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All skin diseases in Ayurveda have been considered under the headings of kushta. Vipadika is one among such disease which has been included under the heading of Kshudra Kushta. It is characterized by Sphutanam (fissures) either in palms or soles or in both with Theevra vedana (severe pain).
Vipadika is correlated with palmar-plantar psoriasis which is a chronic skin disease which mainly affects palms and sole region. In present case report a patient with complaints of dryness and cracking of both soles associated with bleeding and pain for 10 years, was treated with Shodana (virechana) and Shamana aushadhi like ksheera bala capsule, and sukumara ghrita shown a significant result. Shodhana helps remove the root cause of the disease, and prevent recurrence.
Key Words: Kushta, Vipadika, Palmar plantar psoriasis, Shodana, Shamana
Skin is the largest organ of the body which first exposed with the environment agents like physical, chemical and biological agents. The skin protects from microbes and the elements help to regulate body temperature, and permits the sensations of touch, heat and cold. Skin has layers. The epidermis, the outermost layer of skin, provides a water proof barrier and creates the skin tone. The dermis, beneath the epidermis, contains tough connective tissue, hair follicles and sweat glands. The deeper subcutaneous tissue (hypodermis) is made of fat and connective tissue1.
Skin disease not only affects the patient physically but also disturbs mental and social health of the patient. In Ayurveda almost all the skin diseases are explained under kushta and classified as 7 Mahakushta and 11 kshudra kushta. Apart from eighteen types of kushta, another type of kushta namely Swithra (leucoderma) and its types are explained in Ayurveda; on the contrary Ayurveda also considers skin diseases are innumerable. Nidanas of kushta aggravates the Doshas, causes Agnimandya (indigestion) and on the other hand produces Dhatu Shaitilyata (cause weakness of the muscles, etc.). Among all the Doshas, Vata and Kapha get aggravated predominantly and causes the Shithilyata of Dushyas like Twak (skin), Rakta (blood), Mamsa (muscles), Lasika (channels) and obstruct the Lomakupa (sweat glands) to vitiation of Sweda Vaha Srotas (channels of sweat glands). This Prakupita (vitiated) Doshas enters into Rasa
Raktadi Dhatus especially Sanchara (movement) in Tiryaka Siras (vein) and lodges in Twak resulting in kushta2.
It is included in Ksudra kushta with Vata-Kaphaja Dosha involvement and it is characterized by Pani-Pada sphutna (fissure in palms and soles) and Thrivra Vedana (with severe pain)3 The treatment which is given in Ayurveda is Shamana
and Shodhana helps to cure the disease without recurrence of
Palmar plantar psoriasis
Vipadika is correlated with palmar-plantar psoriasis which is a chronic skin disease mainly affects palms and sole region. Palmar plantar psoriasis is a variant of psoriasis that characteristically affects the skin of the palms and soles. Palmar plantar psoriasis is caused by a combination of genetic and environmental factors. The most common genetic factor associated with palmar plantar psoriasis includes the human
leukocyte antigen (HLA) Cw6. On physical exam, thick hyperkeratosis plaques, sterile pustules, or a mixture of morphologies may be seen in palmar plantar
psoriasis. Hyperkeratosis plaques are the most common subtype. Symmetrically distributed lesions are common, as well as erythema, fissuring, and scaling4
The present case study is an Ayurvedic approach in the management of Vipadika. A 12 year old child with parents visited the OPD of SDM College Hassan, presented with c/o of dryness and cracking of both soles associated with bleeding and pain since 10 years and cracking of the skin in and around the nails of fingers since a year.
History of Present Illness
Patient’s grandmother gave a history of cracking of both the soles since child started walking which gradually increased associated with itching sensation and pain in the soles. The condition worsens during winter season where even bleeding
from cracked regions is seen. Pain is said to be so severe such that the patient cannot walk. Since one and a half year peeling of the skin in and around the fingers is seen, not associated with any itching/ burning/ pain. Patient took treatment from
contemporary and other allied medicines for 4-5yrs but recurrence was seen on stopping of medication. Since 3 months she is not under any medication and was admitted here for better relief.
Bowel: Previously -irregular, two days once, since a year-
Food: Mixed diet
Pulse: 80 /Min
BP: 110/90 MmHg
Respiratory Rate: 18/Min
Site –dorsum of foot or sole
Distribution- Symmetrical (both soles)
Dryness, itching and cracking of both the soles is seen (pada sphutana) which is painful bleeding from the cracked region is seen In and around the fingers cracking is seen
Surface –is rough and dry, margin- irregular
Hb %- 12.6gm%
Total WBC count - 8,700cells/mm
Serum creatinine - 0.6 mg/dl
Blood urea- 16.8mg/dl
Table 1: Nidana Panchaka
Table 2: Vyavacheda Nidana (Differential Diagnosis)
Table 3: Deepana Pachana
Table 4: Snehapana Procedure Medicine Dosage Snehapana Sukumara ghrita
Table 5: Panchakarma procedure
Table 6: Follow up medication
RESULTS AND DISCUSSION:
After first medication the symptoms like cracking of both soles, itching, bleeding from cracked region reduced. The patient was advised for follow up medicine and for avoiding fried food items, junk food, curd, non-vegetarian diet, sea foods, and milk products. Deepana pachana
This Churna contain Pippali (Piper longum), Pippali moola (root of Piper longum), Chavya (Piper chaba), Chitraka (Plumbago zeylanica), Nagara (Zingiber officinale) 5 . This combination corrects Agni Dushti, is an appetizer, carminative, and digestive. It is given for Ama Pachana procedure before Panchakarma.
This ghrita contains Punarnava (Boerhaavia diffusa), Bilwa (Aegle marmelos), Kasmari (Gmelina arborea), Patala (Stereospermum suaveolens), Syonaka (Oroxylum indicum), Agni mantha (Premna corymbosa), Prishniparni (Desmodium gangeticum), Shali parni (Pseudarthria viscida, Kantakari (Solanum indicum), Badra (Aerva lanata), Gokshura (Tribulus terrestris), Payasya (Holostemma annulare), Ashwagandha (Withania somnifera), Eranda (Ricinus communis), Shatavari (Asparagus racemosus), Darbha (Desmostachya bipinnata), Kusa (Imperata cylindrical), Ikshumoola (Saccharum officinarum), Potagala (Sphaearanthus hirtus), Pippali (Piper longum), Yeshtimadhu (Glycyrrhiza glabra), Mridweeka (Vitis vinifer ), Yavani (Cuminum cyminum), Shunthi (Zingiber officinale). It’s having Sophaghna (anti-inflammatory) property and is Mutrala in action also. This helps to eliminate toxic contents from the body. It is Vata Pitta Shamaka Ghrita and helps to relieve constipation, pain, bloating and itching also. It’s having anti-mutagenic, antioxidant, emmenagogue, mild estrogenic, muscle relaxant, uterine tonic properties also6 .
It contains Madhuchishta (Honey wax), Manjishta (Rubia cordifolia), Sarja rasa (resin of Veteria indica), Sariva (Hemidesmus indicus), Tila (Sesamum indicum). It helps to relieve pain and burning sensation7.
It contain Amalaki (Emblica officinalis), Haritaki (Terminalia chebula) Marica (Piper nigrum), Musta (Cyperus rotundus), Pippali (Piper longum), Pippali moola, Shunti (Zingiber officianale), Twak (Cinnamomum zeylanicum), Tejapatra (Cinnamomum tamala), Vidanga (Embelia ribes) Jamal Ghota (Croton tiglium), Trivrit (Operculina turpethum) and Sharkara. Among this Haritaki and Amalaki having Anulomana action, Danti is Tikshna Virechaka, Trivrut has Virechaka prabhava, Pippali is Pitta Virechaka and Maricha has Pramathi property, help to expel the Doshas through anal route. Virechana helps to remove the vitiated Doshas from the body to avoid the recurrence of the disease. Virechana drug (Abhayadhi Modaka) quickly reaches up to the cellular level and has an effect on kushtaroga also its best act on Vata Kaphaja Dosha8 .
Mahathikthaka lepa contains Saptha parna (Alstonia scholaris), Ativisha (Aconitum heterophyllum), Patha (Cyclea peltata), Musta (Cyperus rotundus), Ushira (Vetivera zizanoids), Triphala (Harithaki-Terminalia chebula, Vibhithaki-Terminalia bellerica), Amalaki- Emblica officinalis), Patola- Trichosanthes dioica, Pichumardha (Azadirachta indica), etc. In Kushta there is excessive accumulation of kleda. Tikta Rasa is amapachaka & kleda shoshaka in nature, also in Kushta Chikitsa Acharya Charaka gives importance to Tikta Rasa9 .
Ksheera Bala Capsule
This capsule contains Ksheera (Cow’s milk), Bala (Sida cordifolia), Taila (Sesame oil) having Vata Pitta Shamaka property. It helps to relieve pain and inflammation. It is used in pain due to neurological origin. This capsule helps to bring about nerve regeneration and rejuvenation10 .
This case study demonstrated that Ayurvedic management Virechana as Shodhana therapy and Shamana Aushadhi seems very effective for the treatment of Vipadika like skin disorders. From the above case, it can be said that Palmo-plantar psoriasis can be successfully managed through Ayurvedic line of treatment.
2. Gajanana Hedge, Noushad Khan, Concept of Eka Kushta And Chronic Plaque Psoriasis, Ayurpharm Int J Ayur Alli Scie 5(2), 15-16
3. Acharya Charaka, Charak Samhita, Ayurveda Dipika commentary by Shree Chakra Panidatta, Edited by Vaidya Yadavji Trikamji Acharya, Chaukhamba Surbharti Prakasan, Varanasi, Re-printed 2013, Chikitsha chap. 7/22, 29, 451.
6. https://www.ayurtimes.com/sukumaram-kashayam/, 4/6/18
8. Kanungo Swati, Kandus Priya dharshini Aravind, Vepathak surendra martand, Study of Efficacy of Virechana karma by Abhayadhi modaka in Khalithya (a pilot study), IAMJ, Vol 3.2015
9.https://ayurmedinfo.com/2015/08/07/kottakkalmahatiktalepam-uses-ingredients-how-to-use/, 4/6/18 10. https://ayurmedinfo.com/2012/06/02/ksheerabala-101- thailam-benefits-how-to-use-ingredients-side-effects/, 4/6/18