Urticaria resemble Shitapitta. When a person is exposed to Asatmyaj Ahara (incompatible food) and Vihara (lifestyle), Vata and Kapha are disturbed, and can cause this disease; with Pitta, they create redness, swelling and itching on the skin, In the unruly lifestyle of today, one ignores the rules of ‘Dinacharya’ and ‘Ritucharya described in ‘Ayurveda’. Due to heavy industrialization and traffic, one constantly comes into contact with various pollutants. Spicy and fast food, a vogue and fast food, a vogue nowadays, has negligible nutritional values and has the properties similar to Viruddhahara. These all ultimately result in ‘Dhatudaurbalya’ (lowered immunity), which causes sensitization towards allergens as well as antibodies and produces various types of allergic reactions; one of them is ’Urticaria’, which is very common. ‘Urticaria’ is a disease characterized by itchy red rashes on skin almost all over the body. ‘Shitapitta’ has the similar symptomatology and causative factors as those for Urticaria. So, various types of Urticaria can be taken as ‘Shitapitta '. Though the disease, ‘Urticaria’ is not life threatening, it bothers the patient with flares and itching. Urticaria affects 20% of people at some point in their lifetime. In some cases, the disorder is relatively mild, recurrent and frustrating for both the patient and physician. In other cases, it manifests as part of a spectrum of systemic anaphylaxis, which may be life threatening. Patients often seek medical attention with the hope that a reversible cause can be identified. Therefore, the challenge for the clinician is to try to identify a cause that could lead to a specific treatment or avoidance strategy. Patients have to take those medicines for lifetime, which are having some unwanted side effects. Ayurveda can provide better and permanent management for ‘Shitapitta’. Charaka Samhita has mentioned Shitapitta as a sign of skin diseases / Kushtha , as a complication of relapsing fevers /Punaravartaka Jvara , and as a symptom of contact allergies  and can appear as an iatrogenic disease caused due to faulty Vamana procedure . Sushruta Samhita mentioned it as an iatrogenic disease caused from excessive intake of salts  and as a symptom produced by insect bite .
Following signs and symptoms are seen in
Shitapitta [ 10–13]:
• Insect bite like inflammation;
• Severe itching;
• Excessive pain like pricking;
• Burning sensation.
Discussion about Urticaria:
Urticaria is a transient redness and swelling of skin with itching, causing wheals in the dermis or large hypodermal swellings . It is lumpy and itchy rashes which look like the effect of a nettle sting and occurs for more than six weeks [15, 16]. It is the fourth most prevalent allergic disease which affects 20% of the total population once in their lifetime . Acute Urticaria is most common in young patients while chronic type is in middle-aged women which is a more difficult clinical problem [18, 19]. A personal or family history of Atopy is no more common in patients with Urticaria. Though the disease is not a life threatening disorder, the disability and distress caused by Urticaria can lead to serious impairment of quality of life, almost comparable to that experienced by patients with cardiovascular disease [20, 21]. It has a variety of etiology / pathophysiology, having acute and chronic forms. The most common cause of acute Urticaria is a state of hypersensitivity to food or drugs, and it may also result from viral , bacterial (e. g. with Helicobacter pylori ) or parasitic infection [24–26]. Psychogenic factors, as anxiety, stress play an important role in producing Urticaria . It is a vascular reaction pattern of the skin, usually transient, involving the upper dermis, representing localized edema caused by dilatation and increased permeability of the capillaries, and marked by the development of wheals. It manifests as a pruritic, erythematous, raised rash .
However, a recent study has shown that about one third of patients with chronic Urticaria have circulating functional histamine releasing auto-antibodies [29, 30] that bind to the high-affinity IgE receptor (Fc RI) or, less commonly, to IgE [31, 32]. Because of these diverse and complicated disease mechanisms, a combination of medications are commonly used . Antihistamines, corticosteroids, and leukotriene antagonists are commonly used for treatment of Urticaria. The duration of treatment ranges from 30 to 190 days [33, 34]. Though modern medicine can provide temporary symptomatic relief, it usually fails to cure it permanently. So, patients have to take medicines for a long time, which may be having some side effects. As a result, exploration of alternative therapies with more favourable safety profiles is urgently needed . Ayurveda can provide a permanent cure for it.
Both received Shodhana chikitsa by Virechana karma followed by Shamana chikitsa.The Virechana was given as a stat dose to both the patients at 11 a.m. of their respective days. They were advised to consume the combination over a period of 30–60 min to avoid aversion and regurgitation. Loose motions initiated 3–4 h after the ingestion and continued for 24 h and 19 h, respectively, ending with Kaphant Vierchana i.e. clear, colourless stool. After each loose motion, they were advised to consume at least 300 ml of water to avoid dehydration and to flush the intestines of the Pitta toxins.
DRUG PROFILE WITH POSOLOGY
Ghrit Pana for Virechana Panchatikta Ghrit was given for the purpose. This is a medicated Ghrit containing Nimba (Azadirachta indica), Patola (Luffa acutangula), Vyaghri (Solanum xanthocarpum), Guduchi (Tinospora cordifolia), Vasa (Adhatoda vasica). Abhayanga and Sarvanga Swedana preceded the Virechana procedure.
Ayurvedic Medicines: for Treatments:
Aragwadh (Cassia fistula) decoction
Ichcabhedi Ras having Croton tiglium
Kutki powder (Picrorrhiza kurroa)
Ghrit Pana: 20, 40, 60, 80, 100 ml on first 5 days
Rest on 6th day
Virechana 7th day after Abhayangam
Samsarjana diet; Khichri diet from 8th - 12th day
Shamana herbs: 13th day till 30 days
Both the patients were given Shaman Chikitsa with Manjistha, Nishoth and Haridra at the rate 2 g each, i.e., 6 g BD for 30 days after Virechana.
Both the patients showed complete compliance with the treatment. The patient A passed 32 loose stools while the patient B passed 28 stools before showing the desirable results of complete Virechana, i.e., colourless stools. Both the patients improved significantly after the said treatment. They did not require the regular antihistamines they were on for many years. If the conditions before and after the treatment were compared, both showed significant difference in itching, flares and discomfort. Even after a month of discontinuation of the oral herbal medication, they did not report recurrences.
Virechana is the best procedure against Pitta, the Dosha accountable for the symptoms of Shitapitta. Purgation induction could possibly take out the allergens from the gastrointestinal tract (GIT), reducing their concentration in blood and improving the symptoms. This happens due to the altered fluid dynamics and osmosis from the plasma into the alimentary tract [35-38. Most of the processes are temperature specific, and the intense purgation reducing the temperature in the small intestine could deactivate some of the allergens responsible for Urticaria. Once a great deal of toxins removed, Shaman herbs could ensure the nonrecurrence and the patients could be symptom free till date. Nishoth in the Shaman Chikitsa ensured mild everyday Virechana.
A troubling condition like Urticaria can be effectively controlled and cured with Panchakarma procedures. These being non chemical treatments, have all-round advantage over the conventional antihistamine approach. The results are fast to show and the patient need not continue the herbal treatment for long. In these two cases, Ayurveda cured Urticaria rather than treating or managing it.
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