vicharchika gandhaka kc015-udp

“A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA IN VICHARCHIKA”

By

Dr. YOGEESHA ACHARYA, B.A.M.S

Dissertation submitted to the Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore in partial fulfillment of the regulations for the award of

the degree of

“AYURVEDA VACHASPATI”

DOCTOR OF MEDICINE (Ayu)

In

KAYA CHIKITSA GUIDE

Dr.G.SHRINIVASA ACHARYA. M.D. (Ayu)

Professor & HOD Department of Post Graduate Studies in Kayachikitsa

S.D.M.C.A.,Udupi

DEPARTMENT OF POST GRADUATE STUDIES IN

KAYACHIKITSA

S.D.M. COLLEGE OF AYURVEDA, UDUPI.

2010 – 2011

Ayurmitra

TAyComprehended

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation thesis entitled “A CLINICAL STUDY TO

EVALUATE THE THERAPEUTIC EFFECT OF GANDHAKA CHURNA IN

VICHARCHIKA” is a bonafide and genuine research work carried out by me under

the guidance of Dr.G.SHRINIVASA ACHARYA, M.D (Ayu), Professor & HOD,

Dept. of P.G. Studies in Kayachikitsa, S.D.M.C.A, Udupi.

Date : Signature of the Candidate

Place: Udupi Dr.Yogeesha Acharya

Dept. of P.G.Studies in Kayachikitsa

S.D.M.C.A, Udupi.


CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A CLINICAL STUDY TO


VICHARCHIKA” is a bonafide research work done by “Dr.Yogeesha Acharya” in

partial fulfilment of the requirement for the degree of Ayurveda Vachaspati - Doctor

of Medicine in Ayurveda.

Date: Signature of the Guide

Place: Udupi Dr.G.Shrinivasa Acharya. M.D (Ayu)

Professor & HOD

Dept of P.G.Studies in Kayachikitsa

S.D.M.C.A, Udupi.


ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A CLINICAL STUDY TO


VICHARCHIKA” is a bonafide research work done by Dr.Yogeesha Acharya

under the guidance of Dr.G.Shrinivasa Acharya M.D. (Ayu), Professor &HOD.

Signature of H.O.D Signature of Principal Dr. G.Shrinivasa Acharya M.D. (Ayu) Dr.U.N Prasad, M.D. (Ayu) Professor and HOD Principal Dept of P.G. Studies in Kayachikitsa S.D.M.C.A, S.D.M.C.A, Udupi Udupi Date: Date:

Place: Udupi Place: Udupi

COPYRIGHT

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka

Bangalore, shall have the rights to preserve, use and disseminate this dissertation in

print or electronic format for academic / research purpose.

Date: Signature of the Candidate Place: Udupi Dr.Yogeesha Acharya B.A.M.S

© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgement

VI

ACKNOWLEDGEMENT

• At this amenity of successful integrating of my work, I bow my head on the

feet of Goddess Mahakali.

• There is hardly any task which is more pleasant than acknowledgment my

gratitude to all those who have helped in so many ways in preparing this work.

• I feel intense pleasure and satisfaction in expressing myself to my parents

Professor A Madhava Acharya and Mrs.Gayathri M Acharya, it is because

of their pain taking efforts and I have reached up to this step of life.

• First of all I bow to almighty to dedicate this work to the lotus foot of my

parents, beloved sisters & all my family members.

• I convey my sincere thanks to Padmabhushana Dr. D. Veerendra Heggade,

President S.D.M. Educational Society.

• According to our culture teachers are given the immediate next importance to

parents, so I thank whole Teachers who enlightened me with their sincere

blessings.

• I am extremely thankful to Dr. U N. Prasad, Principal, SDM college of

Ayurveda, Udupi for providing all the needed backgrounds for the successful

and timely completion of my critique work.

• I appraise my sincere and hearty gratitude with paramount respect and

affection to my guide and H.O.D, Prof .G. Shrinivasa Acharya, P.G.Dept of

Kayachikitsa, SDMCA Udupi. Even the best of words will be under rated to

portray my mentor. His indefatigable love, enduring help, priceless

suggestions, encouraging words, enthusiasm and zeal will continue to be a

great inspiration in my prospective life.

• I deeply owe the favor and sincerely express my gratefulness to Dr.Shridhar

Holla, Dr. Jonah S, Dr.Srilatha Kamath, Dr Lavanya, Dr.Veera Kumara,

Dr.Rajalakshmi, Dr. Gopikrishna, Dr Aniruddha, Dr Vijayendra Bhat

Dr.Prasanna N Mogasle, Dr. Nagaraj, Dr. Deepak S M.(Deputy Medical

Superintendent), Dr. Y N. Shetty (Medical Superintendent) for their

continuous cooperation and timely encouragement at various levels of the

study.

Acknowledgement

VII

• I would also like to thank Dr. Murulidhar (Director SDM Ayurveda pharmacy)

and Dr. Mohanan, for providing my thesis drug within time and helping me in

this work.

• I would like to remember and wholeheartedly extend my humble thanks to all

my friends Dr Ravikanth, Dr Shailesh, Dr Chaitra, Dr Manu, Dr Gauhar for

their valuable support and encouragement.

• My special thanks extends to my beloved seniors Dr.Prashanth, Dr

Chandrashekar, Dr.Murgesh, Dr.Rathod, Dr.Geetha, Dr.Vaishali for their

guidelines and friendly co-operation.

• I am very much thankful to my juniors Dr Prashasth, Dr Supriya, Dr Veeraj,

Dr Vasundara, Dr Shreelatha for their unforgettable support. And hearty

thanks to Dr Nishanth Pai for his earnest help in the completion of this

dissertation work.

• I am very much thankful to the staff of library, non teaching staff, pharmacy

and hospital unit, Sampark Xerox and all my patients for their kind co-

operation, which was requisite for the successful casing up of this work.

• At last I express my thanks to each & every person who are directly or

indirectly associated in the successful completion of this work.

Date:

Place: Dr .Yogeesha Acharya

List Of Abbreviations

VIII

LIST OF ABBREVIATIONS

A.H. - Ashtanga Hridaya A.S. - Ashtanga Sangraha

AT - After Treatment

BH.S. - Bhela Samhita

BT - Before Treatment

C.S. - Charaka Samhita

DC - Differential Count

ESR - Erythrocyte Sedimentation Rate

Hb - Haemoglobin

H.S. - Harita Samhita

I.P.D - In-Patient Department

K.S. - Kashyapa Samhita

No. - Number

O.P.D - Out-Patient Department

P - Probability

S.D.M - Shri Dharmasthala Manjunatheshvara

S.D - Standard Deviation

S.E.M - Standard Error of Mean

S.S. - Sushruta Samhita

Tc - Total Count

‘t’ - ‘t’ test

VAS - Visual Analogue Scale

Abstract

IX

ABSTRACT

Objective:

To study the therapeutic effect of Gandhaka Churna in patients suffering from

Vicharchika.

Design of Study:

A single blind clinical study with pre test and post test design.

Settings:

SDM Hospital of Ayurveda , Udupi, Karnataka. From December 2009 to October

2010

Study Selection:

20 patients suffering from Vicharchika / Atopic Dermatitis of either sex were selected

for the study.

Intervention:

Selected patients were treated with oral administration of Gandhaka Churna, in dose

of 500mg before food twice a day and the same is continued for 28 days. 100 ml milk

is advised as anupana along with Gandhaka Churna.

Main Outcome of Measures:

The response following the intervention was assessed every week by adapting the

Visual Analogue Scale and SCORAD. Further the change observed by the completion

of the treatment was subjected to paired t test to know the statistical significance.

Results:

The administration of Gandhaka Churna proved to be effective in decreasing the

severity of symptoms. There was marked reduction in mean score of itching i.e. the

severity score before treatment which was 8.050 came down to 2.700 after treatment.

The reduction in severity was also statistically significant as shown by the paired‘t’

Abstract

X

test. Discharge from the lesions before the treatment was 4.350 came down to1.350

after treatment and the paired t test proved its statistical significance.

The criteria discolouration showed improvement in mean score which was 7.900

before treatment decreased to 5.450 after treatment, the statistical test proved its

significance. Pidaka was reduced after therapy from mean score of 2.250 to 1.250

after treatment, the paired t test confirmed statistical significance (p=<0.001). The

Ruja was reduced from mean score which was 6.143 before treatment to 2.714 and

was statistically significant as p=0.009. The Daha showed improvement and the

mean score which was 6.00 before treatment reduced to 2.00 after treatment, the

statistical test unravelled the significance with p=<0.001. Favourable response was

least in regards to the symptoms. Also, an overall improvement of 43.93%.was

recorded in the present clinical trial.

Key Word: Vicharchika, Gandhaka Churna, Atopic Dermatitis.

List of Contents

XI

LIST OF CONTENTS

Sl. NO. CONTENTS Page No.

1 INTRODUCTION 1-3

2 OBJECTIVES 4

REVIEW OF LITERATURE

Chapter 1 - Historical Review 5-7

Chapter 2 - Paribhasha of Kushta and Vicharchika 8

Chapter 3 - Nidana 9-12

Chapter 4 - Samprapti and Bheda 13-18

Chapter 5 – Purvarupa 19-20

Chapter 6 – Rupa 21-23

Chapter 7 - Upadrava 24

Chapter 8 – Chikitsa 25-26

Chapter 9 - Atma Satmya Viruddha Nimittaja Vyadhi 27-31

Chapter 10 - Pathya-Apathya 32-34

3

DRUG REVIEW 35-38

METHODOLOGY

Materials & Methods 39-44

4

Observations 45-66

5 RESULTS 67-77

6 DISCUSSION 78-87

List of Contents

XII

7 CONCLUSION 88

8 SUMMARY 89-92

9 BIBLIOGRAPHIC REFFERENCE 93-105

10 ANNEXURE – PROFORMA 106-122

List of Tables

XIII

LIST OF TABLES

Sl. No. Tables Page No.

1 Vicharchika Nidana 10

2 Difference between Maha Kushta & Kshudra Kushta 16

3 Types of Maha Kushta 16

4 Types of Kshudra Kushta 17

5 Ashtadasha Kushta According to Harita 18

6 Sadhya Asadhya Kushta According to Kashyapa 18

7 Kustha Purvarupa 19

8 Rupa of Vicharchika 21

9 Pathya in Vicharchika 32

10 Apathya in Vicharchika 33

11 Body Surface Area using Rule of 9 42

12 Assessment Criteria of Atopic Dermatitis 43

13 Distribution of Patients According to Age group 45

14 Distribution of Patients According to Sex 46

15 Distribution According to Religion: 47

16 Distribution According to Educational Status 48

17 Distribution According to Marital Status 49

List of Tables

XIV

18 Distribution According to Socio- Economic Status 50

19 Distribution According to Occupation 51

20 Distribution According to Habitat 52

21 Distribution of Patients According to Ahara 53

22 Distrtibution According to Vyasana 54

23 Distribution of Patients According to Prakruti 55

24 Distribution of Patients According to Sara 56

25 Distribution of Patients According to Pramana 57

26 Distribution of Patients According to Samhanana 58

27 Distribution of Patients According to their Satva 59

28 Distribution of Patients According to Satmya 60

29 Distribution of Patients According to Vyayama Shakti 61

30 Distribution of Patients According to Ahara- Abhyavaharana and Jarana Shakti

62

31 Distribution of Patients According to Vaya 63

32 Occurrence of Symptoms of Vicharchika 64

33 Nidana ofKushta Identified in 20 patients 65

34 Occurrence of Purvarupa 66

35 Effect on Kandu 67

List of Tables

XV

36 Effect on Discharge 68

37 Effect on Discoloration ( Vaivarnya) 69

38 Effect on Loss of Sleep 70

39 Effect on Pain 71

40 Effect on Burning (Daha) 72

41 Effect on Eruption of Papules ( Pidaka ) 73

42 Effect on Dryness ( Ruksha) 74

43 Effect on Lichenification 75

44 Effect on Extent of Body Region Affected 76

45 Effect on SCORAD 77

List of Figures

XVI

LIST OF FIGURES

Sl No. Figures Page No.

1 Distribution of Patients According to Age group 45

2 Distribution of Patients According to Sex 46

3 Distribution According to Religion: 47

4 Distribution According to Educational Status 48

5 Distribution According to Marital Status 49

6 Distribution According to Socio- Economic Status 50

7 Distribution According to Occupation 51

8 Distribution According to Habitat 52

9 Distribution of Patients According to Ahara 53

10 Distrtibution According to Vyasana 54

11 Distribution of Patients According to Prakruti 55

12 Distribution of Patients According to Sara 56

13 Distribution of Patients According to Pramana 57

14 Distribution of Patients According to Samhanana 58

15 Distribution of Patients According to their Satva 59

16 Distribution of Patients According to Satmya 60

17 Distribution of Patients According to Vyayama Shakti 61

18 Distribution of Patients According to Ahara- Abhyavaharana and Jarana Shakti

62

List of Figures

XVII

19 Distribution of Patients According to Vaya 63

20 Occurrence of Symptoms of Vicharchika 64

21 Nidana ofKushta Identified in 20 patients 65

22 Occurrence of Purvarupa 66

23 Effect on Kandu 67

24 Effect on Discharge 68

25 Effect on Discoloration ( Vaivarnya) 69

26 Effect on Loss of Sleep 70

27 Effect on Pain 71

28 Effect on Burning (Daha) 72

29 Effect on Eruption of Papules ( Pidaka ) 73

30 Effect on Dryness ( Ruksha) 74

31 Effect on Lichenification 75

32 Effect on Extent of Body Region Affected 76

33 Effect on SCORAD 77

Photo Plate

Introduction

“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” 1

INTRODUCTION Skin is man’s front-line protective barrier between internal structures and the external

environment. It’s tough, resilient and virtually impermeable to aqueous solutions,

bacteria, or toxic compounds. It also performs many vital functions. Skin protects against

trauma, regulates body temperature and serves as an organ of excretion and sensation.

Hypersensitivity to a variety of external environmental and dietetic factors may produce

the characteristic skin diseases which are chronic in nature.

In Ayurvedic literatures skin diseases are elaborated under the heading of Kushta. This is

a chronic relapsing disorder characteristic by discoloration of skin and loss of sensation1.

Kushta is mainly manifested in 2 forms that are Maha and Kshudra. The loss of sensation

is the unique presentation of Maha Kushta, remaining features more towards the Kshudra

Kushta. Even though Vicharchika is a Kshudra Kushta it produce a great misery for the

person due to the dark discoloration of the skin, uncontrollable itching, profuse

discharge2 in initial days and dryness of the skin in later conditions. Nevertheless,

recurring skin rashes, redness, skin edema, itching, dryness, crusting, flaking, blistering,

cracking, oozing or bleeding are the typical clinical manifestations of Atopic Dermatitis.

This disease is largely idiopathic and mostly runs in families. Also the disease is not

uncommon, and a survey study explored the incidence of Ten percent among the general

population3. Atopic Dermatitis is the hypersensitivity disorder and it is a known fact that

complete cure to this illness is a remote possibility in spite of radical rational advanced

treatment of desensitization.

Identical to any other Kushta, all the three Dosha are incessantly involved in the

Samprapti of Vicharchika. Even then, as indicated by the clinical presentation the

morbidity of Kapha4 and Pitta5 Dosha dominates the evolution of the illness. Among the

different other foremost causes of the illness, Viruddha Nidana is mostly emphasized in

the literature. Also Pathophysiology related to hypersensitivity of Atopic Dermatitis.

Vicharchika being the illness always due to Bahudoshavastha, Punah Shodhana,

Shamana, Kushtahara Rasayana and Bahirparimarjana Chikitsa forms the crux of

treatment.

Introduction


Ayurveda has a great role in the management of skin diseases. Many researches have

been carried out in this regards. Some of the examples are

A single blind comparative randomized clinical study comprising 20 patients suffering

from Vicharchika was carried out. The intervention in different groups included

Virechana Karma, Jalaukavacharana and Gandhaka Rasayana. The study proved that the

Jalaukavacharana is more efficacious in relieving the symptoms of Vicharchika in

comparison to Virechana Karma6.

20 patients suffering from Vicharchika were subjected to single blind comparative

clinical study in which the intervention included oral administration of Amruta Guggulu

along with external application of Vishvamitra Kapala Taila. The study was conducted in

randomly allocated two distinct groups. Maximum benefit in terms of therapeutic effect

was observed in the group that received both oral and topical medication7.

A single blind, pretest posttest design clinical study, 20 patients suffering from

Vicharchika were subjected to Virechana Karma. Results revealed none had complete

remission of symptoms. But, 33.33% of patients had marked improvement, 53.33% had

moderate remission and 46.67% had mild improvement8.

From the fore going it is clear that different randomized clinical trials carried out at

different centers are aimed at comparing the therapeutic efficacy of Shodhana and

Shamana treatment either alone or in combination, in patients suffering from Vicharchika

and Eczema. No clinical trials were carried out emphasizing the oral medication alone

with special reference to Vicharchika and Atopic Dermatitis. Hence this clinical study is

planned to evaluate the therapeutic effect of oral medication with Gandhaka Churna9 in

patients suffering from Vicharchika/ Atopic Dermatitis.

Introduction


Hence a sincere effort has been made to evaluate the effect of Gandhaka Churna in

patient suffering from Vicharchika. The present study entitled “A clinical study to

evaluate the therapeutic effect of Gandhaka Churna in Vicharchika” was carried out with

an aim to explore the therapeutic effect of Gandhaka Churna on the activity of the disease

in patients suffering from Vicharchika / Atopic Dermatitis.

Assay of the literature is exploring the equation of Vicharchika and Atopic Dermatitis as

well as establishing the modality of treatment of Satmya Viruddha Nimittaja Vyadhi with

special reference to Vicharchika.

The present study has been carried out in 2 parts; Conceptual Study and Clinical Study.

Conceptual study includes disease review and drug review. Derivation of Vicharchika is

appear first in disease review fallowed with Nidana, Purvarupa, Rupa, Samprapti,

Chikitsa, Pathya Apathya , Sadhya Asadhyata and concept of Satmya Viruddha Nimittaja

Vyadhi and Chikitsa and comparison of Vicharchika with Atopic Dermatitis. Drug

review includes ingredients, dosage and method of preparation of Gandhaka Churna.

For clinical study 20 diagnosed case of Vicharchika were taken. Each patient was given

with capsule Gandhaka Churna 500mg with 100ml of milk as anupana before food, both

morning and night for 28 days. Patients were assessed in terms of pratyatma lakshana of

Vicharchika and SCORAD index of Atopic Dermatitis.

Historical review, Review of Literatures, Methodology, Results, Discussion, Conclusion

and Summary follows in the following pages.

Objectives


OBJECTIVES

i. Assay of the literature exploring the equation of Vicharchika and Atopic

Dermatitis as well as establishing the modality of treatment of Satmya Viruddha

Nimittaja Vyadhi with special reference to Vicharchika.

ii. To explore the therapeutic effect of Gandhaka Churna on the activity of the

disease in patients suffering from Vicharchika / Atopic Dermatitis

iii. To evaluate the remission of the symptoms of Vicharchika / Atopic Dermatitis in

patients treated with Gandhaka Churna.

Historical Review


HISTORICAL REVIEW

Challenging disorder for the mankind from many decades is skin diseases, which

manifest in variety of forms. Skin diseases are even traced from the Vedic literatures.

VEDIC PERIOD

Veda is the oldest literature of the world. Much information about skin diseases are

available in these literatures. In Rig-Veda skin disorders are mentioned with typical

feature of Vaivarnya and Romashatana. The word Kushta is appearing in some areas of

Rig-Veda as medicinal plant rather than the skin disease. Kilasa and Palitya are cited

terminology for the skin disease. Lord Indra has managed the Charma Roga of Apala.

During this period people were disliked the persons who are suffering from charmaroga

due to the ugly look. In Atharva Veda, Shyma Trivrit is considered to be very effective

drug in the management of Kushta. Pama, Apachi, Gandamala are the few terminologies

to mention in relation to skin disorders10.

PURANA

In Agnipurana Nana Rogahara Aushadhani includes Kushtaghna preparation. There is an

elaboration of Khadira as internal medicine and Haratala and Manahshila as external

medicament in the treatment of Kushta. In Garudapurana, Karma Vipaka is a chapter

which contained causative factors of Kushta along with its management.

MANU SMRITI

Kushta is differentiated from Svitra and considered as a serious problem. Kushta,

Rajayakshma are the disorders where familial marriage was not encouraged. Avoiding

papakarma is advised as a management of Kushta.

MAHABHARATA

During this period person who is suffering from Tvak dosha is unfit to become a king.

SAMHITAKALA

Understanding of Kushta reaches its height during Samhita kala. Vicharchika term

appeared first time during this era.

Historical Review


Charaka Samhita

Acharya Charaka categorizes the Kushta as 7 Maha and 11 Kshudra Kushta. Vicharchika

is included under Kshudra Kushta11. The detailed description of Kushta is available in

Nidana 5th and Chikitsa 7th chapter. Other than this there is description of Kushta in the

Samhita. Rakta Pradoshaja Vikara includes the Kushta12. Initial management in the form

of Sthambhana in Raktapitta, Amatisara and Raktarsha produce the Kushta. Kushta is one

of the outcomes of Viruddha Ahara and Achara13.

Sushruta Samhita

Here Paapakarma, Krimi, Oupasargika were highlighted as unique causative factor of

disorder Kushta14. Symptamatalogy of uttarottara dhatu anugata Kushta elaborated first

time in nidana 5th chapter. He included Vicharchika under Kshudra Kushta. He also

identified genetic pre disposition of the disease. Management of Kushta has been

explained in Kushta and Maha Kushta Chikitsa Adhyaya.

Asthanga Sangraha and Asthanga Hridaya

Kushta is classified into 7 types according to Dosha15. Vicharchika has been mentioned

under Kshudra Kushta and said to be Kapha pradhanya Kushta with discharge in the form

of Lasika. Remaining explanation is fallows the Sushruta Samhita.

Bhela Samhita

In Bhela Samhita Kushta has been described in Sutra, Nidana & Chikitsa Sthana. In

Chikitsa Sthana chapter 6th Vicharchika is included in the category of Sadhya Kushta.

Bhela opines it as a moist or oozing lesion with dark red discolouration which is deep

rooted16.

Harita Samhita

The description of Kushta is available in 3rd Sthana in Harita Samhita & ‘Vicharchika’ is

mentioned as one of its varieties. Harita emphasises Vata and Rakta are important factors

for the production of Vicharchika and named as kandu. He considers it as a multiple pin

head sized eruptions with ulceration & itching17.

Historical Review


Kashyapa Samhita

Kushta Chikitsadhyaya is a chapter in which Kashyapa categorize Kushta into 18 variety

as Sadhya and Asadhya, in which Vicharchika is come under Sadhya Kushta. Paka and

Vrana is the unique symptamatalogy of Vicharchika explained by Kashyapa18.

Madhava Nidana

Explanation of the Kushta simulates with the elaboration of Charaka in etiopathogenisis.

Sharangdhara Samhita

The description of Kushta is available in Madhyama Khanda along with its treatment.

The bheda of Kushta is also told in 7th chapter of Purva Khanda.

Vangasena

Some special causes of Kushta had been described including Tila, Kulatha, Valmika

roga, Vruntaka.

Bhavaprakasha

Description of Kushta by Bhavamishra is simulates with Charaka and Dhatugatatva &

Sadhyasadhyata in lines with Sushruta. Arishta lakshana of Kushta has also been

described which were similar to that of Asadhya lakshana by Sushruta19 .

Bhaishajya ratnavali

In the 54th chapter the detail treatment of Kushta is given.

Gadanigraha

Vaidya Shodhal has described Kushta roga in cha.36 of Dvitiya Khanda. Its

classification is as per Charaka (7-Maha Kushta & 11-Kshudra Kushta) while

dhatugatatva is described as per Sushruta20.

In a nut shell from Vedic literatures until up to the Laghutrayi there appears of

progressive inclusion of information in relation to obstinate skin disorders. The

information available is limited to Vaivarya and Romashatana in Rig-Veda, addition of

more information of Charma Roga in Atharva Veda. Role of sinful activity in causation

of Kushta is cited in literatures of Purana. Concrete description of etiology; clinical

manifestation; types; prognosis and treatment in Bhrahatrayi and Laghutrayi unraveled

the understanding of Kushta/Vicharchika.

Paribhasha


Etymology of Kushta

The word 'Kushta' is derived from the Sanskrit root 'Kus Nishkarshane' by adding the

suffix 'Tka' to it, which means 'to destroy with certainty'.

Paribhasha of Kushta

“Kushnati Sharirastha Shonitam Vikrute.

Morbid Dosha provoke the four body elements. Collectively this derangement of the

Seven Dravya if not cared to, leads to the establishment of the disease that make the

skin 'Kutsit' or contemptible. Consequently, the whole body becomes despised;

therefore it is called "Kushtham"21.

Kushta is that which responsible for the vitiation as well discolouration of skin.

Etymology of Vicharchika

The word Vicharchika is derived from Sanskrit origin "Charch" dhatu by using the

prefix 'Vee' to it and suffixed by Navul22; the word Vicharchika is of feminine gender.

The Charch word refers to "Adhyane" has two syllables 'Adhi' which means 'above'

and 'Ayane' means 'to spread out'. Another meaning of Charchya is “to be repeated”23.

Needless to say by derivation we can say that Vicharchika is a relapsing disorder with

spreading nature which has Sukshma Sphota over skin and said to be a Svalpa Kushta.

This Vichar denotes the eruptions over the skin with Pruritus.

Vicharchika Paribhasha

Vicharchika means the disease which has relapsing nature coats/covers the skin in

particular manner and causes cracking of skin of hands & feet mainly.24 Another

definition unravels the Vicharchika as a disorder which has dark pigmentation of skin

along with profuse discharge with itching25. Yet another definition says Vicharchika

is a disorder in which skin become dry with marked linings associated with intense

itching and pain manifested mainly over Gatra Pradesha. If same character is

appeared over feet is said to be Vaipadika26.

Etymology of Eczema

The Greek word ‘Ec’ means out and ‘Zeo’ means boil. Thus, whole word ‘Ekzein’

means, to boil out.

Atopic Dermatitis (Type of Eczema) is an inflammatory, chronically relapsing, non-

contagious and pruritic skin disorder. Acute Eczema may be weeping, crusting and

vesicle formation and Subacute or Chronic may be dryness, scaling, fissuring and

lichenification.

Nidana


NIDANA

Karya Karana Siddhanta is emphasized in classics for each and every subject. One

can predict the Karana (cause) by observing the Karya (production) and vice versa

also. There is even true in regards to Kushta. By observing the Nidana one can predict

the forthcoming Kushta and by observing Kushta can assess the Nidana27. Nidana in

Kushta is given more importance, because little involvement of Nidana produces

disease Kushta. If the Vatadi Dosha becomes virulent other than the Kushta Janaka

Hetu then there is no production of the Kushta. The unique Nidana for the Kushta is

Papakarmaja,Atma SatmyaViruddha and the Inheritance28is highlighted in literatures.

Vicharchika is a Kshudra Kushta and has the Nidana of Kushta in general. All schools

of thought emphasise that Nidana of Kushta itself is responsible for the Vicharchika.

In literatures Kushta Nidana are elaborated under different categories as listed below.

Aharaja Nidana

Viharaja Nidana

Acharaja Nidana

Oupasargika Nidana

Aharaja Nidana –Viruddha Annapana is said to be the main Nidana for the

production of Kushta. Viruddha is the one which causes vitiation of Dosha and does

not eliminate the vitiated Dosha from the body. Consequently this in turn predisposes

to development of different diseases. Kushta is one such major disorder with similar

occurrence. Contrary to this, every person who indulges in Viruddha may not suffer

from Kushta. One who has Deeptagni and Dhatu Sara may not have deleterious

impact due to theViruddha29. It is worth mentioning here that, the etiopathogenisis of

Atma Satmya Viruddha is akin to the role of idiosyncrasy and hypersensitivity in the

causation of Atopic Dermatitis.

Mithyahara is the second important dietetic cause for Vicharchika. Not fallowing the

healthy codes of the food consumption is meant by the term Mithyahara30. Outcome

of the Mithyahara is improper digestion, absorption of the ahara rasa which in turn

produces the disease Kushta. Dermatitis due to the mal absorption and improper

ingestion of the food is highlighted in parallel science.

Nidana


Viharaja Nidana –Viruddha Vihara are listed as the Nidana of Kushta. Exposure to

sunlight and partaking in heavy work immediately after meals may precipitate the

Kushta. Sheetoshna Vyatyasa in the form of intake of cold material immediately after

exposure to hot; habitual intake of hot and cold foods alternatively may also produce

the Kushta. Needless to say excessive heat (especially with humidity) and coldness

are known to provoke outbreaks of Atopic Dermatitis as well as sudden and extreme

temperature swings. Vega Vidharana is another Viharaja Nidana for Kushta.

Acharaja Nidana – This is related with behaviour of a person. If person indulges in

any variety of Papakarma it may contribute to the occurrence of Vicharchika.

Oupasargika Nidana – Spreading of disease from person to person by different

media is considered as Samsarga Prabhava Vyadhi in which Kushta stands first.

Table No-1 Vicharchika Nidana

Nidana CS31 SS32 AS33 AH34 BHS35 HS36

Aharaja Nidana

Viruddha Ahara

Chilachima with milk

+

+

+

+

+

-

Intake of food containing

Hayanaka, Yavaka, Chinaka,

Uddalaka & Koradusha alongwith

Ksheera, Dadhi, Takra, Kola,

Kulattha, Masha, Atasi, Kusumbha

& Sneha

+

-

-

-

-

-

Intake of Mulaka & Lashuna with

Ksheera

- - - - + -

Continuous intake of Gramya,

Audaka & Anupa Mamsa with

Ksheera

-

+

-

-

+

-

Use of Pippali, Kakmachi, Lakucha

with Dadhi & Sarpisha

- - - - + -

Nidana


Use of Mulaka with Guda + - - - + -

Excessive use of alcohol & milk - - - - + -

Intake of articles having sour taste

with milk

-

-

-

-

+

-

Excessive use of green vegetables

with milk

- - - - + -

Intake of honey & meat after

taking hot diet & vice-versa

- - - - + -

Use of fish, citrus & milk together - - - - + -

Matsya,Ksheera & Nimbu together - - - - + -

Mithya Ahara

Excessive use of Navanna, Dadhi,

Matsya, Amla & Lavana

+

+

+

+

+

-

+

-

-

-

-

Excessive use of Tila, Ksheera &

Guda

+ - - - - -

Drava, Snigdha, Guru aharanam

atyartha sevanam

+ - - - - +

Continuous & excessive use of

Madhu & Phanita

+ - - - - -

Intake of food that would cause

burning sensation

+ - - - + -

Intake of food during indigestion + + - - + -

Adhyashana + + - - + -

Asatmya Ahara - + - - - -

Intake of polluted water - - - - - +

Vihara Hetu

Mithya Hetu

To do physical exercise & to take

sun bath after heavy meals

+

-

-

-

-

-

To perform sexual act during

indigestion

+ + - - + -

To do exercise/sexual act after

Snehapana & Vamana

- + - - - -

Nidana


Sheetoshna Vyatyasa + - - - - -

Sudden change from Santarpana to

Apatarpana & vice-versa

+

-

-

-

-

-

Entering or intake cold water

immediately after one is affected

with fear, exhaustion & sunlight

+

+

-

-

+

-

Mithya samsarga Sevana - - - - + -

Vega Vidharana

Withholding of the natural urges

i.e. Mutra & Purisha Vega, etc.

-

+

-

-

+

-

Suppression of the urge of Emesis + + - - + -

Panchakarmapcharaj

Panchakarma Kriyamane Nishidha

Sevana

+

-

-

-

-

-

Improper administration of

Snehapana

+ + - - - -

Achara Hetu

Insulting acts to Brahmins,

Teachers & other respectable

persons

+

+

+

+

-

+

Indulgence in sinful activities in

present or past life

+

+

+

+

+

+

Use of money or material acquired

by unfair means

-

-

+

+

-

-

Censuring or killing virtuous

persons

-

+ + + - +

Samprapti


SAMPRAPTI

Samprapti or pathogenesis is the process of evolution of the disease, right from the

indulgence in the causative factors, to the manifestation of the disease in its full

form37. Samprapti has an important role in understanding the disease as well as

management of the same. In literature elaborated explanation of development of

Kushta is available. Those Samprapti is more towards the manifestation of Maha

Kushta; but also this is applied to the Kshudra Kushta. As Vicharchika is one of the

Kshudra Kushta Samprapti of Kushta can be applied. In some of literature Vishesha

Samprapti of Vicharchika is elaborated. Samanya Samprapti of Kushta as fallows.

By various causative factors as mentioned in Kushta Nidana mainly Viruddha Ahara

and Vihara Dosha assume the state of Sanchaya in their own site. As the Nidana are

continued, all the three Dosha are simultaneously provoked and at the same time the

four Dushya namely Tvacha, Rakta, Mamsa & Lasika attain Shithilatva. Then the

provoked Dosha tend to localise in these deranged four Dushya in the ensuing Prasara

and Sthana Samshraya stage. This is responsible for the further vitiation of the

Saptaka Dravya (Tridosha;Tvak,Rakta,Mamsa and Lasika ) and so produce the

disease Kushta. The quality of Sthirata is essential for the morbid Dosha localised in 4

Dushya to produce the Kushta. If localised Dosha are having the quality of Sarana

then will produce the disease Visarpa. As the Saptakao Dravya Sangraha of Visarpa

and Kushta are similar so one should differentiate the both38.

Involvement of the whole body in Kushta is possible. When the morbid Dosha

mainly Vata Dosha along with remaining 2 other Dosha enter into the Tiryak Sira and

then thrown to all over the body and manifests as circular patches which is known as

Kushta39. In Kushta, the involvement of the 4 Dushya is mandatory. Maha Kushta as

well as Kshudra Kushta will be manifested by the derangement of the all the four. The

Uttarottara Anupravesha in Kushta is referred as involvement of the Medadi Dhatu by

the vitiated Dosha. This unique feature is present only in Maha Kushta and not in

Kshudra Kushta40.

In the Vishesha Samprapti of Vicharchika, the Dosha, after being aggravated, vitiate

the Tvak & Mamsa to produce Pidaka which is accompanied by Daha & Kandu.

Samprapti


The condition wherein, the skin cracks, becomes dry, coarse and if it manifests itself

all over the body, then is known as Vicharchika. If the same Symptamatalogy is

limited to the feet, then is called as Vaipadika42.

Samprapti Ghataka of Vicharchika

Dosha : Tridosha

Dushya : Tvak, Rakta, Mamsa, Lasika (Ambu)

Srotas : Rasa, Rakta, Mamsa

Srotodushti Lakshana: Atipravrutti

Udbhava Sthana : Amapakvashaya

Sanchara Sthana : Sarva Shareera

Adhishthana : Tvacha (Fourth layer /Fifth layer)

Rogamarga : Bahya

Saddhyasadhyata : Krichrasadhya

Dosha : The Kushta is the outcome of compulsory provocation of Tridosha.

Identifying the predominance of Dosha in a given patient of Kushta, aids in the

diagnosis of type of Kushta Roga he is suffering from. Vicharchika is a Kshudra

Kushta and even though this is a Tridoshajanya Vyadhi, literature emphasised the

predominance of specific Dosha in the manifestation of Vicharchika. According to

different schools of thought, it is either Kapha or Pitta Dosha predominates the

Samprapti of Vicharchika. Further to add, invariable involvement of Tridosha is

reflected in the clinical presentation. Shyavata, Bahusrava and Kandu indicate the

involvement of Vata Pitta and Kapha Dosha respectively.

Dushya: Tvak, Rakta, Mamsa and Lasika are the 4 Dushya involved in the

manifestation of the disease. These 4 Dushya are mandatory for the production of

Kushta42. About another opinion about Dushya, it is said that Twak is involved first in

any variety of Kushta; then progressive involvement of the remaining 3 Dushya.

Involvement of the Dushya beyond the Mamsa Dhatu is absent as per Kshudra Kushta

in general and Vicharchika in particular43.

Samprapti


Srotas : Kushta is enlisted under Raktavaha Sroto Vyadhi. But also there is

involvement of other Srotas in the manifestation of the disease. Vaivarnya is an

outcome of Raktavaha Srotas; Pidakodgama justify the Mamsavaha Srotas and

Bahusrava and Rukshya justifies the Rasavaha Srotas.

Classification of Kushta

Kushta is mainly classified into Maha Kushta and Kshudra Kushta. The exact

differentiation of the both is based on variation in occurrence of Purvarupa as well as

progression on the disease involving deeper Dhatu44. The Symptamatalogy of Maha

Kushta is more similar to the clinical presentation of the Hansen’s disease. All the

Maha Kushta can explain under the heading of Leprosy. The predominant symptom

of Leprosy is loss of sensation, and the same is highlighted as a premonitory symptom

of the Maha Kushta. Both The hypo as well as hyper pigmentation of Leprosy is also

elaborated in Maha Kushta. The symptoms of Leprosy are mostly confined to the skin

and peripheral nerves. The skin lesions are anaesthetic, hypaesthesic and anhidrotic45.

This is also true to Maha Kushta and its Purvarupa. In Leprosy clinical manifestation

is confined to the peripheral nervous system, skin, eyes, testis and upper respiratory

tract. This is even true for the Maha Kushta. The Symptamatalogy explained due to

the involvement of deeper Dhatu like that of Nasabhanga, Krimi46 involvement etc are

more towards the Hansen’s disease.

Kshudra Kushta are considered to be less severe in comparison to that of Maha

Kushta. The manifestation of Kshudra Kushta is without Purvarupa of Kushta and

absence of involvement of deeper Dhatu. Any of skin disease manifested with scaly

appearance included under the heading of Eka Kushta which has feature simulating

Matsya Shakala. Disorder manifested with thickening of skin is correlated to that of

Charmakhya Kushta which has the symptom identical to Hasticharma. The cardinal

feature of Weeping is related to Vicharchika and has Bahusrava. Thin layered bullous

eruption with clear fluid is compared to that of Visphota.

Samprapti


The difference between Maha Kushta & Kshudra Kushta can be tabulated as below.

Table No- 2 Difference between Maha Kushta & Kshudra Kushta

MahaKushta Kshudra Kushta

1 Bahu Doshavastha with Dosha

lakshana bahulyat47

Bahu Doshavastha with alpa Dosha

lakshanatvat47

2 Atyartha peeda Absent Athyartha peeda

3 Uttarottara dhatu anupravesha Uttarottara dhatu ananupravesha

4 Presence of Purvarupa Absence of Purvarupa

5 Mahati Chikitsa48 Alpa Chikitsa48

6 Chronic Less chronic

7 Tvaka Svapa is compulsory Tvaka Svapa is not compulsory

8 Possible - Adibala Pravratatva 49 Absent - Adibala Pravrattatva 49

Classification According to Different Acharyas

Table No-3 Types of Maha Kushta

Name C.S50 S.S51 A.H52 BHS53

Kapala + + + +

Udumbar + + Audumbara Audumbara

Mandala + - + +

Rishyajihva + + Rukshakhya +

Pundarika + + + +

Sidhma + - - Alabu

Kakanaka + + + +

Dadru - + + -

Aruna - + - -

Samprapti


Table No-4 Types of Kshudra Kushta

Name C.S54 S.S55 A.H56 BHS57

Eka Kushta + + + +

Charmakhya + _ + CharmaKushta

Kitibha + + + +

Vipadika + _ + Vaipadika

Alasaka + _ Alasa -

Dadru + _ _ +

Charmadala + + + _

Pama + + + +

Visphotaka + _ Visphota _

Shataru + _ Shatarushi Shatarushka

Vicharchika + + Vicharchi +

Sthularushka - + _ Sthularu

Mahakushta - + _ _

Visarpa - + _ _

Parisarpa - + _ _

Sidhma - + + _

Rakasa - + _ _

Gajacharma - _ _ _

Svitra - _ _ +

Vishaja - _ _ +

Samprapti


Classification According to Harita

Harita classified Kushta as Sadhya and Asadhya category. Name of Asthadasha

Kushta are tabulated below

Table No-5 Ashtadasha Kushta According to Harita

1 Kapalaka 10 Vaipadika

2 Udumbara 11 Charmadala

3 Dadru 12 Visphotaka

4 Mandala 13 Bahuvrana

5 Visarpaka 14 Kandu

6 Hastibala 15 Vicharchi

7 Kina 16 Karmaja

8 Gojihvaka 17 Pandura ( Doshaja)

9 Lohitamandala 18 Sahaja

Kashyapa as well as Bhela has classified the 18 types of Kushta as 9 Sadhya and

9 Ashadhya kushta.

Table No-6 Sadhya Asadhya Kushta According to Kashyapa

Sadhya Kushta Asadhya Kushta

Sidhma Pundarika

Vicharchika Svitra

Pama Rishyajivha

Dadru Shatarushka

Kitibha Oudumbara

Kapala Kakanaka

Sthularushka CharmaKushta

Mandala Ekakushta

Vishaja Vaipadika

In a nutshell Tridosha Dusti along with vitiation of the Tvak, Rakta, Mamsa and

Lasika over the Gatra Pradesha produces Vicharchika. The manifestation of

Vicharchika is without Purvarupa of Kushta in most of the occasions, and

Vicharchika comes under Sadhya Kushta.

Purvarupa


PURVARUPA

In the course of manifestation of the disease the signs and symptoms which are appear

before the actual manifestation of the disease is Purvarupa58. Purvarupa is one which

is manifest in 4th stage of Shat Kriyakala. Management of any disease become easy if

diagnosed in this stage. This is the stage were initiation of Dosha Dushya

Sammurchana will begin. Purvarupa as per Kushta is concerned has an important role

to differentiate Maha from that of Kshudra Kushta. Kshudra Kushta are manifested

without Purvarupa where as Maha Kushta has Purvarupa in their course of

manifestation. Another important point appears in Sadhyasadhyta in which all the

Purvarupa appear then Kushta is Asadhya for the management.

Table No-7 Kushta Purvarupa

Purvarupa CS59 SS60 AH61 AS62 BHS63 KS64

Aswedanam + + + + + +

Atiswedanam + + + + + +

Parushyam + + - - - -

Atishlakshnata + - + + - +

Vaivarnyam + + + + + +

Kandu + + + + - -

Nistoda + + + + - +

Suptata + + + + + -

Paridaha + + + + + -

Pariharsha + - - - - -

Lomaharsha + + + + + +

Kharatwam + - + + - +

Ushmayanam + - - - + -

Gauravam + - - - + +

Shwayathu + - - - - -

Purvarupa


Visarpagamanam abhikshanam cha kaye + + - - - +

Kaya chhidreshu upadeha + - - - - -

Pakva-dagdha-dashta-bhagna-kshata-upashkha-liteshu ati-matram vedna

+ - - - - +

Svalpa api vrananam dusti + - + - - -

Svalpana api vrananam asamrohanam

+ + + - - -

Kothonnati + - + + - -

Shrama + - + + - -

Klama + - - - + -

Vrananam sheeghrotpatti chirasthiti

+ - + - - -

Sparsha ajnatva + + - - - -

Raga - - - - + +

Pipasa - - - - + +

Dourbalya - - - - + +

Davathu - - - - + -

Purvarupa that are enlisted above is more pertinent to Leprosy. The Symptamatalogy

explained in Purvarupa may continue in the Rupa stage and is even true to Leprosy.

Leprosy is one in which depigmented patches are the common manifestation in

association with variation in sensory perception.

Rupa


RUPA

Kushta is one of the Rakta Pradoshaja Vikara. Rakta Pradosha will produce wide

range of Symptamatalogy like that of discoloration of the skin up to the loss of

consciousness as in discussed under the title Shonita Dusti65. Kushta comes under the

category of discoloration of the skin along with alteration in touch sense perception.

Kushta is Tridoshaja Vikara where all the three Dosha are responsible for the

production of the disease. But this has an exception when considering the Kshudra

Kushta. Alterations in touch sense perception is remote possibility as per Kshudra

Kushta and also have the minimum symptoms of the Tridosha involvement.

Symptamatalogy of Vicharchika almost simulates that of Atopic Dermatitis.

Wet Eczema and Dry Eczema are the two distinct presentations of Atopic Dermatitis.

Wet Eczema is characterised by profuse discharge. Contrary to this, Dry Eczema

presents with absence of discharge and has Lichenified skin66. Vicharchika also have

similar manifestation in the form of Bahusrava to that of Raji (Lichenification).

Chronic illness of skin eruptions, itching and oozing characterizes Vicharchika.

Nevertheless, Recurring skin rashes, redness, skin oedema, itching, dryness, crusting,

flaking, blistering, cracking, oozing, or bleeding are the typical clinical manifestations

of Atopic Dermatitis. Rupa of Vicharchika according to different Acharyas

summarised below.

Table No-8 Rupa of Vicharchika

Rupa CS67 SS68 AS69 AH70 KS71 BHS72 HS73

Vedana Vishesha

Kandu + + + + - - +

Vedana - - - - + - -

Ati ruja - + - - - - -

Daha - + - - - - -

Colour of Pidaka

Shyava + - + + - + -

Lohita - - - - + + -

Shveta - - - - - - +

Shyama - - - - + - -

Rupa


Nature of Skin and Pidaka

Ruksha - + - - - - -

Khara - + - - - - -

Daalyate Tvak - + - - - - -

Raji - + - - - - -

Character of Discharge

Bahusrava + - - - + - -

Lasikadhya - - + + - - -

Praklinnata - - - - - + -

Special Feature

Paakavati - - - - + - -

Bahuvrana - - - - + - +

Mamsena upachita - - - - - + -

Visphota sannibha - - - - - - +

Kandu (Itching): This is the cardinal feature of Vicharchika. Due to the vitiation of

the Kapha Dosha there is development of Kandu. Even the vitiation of Vata Dosha

produces Kandu in the body. Severity of the itching is maximum in Atopic

Dermatitis. Hypersensitivity reaction will produce the histamine which is responsible

for the itching in Atopic Dermatitis.

Pidaka (Papulation): When vitiated Pitta localised in Tvacha along with Rakta

produce Pidaka which has discolouration74. Initiation of the Atopic Dermatitis in the

form of maculo-papular lesions over the skin and then they start to group together.

Srava (Weeping): Involvement of Pitta and Kapha Dosha in Vicharchika produce

Srava. The Srava which is profuse may be watery. Manifestation of Atopic Dermatitis

in wet form is characterized by discharge which is usually watery and occasionally

blood mixed.

Rupa


Vaivarnya(Erythema and Discoloration): Vicharchika is characterised with

discoloration in the form of Shyava to that of Rakta(Redness). Redness may be

compared with that of Erythema which is due to the vascular dilatation. Shyava is the

pigmentation of the skin. Needless to say Rakta Vaivarnya is seen in Wet Atopic

Eczema and Shyava in Dry Atopic Eczema.

Nature of Skin: Atopic Dermatitis is one in which there is possibility of blockage of

sweat gland. So there is development of dry skin. Dry skin is responsible for the

itching. Due to continuous itching there is development of cracking of skin and

increased thickening of the skin along with prominent skin appendages. In a course

of Vicharchika there is development of Rukshata intern produce Kharat to the skin. If

same continues for longer duration it will produce Tvak Vidarana and appearance of

Raji similar to that of the Lichenification.

Vedana: In Vicharchika symptom of Vedana vary from burning sensation to pain

over the involved skin. Atopic Dermatitis is characterised by erosion of skin and

aberration of the skin. The pain receptors known as nociceptors that are free nerve

endings are widely spread in superficial layer of the skin. Tissue irritation will

produce prostaglandin, which in turn stimulate the nociceptors. In Atopic Dermatitis

there may be the chronic pain and referred as burning or aching.

Special Features : These are the features usually absent in typical non complicated

Atopic Dermatitis. If the Atopic Dermatitis is along with Stasis Dermatitis there is

possibility of development of Vrana and Paka.

So the overall manifestation of Vicharchika simulates the manifestation of Atopic

Dermatitis. In wet dermatitis Weeping, Itching is the cardinal feature which is

coherent with the Bahusrava and Atikandu. If Atopic Dermatitis attains chronicity,

then is characterised by dry skin, erosion of the skin, lichenification and pain.

Rukshata, Vidarana of Tvak, Raji, Atiruja explains the same in Vicharchika.

Upadrava


UPADRAVA

The Symptamatalogy which appear after complete manifestation of the primary disease is

considered to be Upadrava75. In any of the disease if Upadrava are manifested then is

indicative of more difficulty in its management. The Upadrava that are enlisted in Kushta

is applied to the Maha Kushta rather than the Kshudra Kushta. All of these Upadrava are

also seen in Hansen’s disease rather than any other skin manifestation. Upadrava of

Kushta which are enlisted includes Prasravana, Angabheda, Angapatana, Trishna, Jvara,

Atisara, Daha, Daurbalya, Arochaka & Avipaka76. Vicharchika is a Kshudra Kushta and

is probably devoid of Kushta Upadrava.

SADHYA-ASADHYATA OF VICHARCHIKA

Regarding prognosis, classics have stated that the disease of Kushta appearing in a

person, who has full control over his sense organs and confined only to Tvacha, Rakta

and Mamsa Dhatu of the body, involving Vata and Kapha Dosha should be regarded as

curable and can be eradicated completely77. If Kushta is manifested with the involvement

of Meda Dhatu is Yapya, Yapya requires palliative treatment and is never rooted out. In a

case when Kushta shows its manifestation in Asthi, Majja & Shukra or any Kushta

having the complications as described above are all incurable78. As Tvacha, Rakta and

Mamsa Dhatu are generally vitiated in the disease Vicharchika, so it may be counted

under the category of "Sadhya Kushta". The improper regimen leads curable diseases to

incurability79; hence proper measures should be carried out at the early stages of the skin

diseases.

Chikitsa


CHIKITSA

The modality through which the Vighatana of Dosha Dushya Sammurchana and

thereby attainment of normal functioning of Dosha Dushya and Mala is considered as

Chikitsa80. Daiva Vyapashraya and Yukti Vyapashraya are the main 2 categories of

Chikitsa and both are emphasised in literatures. As Kushta is a disorder which has a

Papakarma as a Nidana; and hence the Daiva Vyapashraya Chikitsa has an important

role to play in the effective management. In contrast to this, Yukti Vyapashraya

Chikitsa is also equally important in the treatment of Kushta81. The different principle

of management elaborated in Kushta Chikitsa is more towards the Maha Kushta.

Kshudra Kushta do not have the tendency of Uttarottara Dhatu Anupravesha and thus

milder therapeutic approach is rational.

Even though Vicharchika is a Kshudra Kushta, it is characterised by Bahudosha

Avastha, and hence all the management of Kushta should be carried out in

Vicharchika. Shodhana, Shamana, Kushtahara Rasayana, Bahirparimarjana Chikitsa

forms the useful modes of the treatments. Punah Shodhana is the main line of

treatment for Kushta. Depending on the involvement of the Dosha Sarpipana is

indicated in Vata pradhanya Kushta, Vamana in Kapha pradhanya Kushta, and

Virechana in Pitta pradhanya Kushta82. Vamana may be administered once in every

15 days, Virechana may be administered once in every 30 days, Nasya may be done

once in every 3 days and Siramokshana is to be done once in every 6 months.

Shodhana is even indicated in Purvarupa of the Kushta and during the Uttarottara

Dhatu involvement83.

Shamana is the other principle of management which includes Antaparimarjana and

Bahirparimarjana measures. Shamana therapy with Tikta and Kashaya Dravya after

administration of proper Shodhana is advised84. It pacifies remnant Dosha. More to

add, Shaman is advised for Bala, Vruddha, Sukumara and Garbhini in whom

Shodhana is contraindicated. The main principle of Shamana therapy is to normalize

and to maintain the levels of all three Dosha and purification of Rakta as well as

Raktavaha Srotas. For the purpose of Shamana, many drugs and formulations have

been described. As Bahirparimarjana Shamana is the purification of the skin by the

external application of the medicament.

Chikitsa


Mode of Bahirparimarjana includes Lepa, Parisheka and Avachurnana85 etc. Out of

this Lepa has been given importance so that it should be repeated in every 3days86.

Rasayana also has importance in Chikitsa of Kushta. Vicharchika is a chronic

relapsing disorder in which vitiation of Tridosha along with accumulation of the same

in Tvak, Rakta, Mamsa and Ambu. Relapse of the Vicharchika occurs when the

Vyadhikshamtva of the Dhatu become poor. Hence to enhance the Vyadhikshamatva

of the Dhatu different Naimittika Rasayana are elaborated in the classics. Bhallataka,

Tuvaraka, Bakuchi, Shilajatu. Guggulu, Khadira Rasayana are indicated as

Kushtahara Rasayana87.

Even though there are different principles of management; combination of Shodhana,

Shamana and Rasayana in a proper way restricts the recurrence of the disease Kushta.

Needless to say Vicharchika is well managed by the above said crux of treatment.

Atma Satmya Viruddha Nimittaja Vyadhi


ATMA SATMYA VIRUDDHA NIMITTAJA VYADHI

The skin is the first organ which is in contact with the different environmental factors.

The dust, smoke and variation in the climate are the common happening of the

environment. The food which is consumed by the person is also having an impact on

skin. In general the people are capable of tolerating the environmental changes as well

as some of the food which are said to be allergen for the others. The people who are

suffering from the Atopic Dermatitis or Vicharchika, the above factors are considered

to be the triggering factor of the same. The people who are asymptomatic of

Vicharchika may develop the episodes and who are has an episode of the disease may

exhibit increase in Symptamatalogy. This happening is not present in every person.

Person who are suffering from the disease of Vicharchika / Atopic Dermatitis are

having this type of unique manifestation due to hypersensitivity to the particular

allergen. Atopic Dermatitis is one which is triggered by the dietetic as well as

environmental causes. Such type of allergic manifestation is best explained through

Atma Asatmya as well as Atma Satmya Viruddha Nimittaja Vyadhi.

Satmya and Asatmya are the terminology used in literature for the body response to

the variety of external factor. It includes different environmental factors and dietetic

habits. The response which is wholesome to the body after exposure to variety of

external factor is known as Satmya88. Person may accustom to any factor from birth

or later life, if they have a wholesome effect to the body then termed as Satmya. So

Satmya may be innate or acquired. Even though literature explains Ekanta Hita or

Satmya, they will change depending upon the different entity. The body response

which is unwholesome to the health when they expose to the particular external factor

is known as Asatmya. Asatmya also varies according to the different entity. In other

word to say, Satmya helps in building of the body where as Asatmya will destroys the

body. Prakruti, Vaya, Rutu, Desha, Kala, Vyadhi are the modulating factor of Satmya

and Asatmya89. For example Ghee is said to be wholesome to all person as explained

in our literatures. Depending upon the different factor there is possibility of

unwholesome effect of Ghee. Intake of Ghee during Vasanta rutu; Ghrita prepared

with Viruddha Dravya; administration of Ghrita in Anupa area and finally intake of

Ghrita in Kapha Dosha predominant and Obese person is said to be Asatmya even

though in general Ghee is Satmya to every person90.



Prakruti is the natural body constitution depending upon the dominance of the Dosha

during conception. Each Prakruti has its own unique characteristic features. Those

characters remain same throughout the life. For each and every Prakruti there are

some harmonising as well as destroying factors exist. Say for example Vyayama is

considered to be harmonising to the person who is having Kapha Prakruti . This is

known as Prakruti Satmya. Any of the activity which is deteriorating the health of the

person is Prakruti Asatmya. For example Vyayama to the Vata Prakruti person is not

ideal and are Prakruti Asatmya.

Satmya and Asatmya related to Vaya, Rutu, Desha ,Kala ,Vyadhi can be explained as

same that of the Prakruti . These are common far those person belonging to the same

category. It does not vary from person to person. Apart from these variety of Satmya

and Asatmya there is little variation from the general rule of Oka Satmya and Atma

Satmya.

Habitual consumption of some food or habitual to the particular activity makes the

person to get adopt to the same. This is known as Oka Satmya. Oka Satmya may be

complimentary to the health or derogatory to the health. This is a unique variety of

Satmya; in which derogatory factor may not prove harmful to the health. Such type of

habituation leading to favourable adaptation is regarded as Oka Satmya91.

Another concept of Satmya and Asatmya which does not fallow any of above said

principle is termed as Atma Satmya. Atma Satmya is one which differs from person to

person92. The favourable and unfavourable factors are unique to that individual only.

Some factors which are complimentary to the individual may not for another. This

implies towards the Atma Satmya. Some material generally considered to be good

may produce derogatory effect in some person. In such derogatory manifestation

includes skin manifestation and respiratory Symptamatalogy. Person who has Tamaka

Shvasa exposure to raja may trigger the condition. Same way person who has having

the skin manifestation may enhanced by the intake of fish, pea nut, shellfish, egg etc.

This is referred as Atma Asatmya. This is referred as idiosyncrasy or hypersensitivity

in modern literatures. Consequence of Atma Asatmya may be producing the different

disorder. Coming paragraphs elaborate the same.



Asatmya refers to exposure to against once Satmya. That means Asatmya termed as

Satmya Viruddha. So exposure against to Atma Satmya is referred as Atma Satmya

Viruddha. Viruddha is of different variety which includes even Satmya Viruddha. The

different disorders produce by the Viruddha. So an outcome of Atma Satmya

Viruddha is comes under vast category of the illness produced by the Viruddha. In

other word to say the disease produced by the Atma Asatmya may be narrated as

Atma Satmya Viruddha Nimittaja Vyadhi.

Viruddha is one in which vitiation of Dosha with not expelling out of the body. Due

to this vitiated Dosha reaches to its peak of provocation and in term produce different

disorders. In literature Visarpa, Kushta, Kilasa, Sheetapitta, Udarda etc are enlisted as

outcome of Viruddha. Viruddha in the form of food and activity will precipitate the

disease Vicharchika. Intake of milk with fish or sour food may precipitate the skin

manifestation. Same way sudden variation of environmental temperature also triggers

the Vicharchika and other skin manifestation. Viruddha Ahara Sevana in the form of

above said is considered to be unique for the manifestation of the skin disorder. This

is explained as Atma Satmya Viruddha. If the person is having Atma Asatmya and

exposure to the different triggering factor may land up in any one of the skin

manifestation. Intensity of Atma Satmya Viruddha Nimitta Vyadhi is depending up on

the different entity that includes Vaya, habituate to that of Atma Asatmya, 93 etc.

As Vicharchika belongs to the disease produced by the Viruddha Nimittaja; so

principles of management of the same is applicable to the Vicharchika. Those

principle are the

Avoiding the Atma Asatmya factor and gradual removal of the Atma Asatmya

factor.

Adaptation of Atma Asatmya factor.

Shaman Chikitsa suppressing the Atma Satmya Viruddha response.

Shodhana Chikitsa preventing the Atma Satmya Viruddha response.

Rasayana Chikitsa to enhance the Vyadhikshamatva against the Atma Satmya

Viruddha response.



Avoiding the Atma Asatmya factor and gradual removal of the Atma Asatmya

factor.

First treatment modality of any disease is avoiding the causative factor. That is

elaborated as Nidana Parivarjana. One can identify the Atma Asatmya and that should

be avoided. Another modality is gradual removal of Atma Asatmya. Asatmya which

is derogatory to the body gradually removed and Satmya to that person should be

started. This is more applicable to the Ahara Asatmya of that particular person94.

Adaptation of Atma Asatmya factor

If there is not possible of avoiding the Atma Asatmya; then the next principle is

considered to be adaptation of Atma Asatmya. Adaptation is referred to make the

Atma Asatmya to Atma Satmya by different therapeutic measures. The adaptation

technique is mainly elaborated in management of Viruddha. Literatures explain that

make the Abhisamskrita to the body against Viruddhanna or those Dravya which

produces the derogatory effect. This possible by the continuous usage of the same.

The adaptation may be by natural or by therapeutic measures95. As per skin

manifestation is concerned milk , fish, peanut are considered to be the Atma Asatmya

So one can continuously use those in minimal quantity will produce the Atma Satmya

against the same. Literatures highlighted that Satmya to that particular Viruddha does

not produce any manifestation. By the Abhisamskara; Shareera will get resistance

against Atma Asatmya or get saturated to the body96. The concept of Abhisamsakara

is explained as immunotherapy in modern literatures.

Shamana Chikitsa suppressing the Atma Satmya Viruddha Response

Shamana is another line of treatment tackling the Atma Satmya Viruddha Nimittaja

Vyadhi. Shamana is one which makes the normalcy of vitiated Dosha and maintains

the normal Dosha. This is the treatment which can apply for each and every person.

The administration of the Shaman medicine before the episodes of Atma Asatmya

Vyadhi is beneficial97. Needless to say administration of Shamana prior to the disease

manifestation will check the sequence of pathological events. There are lots of

Shamana medication enlisted for Atma Satmya Viruddha Nimitta Kushta Vyadhi.



Shodhana Chikitsa preventing the Atma Satmya Viruddha Response.

Shodhana is another line of treatment for the Satmya Viruddha Nimittaja Vyadhi. As

the disease of Atma Asatmya occurring in episodic nature so Shodhana is best during

symptom free period. This will eliminate the morbid Dosha out of the body and

maintains the normalcy of the Dosha. Once the Dosha attains the normalcy there is

enhancement of the Vyadhikshamatva and episodes of the Atma Asatmya Vyadhi will

be decreased98.

Rasayana Chikitsa to enhance the Vyadhikshamatva against the Atma Satmya

Viruddha Response

Rasayana is a treatment which enhances the Vyadhikshamatva of an individual. Aim

of the Rasayana is reduce the recurrence of any disease and maintenance and

improvement of the functioning capacity of Dosha and Dhatu. As per the disease and

Rasayana in literature particular Rasayana are elaborated for the every disease. These

Rasayana are termed as Vyadhihara Rasayana. These Vyadhihara Rasayana are

important for the reconditioning the body against the Atma Satmya Viruddha

Nimittaja Vyadhi99. These Rasayana will work on the initial pathology of a disease

that is Kha Vaigunya and Sroto Dusti. Rasayana has its maximum effect if

administered after the Shodhana. So that body will capable of withstanding against

the Atma Satmya Viruddha Ahara or Vihara. In literatures there are many Kushta

Vyadhihara Rasayana are explained; it includes Tuvaraka Rasayana, Bhallataka

Rasayana, Bakuchi Rasayana etc.

Pathya-Apathya


PATHYA-APATHYA

Pathya Apathya in Vicharchika

Observance of Pathya and Apathya is equally important in Kushta as any other

disease. As cited earlier Atma Satmya Viruddha is one of the cause for disease and

hence the necessity of knowing about Pathya and Apathya. As the Vicharchika is a

form of Kshudra Kushta, the Pathya Apathya of the disease Kushta is applicable to

Vicharchika. The main Nidana like that of Viruddha Ahara and Viruddha Vihara are

considered to be the Apathya and those maintain the normal functions of the Tridosha

are considered as Pathya in literatures. Knowledge of this helps to avoid the Atma

Satmya Viruddha factors even. Enlist of Pathya in literature view is tabulated below.

Table No-9 Pathya in Vicharchika

Sl. No. Pathya Dravya References

1. Laghu Anna CS100

2. Tikta Shaka CS,AH 101

3. Bhallataka CS,SS102,AH

4. Triphala CS,AH

5. Nimba CS,SS,AH

6. Purana Dhanya CS,SS

7. Jangala Mamsa CS,SS,AH

8. Mudga CS,AH

9. Patola CS,AH

10 Ghrita CS,AH

11. Shashtika Shali, Yava, Godhuma,

Karadush, Shyamaka, Uddalak.

SS,AH

12. Adhaka SS,AH

Pathya-Apathya


13. Pana-Parisheka Avagaha of Khadir

Kashaya.

CS,SS,AH

14. Masura AH

15. Mandukaparni SS

16. Avalguja SS

APATHYA

Any Ahara or Vihara which hampers the normal functioning of the Tridosha and

cause/ aggravate the disease is known as Apathya. The Nidana described for Kushta

may generally be regarded as Apathya for Vicharchika. Besides this the Acharyas

have described some other factors which should be avoided as they may cause skin

diseases and Vicharchika as well. These are described in a tabular form below.

Table No-10 Apathya in Vicharchika

Sl.No. Apathya Dravya References

1. Guru Anna CS103

2. Dugdha CS,SS104,AH

3. Amla Rasa CS,SS,AH105

4. Dadhi CS,SS,AH

5. Anupa Mamsa CS,SS,AH

6. Matsya CS

7. Guda CS,SS,AH

8. Tila CS,AH

9. Mamsa & Vasa SS

Pathya-Apathya


10. Taila SS

11. Kulatha SS

12. Masha SS,AH

13. Vidahi Anna SS,AH

14. Abhishyandi Anna SS

15. Ikshu Vikara SS

16. Lavana CS,AH

17. Maithuna SS

Drug Review


DRUG REVIEW

In the present study the Gandhaka Churna is orally administered in patient’s suffering

form Vicharchika as Shamana medicine. The detail of the same is given below.

Composition of Gandhaka Churna (Sahasra Yoga) 106

Shodhita Parada :1 Part (80grams)

Shudha Gandhaka :6 Part (480grms)

Shodhita Bakuchi(Seeds) Churna :7 Part (560grms)

Kakamachi Panchanga :Svarasa 480grms per bhavana,total 3.5kg

Bhringaraja Panchanga :Svarasa 480grms per bhavana,total 3.5kg

Indication : Ashtadasha Kushta

Matra : The dosage of Kajjali in skin manifestation (Vidhradhi) is 1gm per day.

By implication the same dosage is taken for the Gandhaka Churna.

Method of Preparation

Seven Bhavana of Kaakmaachi Svarasa (Svarasa obtained by 480grms of

Kakamachi per Bhavana) and followed by Seven Bhavana of Bhringaraja Svarasa

(Svarasa obtained by 480grms of Bhringaraja per Bhavana ) should be given to

Shuddha Gandhak seperately. Then Kajjali Should be prepared by adding the same

Gandhaka and Shuddha Parada. The Kajjali should then be dried and Bakuchi Churna

should be added to it. Fine powder of the mixture should then be prepared and then it

should be capsuled.

BAKUCHI107

Latin name : Psoralia corylifolia

Family : Papilionaceae

Synonyms : Somaraji, Kushtagni, Kusthanashini, Putiphala,

Shashilekha.

Vernacular names : Hindi : Babachi

English : Psoralia seed, Bawachan seed

Kannada : Bavanchi

Drug Review


Rasa Panchaka :

Rasa : Tikta, Katu, Madhura

Guna : Ruksha, Sara

Virya : Sheeta

Vipaka : Katu

Doshaghnata : Kapha Vata Shamaka

Karma : Rasayana, Ruchya, Visthambhini, Hrudya.

Rogaghnata : Kushta, Krimi,Asrapitta,Svasa,Meha,Jwara,Tvakdosha.

Part Used : Bija

Bakuchi seed : Vatakapha Kushta hara,Keshya and Tvachya.

Chemical Constituents: Essentialoil, Psoralen, Isopsoralen, Resin, Terpenoidoil,

Bavanchin, Psoralen, Isopsoralen and Essential oil are the

Active Constituents.

Pharmacognasy:

Anti bacterial: Seed oil has Antistreptococcal infection. Essential oil has a powerful

selective effect against skin Streptococci. Analgesic: Bavanchin has mild Analgesic

effect. Seed extracts has Antihelminthic activity and Bavanchin has

Antiinflommatory activity.

Clinical Reports

Ethno botanical studies showed powered seeds if given orally were beneficial in

Eczema. Essential oil used internally for leaucoderma and leprosy.

Kakamachi108

Latin Name : Solanum nigrum

Family : Solanaceae

Vernacular Names : Hindi : Makoy, Gurkamai.

English : Black Nightshade.

Kannada : Kakehannu, Karekanchi

Classification : Sakavarga, Tikta Skanda,Shatavaryadi Varga.

Rasa Panchaka :

Rasa : Tikta ,Katu

Guna : Laghu,Snigdha

Virya : Ushna

Drug Review


Vipaka : Katu

Doshaghnata: Tridoshaghna

Karma :Svarya, Vrusya, Rasayana, Hrudya,Netryam

Rogaghnata : Kushta, Shopha, Arsha,Jvara, Meha,Hikka,Hrudroga,Kandu

Part Used : Pancanga

Chemical Constituents: Root and Stem: Tigogenin,Uttronin,Uttrosides.

Berries: Steroidal glycosides and steroidal alkaloids

Pharmacognasy: Anti Hepatotoxic and Antitumor

Bhringaraja109

Latin name : Eclipta alba

Family : Asteraceae

Synonyms : Markava, Kesharaja, Mahanila, Angaraka, Pitrapriya, Ajagara

Vernacular Names : Hindi : Bhangra

Kannada : Garga

Rasa Panchaka :

Rasa : Katu, Tikta

Guna : Ruksha, Tikshna

Virya : Ushna

Vipaka : Katu

Doshaghnata : Kaphanashaka

Karma : Amanashaka, Dantya, Rasayana, Tvachya, Balya, Chakshushya.

Rogaharatva : Sopha,Arsha, Pandu,Hridroga, Visa, Kushta,Kasa, Svasa.

Part Used : Pancanga

Chemical Constituents: Coumstans,Wadelectone,Dimethyl wadelectone,Thiophene

Derivitives, Alkaloids.

Aerial parts: Apigenin, Cynaroside

Pharmacognasy:

Antibacterial, Anti viral, Analgesic, Anti pyretic, Antihepatotoxic Antihyperglysemia,

Anti inflammatory, Anti Diarrheal, Anti tumor, Anti convulsing.

Clinical Reports: Powder of Bhringaraja cured 100% patients from Infective

Hepatitis. Paste containing seed of Psoralea corylifolia and Eclipta alba leaf juice

exhibited Significant Anti Leprotic action.

Drug Review


Gandhaka110

Vernacular Names: English Name : Sulphur, Brime Stone Sulphur

Samskrta : Gandhaka

Hindi : Gandhaka

Synonyms: Navanita, Gandhaka, Kruragandha, Kitaghna, Lekhi, Kitanasana,

Kushtari, Pamari

Classification: Suvarnadi varga, Candanadi varga, Dhatu varga, Uparasa varga

Rasa Panchaka:

Rasa : Katu, Tikta, Kashaya, Madhura.

Guna : Ushna, Snigdha, Sara.

Veerya : Ushna.

Vipaka : Madhura.

Karma : Deepana,Pachana, Krimihara, Rasayana, Yogavahi.

VyadhiPrabhava : Kandu,Kushta,Visarpa,Dadhru,Krimidosha.

Doshaghnata : Vatakapha Shamaka, Rakta Shodhaka

Prabhava : Twakavikaranashaka, Kushtanashaka.

Dose : Rasatarangini : 1-8 Ratti

Anupana : Pakwa Kadalipatra in Skin disease

Parada111

Vernacular Names : Samskrta :Parada

Hindi : Parada

Latin : Hydrargyrum

English : Mercury, Quick silver

Rasa Panchaka

Rasa : Sad Rasa

Guna : Snigdha, Sara, Guru

Virya : Usna

Vipaka : Madhura

Karma : Yogavahi, Rasayana, Balya, Vrsya etc.

Dosha Prabhava: Tridosaghna

Vyadhi Prabhava: Krmi,Kustha, Vataroga,Valipalita roga etc.

Methodology


MATERIALS AND METHODS

Aims and Objectives of the Study:

Assay of the literature exploring the equation of Vicharchika and Atopic

Dermatitis as well as establishing the modality of treatment of Satmya

Viruddha Nimittaja Vyadhi with special reference to Vicharchika.

To explore the therapeutic effect of Gandhaka Churna on the activity of the

disease in patients suffering from Vicharchika / Atopic Dermatitis.

To evaluate the remission of the symptoms of Vicharchika / Atopic Dermatitis

in patients treated with Gandhaka Churna.

Source of Data:

20 patients diagnosed as Vicharchika / Atopic Dermatitis fulfilling the Diagnostic/

Inclusion and Exclusion Criteria was selected irrespective of their sex and religion

and was recruited for the study after getting a written consent from every patient.

Methods of Collection of Data:

A special proforma was prepared incorporating all the clinical manifestation and

Assessment Criteria including laboratory investigation findings of the Vicharchika /

Atopic Dermatitis. Complete clinical data was collected from all the selected patients

as per this proforma before the intervention and every week following this until the

completion of the study. Results obtained were statistically analyzed by adapting the

paired t test.

Design of Study:

Single blind clinical study of pre test post test design.

Intervention:

Oral administration of Gandhaka Churna in dose of 500mg before food twice a day

and is continued for 28 days. 100ml milk is advised as anupana along with Gandhaka

Churna.

Methodology


Duration of the Study:

28 days of medication followed by another 28 days of follow up

Diagnostic Criteria:

Presence of symptoms of Vicharchika that include Kandu, Pidaka, Bahusrava,

Ruja and Ruksha.

Criteria of Hanifin and Rajka for the Diagnosis of Atopic Dermatitis.

Inclusion Criteria:

Patients fulfilling the criteria of diagnosis with no restriction of sex and

religion.

Patients aged between 16 – 70 years.

Exclusion Criteria:

Patient with any other systemic illness like Diabetes Mellitus.

Patient suffering from allergic manifestation like Bronchial Asthma.

Children and elderly patients beyond the age group of 16 to 70 years.

Assessment Criteria:

Kandu, Ruja, Bahusrava, Pidaka, Vaivarnya, Rukshata, Daha were assessed by

adapting Visual Analogue Scale.

SCORAD Index for Severity Scoring of Atopic Dermatitis.

Investigations:

Hematological Routine investigation: Hb%, TC, DC, ESR.

Fasting and Random blood sugar where ever necessary.

Criteria of Hanifin and Rajka for the Diagnosis of Atopic Dermatitis:

Stages:

Infantile stage (up to 2 years of age): (a) highly pruritic, scaly, red and crusted patches

on both cheeks of the face and on the extensor portions of the extremities, (b)

eczematous changes of the scalp, (c) wheal formation.

Methodology


(2) Childhood stage (2 - 12 years of age): (a) papules on the flexural areas, (b)

thickened plaques showing Lichenification and excoriation, (c) in Blacks the

presence of follicular papular lesions and changes in pigmentation (hyper or hypo)

(3) Adult stage (puberty onward): may have no signs or may have a chronic, relapsing

condition. If lesions present, (a) Lichenification hands, ankles, fingers, feet may

occur in the flexural areas, (b) facial involvement may occur, (c) wrists, and toes

may be involved.

Major (basic) Criteria - 3 or more of the following

Pruritis

Typical morphology and distribution (flexural Lichenification or linearity in

adults; facial and extensor involvement in infants and children)

Chronic or chronically-relapsing Dermatitis

Personal or family history of Atopy (Asthma, Allergic Rhinitis, Atopic

Dermatitis)

Minor Criteria - 3 or more of the following (in addition to major criteria)

Xerosis (presence of generalized dry skin)

Ichthyosis , Palmar Hyperlinearity or Keratosis Pilaris

Immediate (type 1) skin test reactivity

Increased serum IgE levels

Early age of onset

Tendency toward Cutaneous infections (especially staphylococcus aureus and

herpes simplex) or impaired cell-mediated immunity

Tendency toward nonspecific hand or foot dermatitis

Nipple Eczema

Cheilitis

Recurrent Conjunctivitis

Keratoconus

Anterior Subcapsular Cataracts

Orbital darkening

Facial pallor or Facial Erythema

Methodology


Pityriasis Alba

Anterior neck folds

Itch when sweating

Intolerance to wool and lipid solvents

Perifollicular accentuation

Food intolerance

Course influenced by environmental or emotional factors

White dermographism or delayed blanch

The SCORAD Index for Severity Scoring of Atopic Dermatitis:

The SCORAD Index is based on 3 sub scores:

(1) A (extent score based on body surface area)

(2) B (intensity score based on 6 clinical findings in atopic dermatitis)

(3) C (subjective symptoms)

A: extent score = SUM (body surface area involved, using rule of 9)

Table No-11 Body Surface area using rule of 9:

Body Region percent BSA if < 2 years

of age

percent BSA if >= 2 years

of age

head, anterior 8.5 4.5

head, posterior 8.5 4.5

trunk, anterior 18 18

trunk, posterior 18 18

Genitals 1 1

left arm anterior 4.5 4.5

Methodology


left arm posterior 4.5 4.5

right arm anterior 4.5 4.5

right arm posterior 4.5 4.5

left leg anterior 9 9

left leg posterior 6 9

right leg anterior 9 9

right leg posterior 6 9

B: intensity score = SUM (points for 6 criteria)

Table No-12 Assessment Criteria of Atopic Dermatitis

Criteria 0 = Absent 1 = Mild 2 = Moderate 3 = Severe

Erythema

Edemaor papulation

Oozing or Crusting

Excoriation

Lichenification

Dryness

Where:

• Intensity is based on the average intensity in a representative area.

• Dryness is evaluated in uninvolved areas.

Methodology


C = subjective symptoms of Pruritis and sleep loss =

= (score for Pruritis from 0 to 10) + (score for sleep loss from 0 to 10)

Where:

• Pruritis and sleep loss are graded on a Visual Analog Scale ranging from 0 (none) to

10 (extreme)

• The severity is based on the average extent for the last 3 days or nights.

SCORAD index = (A / 5) + (7 * B / 2) + C

Observation


OBSERVATION

In the present study, 20 Patients fulfilling Diagnostic Criteria as well as the Inclusion

Criteria of Vicharchika were studied. Patients were observed before, during and after

the treatment. Following pages contain the descriptive statistical analysis of the

Patients studied along with the observations.

Distribution of 20 Patients According to Different Age group

Among the 20 Patients taken for the study 30% of the Patients belonged to the age

group of 46-55 years. This is followed by 20% of the Patients in the 16 -25 age group.

Distribution of the Patients According to the age group is depicted in the following

table (Table no.13) and pie diagram (fig no.-1).

Table no.-13 Distribution of Patients According to Age group

Age (in years) No. of Patients %

16-25 4 20%

26-35 3 15%

36-45 2 10%

46-55 6 30%

56-65 3 15%

66 and more 2 10%

Figure no.-1 Distribution of Patients According to Age group

20%

15%

10%

30%

15%10%

AGE

16‐25 26‐35 36‐45 46‐55 56‐65 66‐75

Observation


Distribution of Patients According to Sex

In the sample taken for the study, 70% were males in contrast to 30% of females.

Details are shown in the table (Table no. 14) and pie diagram (fig no.-2)

Table no.-14 Distribution of Patients According to Sex

Sex No. of Patients %

Male (M) 14 70%

Female (F) 6 30%

Figure no.-2 Distribution of Patients According to Sex

Observation


Distribution of 20 Patients According to Religion

Out of 20 Patients 80% of Patients were Hindus, Muslims and Christians were 10%

each. The same is detailed in the table (Table no. 15) and pie diagram (fig no.-3).

Table No.-15 Distribution According to Religion

Religion No. of Patients %

Hindu (H) 16 80%

Muslim (M) 2 10%

Christian (Ch) 2 10%

Figure no.-3 Distribution According to Religion

Observation


Distribution of 20 Patients According to Educational Status

Majority of Patients comprising 50 % in this group have completed their higher

secondary class education followed by graduates contributing 35%. The complete

details of the distribution of Patients According to education is detailed in the table

(Table no. 16) and pie diagram (fig no.-4)

Table No.-16 Distribution According to Educational Status

Education No. of Patients %

Uneducated (UE) 1 5%

Primary school (P) 2 10%

Higher secondary (HS) 10 50%

Graduation (GR) 7 35%

Post-graduation (PG) 0 0%

Figure no.-4 Distribution According to Educational Status

Observation


Distribution of 20 Patients According to Marital Status

65% of Patients were married in contrast to 30% of Unmarried individuals in the

present sample. The marital status of the 20 Patients is shown in the table (Table no.

17) and pie diagram (fig no.-5)

Table No.-17 Distribution According to Marital Status

Marital Status No. of Patients %

Married(M) 13 65%

Unmarried (UM) 6 30%

Divorce (D) 0 0%

Widow(W) 1 5%

Figure no.-5 Distribution According to Marital Status

30%

65%

5%

MARITAL STATUS

UNMARRIED MARRIED WIDOW

Observation


Distribution of 20 Patients According to Socio- Economic Status

Majority of Patients belonged to the Middle class (60%), 20% each were in lower

middle class and upper middle class. The distribution of Patients According to Socio-

Economic Status is given in table (Table no. 18) and pie diagram (fig no.-6)

Table No.-18 Distribution According to Socio- Economic Status:

Socio-Economic Status No. of Patients %

Lower class(L) 0 0%

Lower middle class(LM) 4 20%

Middle class (M) 12 60%

Upper middle class(UM) 4 20%

Upper class(U) 0 0%

Figure no.-6 Distribution According to Socio- Economic Status

Observation


Distribution of 20 Patients According to Occupation

Maximum numbers of Patients were Students, farmers and housewives, each group

contributing 20%. The distribution of 20 Patients According to their occupation is

shown in the table (Table no. 19) and pie diagram (fig no.-7) below.

Table no.-19 Distribution According to Occupation

Occupation No. of Patients %

Student 4 20%

Housewife 4 20%

Painter 2 10%

Professional 3 15%

Farmer 4 20%

Others 3 15%

Figure no.-7 Distribution According to Occupation

Observation


Distribution of 20 Patients According to Habitat

Among the 20 Patients 85 % were from the urban area and the remaining 15 % were

rural dwellers. The details of the same is shown in the table (Table no. 20) and pie

diagram (fig no.-8)

Table no.-20 Distribution According to Habitat

Figure no.-8 Distribution According to Habitat

Habitat No. of Patients %

Urban (U) 17 85%

Rural (R) 3 15%

Observation


Distribution of Patients According to Ahara

Out of 20 Patients, 75 % had the habit of taking both vegetarian and non-vegetarian

foods. And the remaining 25% Patients were vegetarians. Complete details of the

same is given in the table (Table no. 21) and pie diagram (fig no.-9)

Table No.-21 Distribution of Patients According to Ahara

Ahara No. of Patients %

Vegetarian 5 25%

Mixed 15 75%

Figure no.-9 Distribution of Patients According to Ahara

Observation


Distribution of Patients According to Vyasana

30 % of the Patients confessed the Different addictions they had and the remaining

70% Patients had no. history of any addictions. Table (Table no. 22) and pie diagram

(fig no.-10) show more details of the addictions in 20 Patients of Vicharchika.

Table No.-22 Distribution According to Vyasana

Vyasana No. of Patients %

Smoking 2 10

Alcohol 2 10

Snuff 1 5

Tobacco 0 0

Pan 1 5

None 14 70

Figure no.-10 Distribution According to Vyasana

Observation


Distribution of Patients According to Prakruti

A majority of Patients belonged to Pitta Kapha Prakruti (50%) and 25% belonged to

Vata Pitta Prakruti. The details of other incidence are shown in the table (Table no.

23) and pie diagram (fig no.-11).

Table No.-23 Distribution of Patients According to Prakruti

Prakruti No. of Patients %

Vata 1 5%

Pitta 0 0%

Kapha 1 5%

VataPitta 5 25%

VataKapha 3 15%

PittaKapha 10 50%

Figure no.-11 Distribution of Patients According to Prakruti

5% 0% 5%

25%

50%

15%

PRAKRUTI

VATA PITTA KAPHA

VATA PITTA PITTA KAPHA KAPHA VATA

Observation


Distribution of Patients According to Sara

90% Patients exhibited Madhyama Sara, and the remaining 10 % of Patients had

Aavara Sara. The complete detail of the same is shown in the table (Table no. 24) and

pie diagram (fig no.-12).

Table No.-24 Distribution of Patients According to Sara

Sara No. of Patients %

Pravara 0 0%

Madhyama 18 90%

Avara 2 10%

Figure no.-12 Distribution of Patients According to Sara

Observation


Distribution of Patients According to Pramana

The assessment of Pramana of the body in 20 Patients revealed that 95% Patients had

Madhyama Pramana as against only 5 % had Heena Pramana . Further details are

made clear in the table (Table no. 25) and pie diagram (fig no.-13).

Table No. -25 Distributions of Patients According to Pramana

Pramana No. of Patients %

Adhika 0 0%

Sama 19 95%

Heena 1 5%

Figure no.-13 Distribution of Patients According to Pramana

Observation


Distribution of Patients According to Samhanana

Among the 20 Patients, 90% recorded Madhyama Samhanana . 5% each Patients

showed Avara Samhanana, and Pravara Samhanana. Table (Table no. 26) and pie

diagram (fig no.-14) depict more details of the same.

Table No.-26 Distribution of Patients According to Samhanana

Samhanana No. of Patients %

Pravara 1 5%

Madhyama 18 90%

Avara 1 5%

Figure no.-14 Distribution of Patients According to Samhanana

Observation


Distribution of Patients According to their Satva

The assessment of the Satva in 20 Patients showed 65%Patients having Madhyama

Satva. Another 20 % of Patients had Pravara Satva. Remaining 15 % of Patients

recorded Avara Satva. The details of the Satva in this sample is depicted in the table

(Table no. 27) and pie diagram (fig no.-15).

Table No.-27 Distribution of Patients According to their Satva

Satva No. of Patients %

Pravara 4 20%

Madhyama 13 65%

Avara 3 15%

Figure no.-15 Distribution of Patients According to their Satva

Observation


Distribution of Patients According to Satmya

Analysis of Satmya revealed that 55 % had Avara Satmya, 45% had of Madhyama

Saatmya and no one exhibited Pravara Satmya. The table (Table no. 28) and pie

diagram (fig no.-16) show the details of the same.

Table No.-28 Distribution of Patients According to Satmya

Satmya No. of Patients %

Pravara 0 0%

Madhyama 9 45%

Avara 11 55%

Figure no.-16 Distribution of Patients According to Satmya

Observation


Distribution of Patients According to Vyayama Shakti

70% 0f the Patients had Pravara Vyayama Shakti, 25% had Madhyama Vyayama

Shakti and 5% had Avara Vyayama Shakti. The table (Table no. 29) and pie diagram

(fig no.-17) show the complete details of the distribution of Patients According to

Vyayama Shakti.

Table No. -29 Distribution of Patients According to Vyayama Shakti

Vyayama Shakti No. of Patients %

Pravara 14 70%

Madhyama 5 25%

Avara 1 5%

Figure no.-17 Distribution of Patients According to Vyayama Shakti

Observation


Distribution of Patients According to Ahara – Abhyavaharana and Jarana

Shakti

10% Patients had Avara- Abhyavaharana and Jarana Shakti, 50% had Madhyama-

Abhyavaharana and Jarana Shakti and 40 % had Pravara- Abhyavaharana and Jarana

Shakti. Distribution of the Patients According to Abhyavaharana Shakti is shown in

the table (Table no. 30) and pie diagram (fig no.-18).

Table No.-30 Distribution of Patients According to Ahara- Abhyavaharana and

Jarana Shakti

Aahaara-Abhyavaharana

Shakti

No. of Patients %

Pravara 8 40%

Madhyama 10 50%

Avara 2 10%

Figure no.-18 Distribution of Patients According to Ahara- Abhyavaharana and

Jarana Shakti

Observation


Distribution of Patients According to Vaya

It was observed that 65% of the Patients were of Parihani age category. Further, 20%

Patients belonged to the age category of Vruddhi. 10% of Patients belonged to age

category of Yauvana. The remaining 5% Patients were in age category of Sampurnata.

The complete detail of the same is given in the table (Table no. 31) and pie diagram

(fig no.-19).

Table No.-31 Distribution of Patients According to Vaya

Vaya No. of Patients %

Vruddhi 4 20%

Yauvana 2 10%

Sampurnata 1 5%

Parihani 13 65%

Figure no.-19: Distribution of Patients According to Vaya

Observation


Occurrence of Symptoms in 20 Patients of Vicharchika

The symptoms Pidaka and Vaivarnya were observed in all the Patients (100%),

Kandu in 95% of Patients and Ruksha in 90% and Srava were found in 80 % of

Patients. More details of the same is depicted in the table (Table no. 32) and Bar

diagram (fig no.-20)

Table No.-32 Occurrence of Symptoms of Vicharchika

Symptamatalogy No. of Patients % of Patients

Kandu (K) 19 95%

Daha (D) 3 15%

Ruja (R) 6 30%

Pidaka (P) 20 100%

Vaivarnya(V) 20 100%

Srava (S) 16 80%

Ruksha(Ru) 18 90%

Raji (Ra) 7 35%

Relapsation(Re) 14 70%

Figure no.-20 Occurrence of symptoms of Vicharchika

Observation


Nidana of Kushta identified in 20 Patients

The exploration of Nidana in 20 Patients suffering from Vicharchika revealed that

80% of Patients exhibited faulty dietetic habits. Another 35% Patients showed

erroneous Vihara as cause of the illness. Mere 5 % of Patients exhibited Manasika

factor as Nidana. Details of the same is given in the table (Table no. 33) and Bar

diagram (fig no.-21)

Table No.-33 Nidana of Kushta identified in 20 Patients

Nidana No. of Patients %

Aharaja(A) 16 80%

Viharaja (V) 7 35%

Manasika (M) 1 5%

Figure no.-21 Nidana of Kushta identified in 20 Patients

Observation


Occurrence of Purvarupa in 20 Patients

Only in 25 % of Patients the Purvarupa of Kushta was documented and the remaining

75 % of Patients have shown no Purvarupa. Table (Table no. 34) and pie diagram (fig

no.-22) show the occurrence of Purvarupa.

Table no.-34 Occurrence of Purvarupa

Purvarupa

Present 5 25%

Absent 15 75%

Figure no.-22 Occurrence of Purvarupa

Observation


Results


RESULTS

Patients suffering from Vicharchika were treated with Gandhaka Churna in a dose of

500 mg twice a day for 28 days in this single blind, pre test post test clinical trial. The

effect of the treatment following medication was assessed periodically in regards to

Kandu, Srava, Vaivarnya, Loss of sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification,

Extent of body region affected, SCORAD . The details of the same with statistical

analysis adapting paired t test is elaborated in this section on results.

Effect on Kandu

The administration of Gandhaka Churna was found to be effective in reducing the

Kandu (Itching). The mean VAS score for Kandu prior to the treatment was 8.05

which reduced to 2.700 after the treatment with mean difference of 5.350. The

analysis by applying the paired‘t’ test proved the statistical significance of the

improvement as P=<0.001. Details are shown at full length in the table (Table no 35)

and fig (fig no-23).

Table no.-35 Effect on Kandu

Figure no.-23 Effect on Kandu

Mean Kandu

VAS score

Difference

in Means

% Paired ‘t’ Test

BT

(±SE)

AT

(±SE)

S.D. S.E.M ‘t’ P

8.050

(0.535)

2.700

(0.341)

5.350

66.45% 2.661 0.595 =8.991 P=<0.001

Results


Effect on Discharge

The mean VAS score of Discharge (Srava) reduced from initial value of 4.350 to

1.350 after the treatment, with a difference of 3.000. This reflects the marked

remission in the symptom discharge by the medication. Also the analysis revealed the

change that occurred with the treatment is greater than would be expected by chance;

and hence is a statistically significant change (P = <0.001). Details of the same is

given in the table (Table no. 36) and fig (fig no.-24)

Table no.-36 Effect on Discharge

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


4.350

(0.654)

1.350

(0.274)

3.000

68.96% 2.200 0.492 = 6.097 P=<0.001

Figure no.-24 Effect on Discharge

0

1

2

3

4

5

6

DISCHARGE

BT

AT28

Results


Effect on Discoloration (Vaivarnya)

The mean VAS score of Vaivarnya prior to the treatment was 7.900. After the

treatment the same reduced to 5.450. Hence the Gandhaka Churna is effective in

reducing the severity of discoloration in patients of Vicharchika. Further, The

statistical analysis by adapting paired t test showed that the change occurred with the

treatment is greater than would be expected by chance; there is a statistically

significant change (P = <0.001). In the table (Table no 37) and fig (fig no-25) the

details of the values and statistical analysis is shown.

Table no.-37 Effect on Discoloration (Vaivarnya)

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


7.900

(0.390)

5.450

(0.344)

2.450

31% 1.468 0.328 = 7.463 P

=<0.001

Figure no-25 Effect on Discoloration (Vaivarnya)

Results


Effect on Loss of Sleep

An initial mean VAS sleep score was 6.400 in 20 patients suffering from Vicharchika.

The value dropped to 2.950 following the treatment thus recording good improvement

by the medication. Justifying the same, the paired t test also showed that the

improvement by the medication is statistically significant with t = 8.219 and p<0.001.

The complete details of the sleep score is depicted in the table (Table no 38) and fig

(fig no-26).

Table no.-38 Effect on Loss of Sleep

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


6.40

(0.591)

2.95

(0.478)

3.450

53% 1.877 0.420 =8.219 P=<0.001

Figure no.-26 Effect on Loss of Sleep

Results


Effect on Pain (Ruja)

The severity of pain reduced to a larger extent by the medication with Gandhaka

Churna in all the 20 patients. The mean VAS score prior to the treatment was 6.143

which reduced to 2.714 with mean difference of 3.429 after treatment. The change

that occurred with the treatment is greater than would be expected by chance; there is

a statistically significant change (P = 0.009). Details of the same are shown in the

table (Table no 39) and fig (fig no-27).

Table no.-39 Effect on Pain (Ruja)

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


6.143

(1.471)

2.714

(0.837)

3.429

55.81% 2.370 0.896 =3.827 P=0.009

Figure no.-27 Effect on Pain (Ruja)

Results


Effect on Burning (Daha)

The oral medication with Gandhaka Churna is effective in reducing the severity of

burning sensation in patients suffering from Vicharchika. The mean initial VAS score

of Daha was 6.000 and the same dropped to 2.000 after the treatment, thus recording

a fall in severity by 4.000. This improvement in the Daha also proved to be

statistically significant as revealed by paired t test. The detail of the values at fuller

length is shown in the table (Table no 40) and fig (fig no-28).

Table no.-40 Effect on Burning (Daha)

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


6.000

( 0.707)

2.000

( 0.913)

4.000

66.7% 0.816 0.408 =9.798 P=0.002

Figure no.-28 Effect on Burning (Daha)

Results


Effect on Eruption of Papules (Pidaka)

The eruption of papules reduced markedly following the treatment with Gandhaka

Churna. The mean score Pidaka prior to the treatment was 2.250, which reduced to

1.250 with mean difference of 1.000 after treatment. The analysis by applying

paired‘t’ test showed statistically significant change as P=<0.001 thus proving the

therapeutic efficacy of Gandhaka Churna. In the table (Table no 41) and fig (fig no-

29) the details of the same is elaborated.

Table no.-41 Effect on Eruption of Papules (Pidaka)

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


2.250

(0.176)

1.250

(0.099)

1.000

44.44%

0.649 0.145 =6.892 P=<0.001

Figure no.-29 Effect on Eruption of Papules (Pidaka)

0

0.5

1

1.5

2

2.5

3

PAPULATION

BT

AT28

Results


Effect on Dryness (Ruksha)

The severity dryness reduced from initial score of 2.158 to 1.316 with 0.842 as

difference of mean. Therefore the medication is effective against the dryness

symptom of Vicharchika. The change that occurred with the treatment is greater than

would be expected by chance; there is a statistically significant change (P = <0.001).

The mean values as well as details of statistical analysis is shown in the table (Table

no 42) and fig (fig no-30).

Table no.-42 Effect on Dryness (Ruksha)

Figure no.-30 Effect on Dryness (Ruksha)

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


2.158

( .158)

1.316

( .110)

0.842

39%

0.602 0.138 =6.096 P=<0.001

Results


Effect on Lichenification

The mean severity score of Lichenification prior to the treatment was 1.714 and that

remained same even after treatment. Oral medication with Gandhaka Churna has

shown no benefit in reducing the symptom Lichenification of Vicharchika. The details

are shown in the table (Table no 43) and fig (fig no-31).

Table no.-43 Effect on Lichenification

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


1.714

( 0.184)

1.714

( 0.184)

0.000

0% 0.000 0.000 0.000 P=1.000

Figure no.-31 Effect on Lichenification

Results


Effect on Extent of Body Region Affected


involvement of body region. The mean score prior to the treatment was 13.819 which

reduced to 9.689 with mean difference of 4.131 after treatment. The statistical

analysis by paired t test showed significant change as P=0.011. Mean scores and

details of the statistical analysis is shown in the table (Table no 44) and fig (fig no-

32).

Table no.-44 Effect on Extent of Body Region Affected

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


13.819

( 3.766)

9.689

( 2.631)

4.131

29.89% 6.147 1.449 =2.851 P=0.011

Figure no.-32 Effect on Extent of Body Region Affected

0

2

4

6

8

10

12

14

16

18

20

BODY REGION AFFECTED

BT

AT28

Results


Effect on SCORAD


SCORAD. The mean score prior to the treatment was 47.000 which reduced to 26.350

with mean difference of 20.650 after treatment. The change that occurred with the

treatment is greater than would be expected by chance; there is a statistically

significant change (P = <0.001). The different values of mean scores and statistical

analysis are elaborated in the table (Table no 45) and fig (fig no-33).

Table no.-45 Effect on SCORAD

Figure no.-33 Effect on SCORAD

Mean Difference

in Means


BT

(±SE)

AT

(±SE)


47.000

( 2.773)

26.350

( 1.943)

20.650

43.93% 9.773 2.185 =9.450 P=<0.001

0

10

20

30

40

50

60

SCORAD

BT

AT28

Discussion


DISCUSSION

Jnana Sadhana is an outcome of Shastra Sahita Tarka112. It is the characteristics of the

present era that there is no place for blind faith in tradition & authority of Shastra,

hence only those facts established by proofs after careful investigations, observations

& experiments & supported by accurate data & convincing reasoning can convince

the people about validity & even the facts requires support of statistics. A discussion

based on Shastra, over any conceptual & practical oriented study definitely gives one

or other fruitful conclusions.

Review of Literature

The Skin Disorders are considered to be the challenging disorder from the Vedic

period. In Ayurvedic literatures skin disorders are elaborated mainly under the

heading of Kushta and Visarpa. Vicharchika is a disorder enlisted under Kushta.

Altered touch sensation with discoloration of the skin is referred as Kushta in general.

Ksudra Kushta are the exception for the general rule. As there is involvement of

Arambhaka Dosha is lesser. Hence complete manifestation of general symptoms of

Kushta lacks in Kshudra Kushta.

Viruddha Ahara and Vihara are considered to be the main Nidana for the disease

Kushta in general and Vicharchika in particular. Viruddha is one which vitiate the

Dosha but do not expel out of the body. These vitiated Dosha acts as Visha and

produce vishavat effect that is alteration of sensorium and even may lead to the

death113. This is true in the Anaphylitic shock due to the some drugs that are not

complimentary to the body. This is due to the hypersensitivity reaction and same in

Ayurvedic literature termed as Atma Asatmya. Atopic Dermatitis is a disorder is an

outcome of hypersensitivity reaction as well as improper food ingestion stated as

Mithyahara in literatures. Outcome of the Mithyahara is improper digestion,

absorption of the ahara rasa in tern produce disease Kushta. Dermatitis due to the mal

absorption and improper ingestion of the food is highlighted in parallel science.

Sheetoshna Vyatyasa in the form of intake of cold material immediately after

exposure to hot or habitual intake of hot and cold material in alternate may produce

the Vicharchika.

Discussion


In other words to say excessive heat (especially with humidity) and coldness are

known to provoke outbreaks of Atopic Dermatitis as well as sudden and extreme

temperature swings. Needless to say aetiology of Vicharchika and Atopic Dermatitis

are almost similar.

Vicharchika has been mentioned in almost all Ayurvedic texts, either in form of

Kshudra Kushta, Kshudra Roga or Sadhya Kushta. Vicharchika is not fatal even it

become very severe. The Doshaja Symptamatalogy is not predominant like that of

Maha Kushta and hence known as Kshudra. Various Acharyas mentioned

Vicharchika with different Doshic involvement along with their symptom complex.

Vicharchika has a Kapha dominancy because, there is an excess Itching,

Discolouration, Boil, Profuse Oozing , which also indicates its initial stages similar

to that of Atopic Dermatitis in Acute and Infantile and Childhood phase. Vicharchika

which has Vata dominancy with characteristics like Raji (marked lining) and Ati

Kandu (Excess Itching) and Arti (Pain) and Ruksha (Dryness) etc., which indicate

Chronic or later stage which similar to that of Atopic Dermatitis in adult phase with

chronicity. Thus this separation may indicate the 2 different stages of Vicharchika,

they are Sravi Vicharchika and Ruksha ( Asravi) Vicharchika.

The Symptamatalogy of Vicharchika is similar with Eczema i.e., SaKandu (Excessive

Itching), Pidaka (Boil/Pustule/Vesicle), Shyavata (discolouration/hyperpigmentation),

Bahusrava (Weeping) and later Raji (marked linings/Lichenification/Criss-cross

marking), Ruja (Pain), Saruksha (Excessive Dryness).

After going through the above it can be said that Vicharchika is a clinical entity in

which the lesion has the Shyava colour of Pidaka with excessive itching and oozing,

which may develop anywhere in the body (Gatreshu), and may be either wet or dry.

Atopic Dermatitis can be considered in the same category because first manifestation

of Eczema is Erythema or Reddening of skin, Oedema, Vesiculation, Oozing,

Crusting and later Lichenification. Due to the intra and extra environmental changes

within the body and its reactions against them, may produce extreme stages of

Vicharchika. Main place of etiopathogenisis, is in Tvak (Adhisthana), Rakta , Mamsa

and Lasika.

Discussion


Saptako Dravya Sangraha is mandatory for the production of the Kushta. Each and

every Kushta is Tri Doshaja in nature. In literature “Kushta Visheshai Dosha” and

“Dosha Visheshai Punascha Kushta” is explained. That means by seeing the vitiation

of Dosha one can assume the forth coming variety of Kushta and same way by

analysing the Kushta bheda one can assume the Dosha vitiation. This highlights the

Karya Karana Sambandha between Dosha as well as Kushta and said to be unique for

Kushta. The involvement of deeper Dhatu is absent in Kshudra Kushta this is due the

vitiated Dosha are not having the character of Adibala Pravrittatva and morbidity of

Vyadhi Arambhaka Dosha are in minimum intensity.

Shodhana, Shamana, Vyadhihara Rasayana and Bahirparimarjana Chikitsa are the

crux of principles of treatment for Vicharchika. Repeated administration of Shodhana

has been given importance in literatures. The recurrence of Kushta is remote possible

if all modalities of management like Shodhana, Shamana, Vyadhihara Rasayana and

Bahirparimarjana are fallowed as treatment.

The moot point in conceptual part is Atma Satmya Viruddha Nimittaja Vyadhi and its

Chikitsa. Complimentary and derogatory material is almost same for every person in

general. That is known as Satmya and Asatmya. It may depends on Prakruti Desha

Kala Vaya ect. Out of these; unique Satmya known as Atma Satmya. This is particular

for an individual. If a person exposure against once Satmya produces disease then is

called as Atma Asatmya Vyadhi. As Asatmya refers to Viruddha to once Satmya so

the disease produced by the Atma Asatmya referred as Atma Satmya Viruddha

Nimitta Vyadhi. Viruddha is one which produces different Vyadhi in which Kushta in

general and Vicharchika in particular remains first. Atopic Dermatitis is one which is

an outcome of intake of eggs, fish etc may be possible and sudden variation of

environmental condition triggers the Atopic Dermatitis. This is similar to that of Atma

Satmya Viruddha called as Hypersensitivity or Idiosyncrasy. This is the main

pathology behind the Atopic Dermatitis. Management of the Atma Satmya Viruddha

Nimitta Vyadhi includes avoiding the Nidana, same for Atopic Dermatitis as avoiding

the triggering factor. The second principle is adaptation of Atma Asatmya when there

are such circumstances so that avoidance is not possible. This is possible by the

Abhyasa of exposure to the Nidana in smaller dosage. This is also one of the main

management of Atopic Dermatitis as Immunotherapy.

Discussion


Remaining principle of treatment includes proper administration of Shodhana, proper

management through Shamana and finally enhancement of Vyadhikshamatva by the

Kushta Vyadhihara Rasayana.

Drug Review

Gandhaka Churna is a Herbomineral preparation indicated in all variety of Kushta.

Shuddha Gandhaka is treated with Seven Bhavana of Kakamachi (Solanum nigrum)

Swarasa, followed by another Seven Bhavana of Bhringaraja (Eclipta alba)

Swarasa. Then Kajjali is prepared by adding the same Gandhaka and Shuddha Parada.

Thus prepared Kajjali is then be dried and Bakuchi Churna (Psoralia corylifolia) is

added to it. Fine powder of the mixture is capsuled and used for oral administration.

Methodology

This is a single blind clinical study with a pre-test and post-test design. 20 Patients

between the age group of 16 to 70 years suffering from Vicharchika were taken for

the study from O.P.D and I.P.D of SDM college of Ayurveda Hospital, Udupi. The

Pratyatma lakshana of Vicharchika like Kandu, Pidaka, Vaivarnya, Bahusrava, Daha,

Raji, Atiruja and Rukshata were mainly considered for the diagnosis as per Ayurvedic

science and Criteria of Hanifin and Rajka for the Diagnosis of Atopic Dermatitis in

modern point of view. As a routine, hematological investigations were carried out in

all the Patients taken for the study. Once they were diagnosed as Vicharchika/ Atopic

Dermatitis then they should fulfil the inclusion and exclusion criteria. Even though

Shodhana is best for Kushta but that is not indicated in every person, so in the present

study, Gandhaka Churna as Shamana Oushadha is used. In the present study, 20

Patients were registered which were subjected to oral administration of the Gandhaka

Churna in capsulated form with dose of 500mg twice a day before food , milk as

anupana for the 28 days. During this interval weekly assessment is done by using the

Visual Analogue Scale and SCORAD index. In Visual Analogue Scale subjective

criteria are assessed, such that of Kandu, Srava, Vaivarnya, Loss of Sleep, Ruja and

Daha. Remaining objective criteria are assessed through the SCORAD index.

Observation and Results

In the present study the entire sample was grouped into 6 age groups. Among them

maximum 30% Patients were belonged to 46-55 and 20% belonged to 16-25 years of

Discussion


age group. This shows the prevalence of illness in Madhyamavastha. In this age

possibility of mental stress and other exposure i.e. occupational, environmental,

unwholesome food were more which leads to Dermatitis. From this one can consider

the adulthood Atopic Dermatitis.

Generally Atopic Dermatitis may occur in any stage of life but most common in

Infant and Puberty. In present study 2 Infants were reported but excluded from the

study as per the exclusion criteria, as the dosage of medicine fixed in the study is for

adults.

The gender wise distribution of the Patients reveals that 70% of the Patients were

male while 30% Patients were female. So it can be said that in this study males are

more affected than females.

Maximum number of Patients were Students, Farmers and Housewives (20%) .

Students are having stress which is one of the causes for Vicharchika. Farmers always

have contact with different irritant substance which triggers the disease Vicharchika

or Atopic Dermatitis. Housewives are in contact with different material which

produces usually Allergic Dermatitis or Hand Dermatitis. Professionals who include

Teacher and Engineers tend to stand for a prolonged period and hence the possibility

of Stasis Dermatitis is more rather than the Atopic Dermatitis. Other includes

Kuliworker, possibility of unhygienic polluted environment may be the cause for

Dermatitis.

Majority of Patients were married (65%) and 30% were unmarried. This is observed

during the study. As per the inclusion criteria, the Patients between the age group of

16 to 70 were opted, and the marriageable age of individuals falls in this age group.

The same is reflected in the present sample with more numbers of married

participants.

Maximum number of patient’s i.e. 80% were Hindus, 10% were Muslims, and 10%

were Christian. This indicates the dominance of the Hindu population in the locality

of study.

In this series, Majority of Patients belonged to the Middle class (60%), 20% each

were in lower middle class and upper middle class. This trend of distribution in this

sample also represents the socioeconomic state of individuals in and around Udupi.

Discussion


Majority of Patients were found in Higher Secondary Class (50%) and Graduates

(35%). Vicharchika is also observed in uneducated as well as people having Primary

Education. Therefore it seems that that education does not influence the causation of

the illness.

In this series, maximum number of patient’s i.e. 85% were coming from urban area,

where as 15% Patients were from rural area. So it can be said that Patients from urban

area are more susceptible for Eczema than rural area due to unhygienic, polluted and

Industrial Environment. Or else, as the hospital from where the present sample is

taken is located in the City area, this might have influenced the sample.

Maximum number of patients’ i.e. 75% were mixed while rest of the Patients i.e.

25% was taking Vegetarian type of Diet. The main item in mixed diet is Fish,

Chicken and Black Gram item. These are considered to be Guru, Vidahi and Viruddha

Ahara and hence likely to have influenced causation of Vicharchika in such

individuals.

70% of the Patients did not reveal the history of any sort of addiction. Remaining 30%

confessed the addiction to Pan chewing, Alcohol, Tobacco etc. Any role of addictions

either in the causation or in perpetuation of Vicharchika could not be said from this

sample of 20 Patients.

A majority of Patients belonged to Pittakapha Prakruti (50%) and 25% belonged to

Vatapitta Prakruti. Vatakapha Prakruti was observed in 15%, Vata and Kapha in 5%

each. Vicharchika is a disorder predominant of Kapha with involvement of Pitta

Dosha (Parisrava). It may be contended that person belonging to Pittakapha Prukruti

are more prone to get Vicharchika. The same is reflected in the present sample.

90% Patients were found in Madhyama Sara, 10 % were found as Avara Sara. Sara

indicates the strength as well as immunity power of the person. Person who has Avara

and Madhyama Sara will suffer from the disease. In the present study, no patient

recorded Pravara Sara corroborating the fact that people having Madhyama and Avara

Sara are more prone to any illness in general.

In this series 90% Patients belonged to Madhyama Samhanana and 5% each had

Avara and Pravara Samhanana. Samhanana of the Patients in this study does indicate

the predilection of illness to Patients of any Samhanana.

Discussion


Analysis of Satmya revealed that 55 % were Avara Satmya, 45% were of Madhyama

Satmya and no one belonged to Pravara Satmya. It is said that the risk of diseases is

much less in Patients having the habit of Pravara Satmya. Corroborating the same in

the present sample no patient recorded Pravara Satmya.

65%Patients were belonged to Madhyama Satva. 20% belonged to Pravara Satva and

remaining 15% belonged to Avara Satva. In general Satva indicates the mental

stability and the Pravara Satva works against disease process. Substantiating the same,

in the present sample of 20 maximum number of Patients either had Madhyama Satva

or Avara Satva. Only 20 % of Patients recorded Pravara Satva.

Patients having Madhyama and Avara Abhyavaharana Jarana Shakti tend to develop

Agnimandya and consequently Ama. Ama is the root cause of the variety of illness

including the Vicharchika. In the present study a total of 60 % of Patients had either

Avara or Madhyama Abhyavaharana and Jarana Shakti. This observation agrees with

the understanding of risk of diseases due to Agnimandya and Ama Dosha.

70% of the Patients had Pravara Vyayama Shakti, 25% had Madhyama Vyayama

Shakti and 5% had Avara Vyayama Shakti. There is no much relation between the

Vyayama Shakti and causation of perpetuation of Vicharchika.

The analysis of Nidana reveals that 80% of the Patients has Aharaja Nidana, 35%

Patients had Viharaja Nidana. 5% had Manasika Nidana . Aharaja Nidana is observed

more in the study. Intake of Viruddha Ahara in the form of Matsya and Dugdha is

available in study. Same way Vishamashana that is intake of food in irregular time is

observed. Intake of Mithyahara in the form of intake of Vidahi Ahara ( idli, dosa and

fast food) , taking hot and cold material together is observed in the study. As Viharaja

Nidana is concerned Vegadharana and exposure to sunlight and heavy work after

intake of food is observed. There is also available of Patients who are exposed to

sunlight and then immediately enter into the Ac room. In this series, only 5% of

patient had Manasika Nidana in the form of Chinta and Bhaya.

Different types of Aharaja Nidana may be responsible for Vicharchika, diet and state

of digestion is responsible for the production of Eczema. Metabolic toxins, internal

body products, element of diet and drug may act in different ways and provoke the

Discussion


Allergic reaction, which may provide internal atmosphere to Endogenous Eczema and

Exogenous Eczema also.

Vegadharana will produce the vitiation of the Dosha intern produce the Agnimandya

and leads to the disease Kushta. Sudden environmental change may trigger the blood

circulation as well as Endocrine System which produce Vicharchika. Needless to say

Atopic Dermatitis is triggered by the sudden environmental changes. Emotions are

effect the normal function of the Endocrine System and produce the skin

manifestation.

Purvarupa was absent in 75% Patients and present in 25% of Patients. This shows that

any of Kshudra Kushta will manifested with less preponderance of Purvarupa or in

some occasions without Purvarupa.

The symptoms Pidaka and Vaivarnya were observed in all the Patients (100%),

Kandu in 95% of Patients and Ruksha in 90% and Srava were found in 80 % of

Patients. So that it can considered that, in Sravi Vicharchika discharge along with

Kandu is the major symptom. In Asravi Vicharchika Rukshata is main symptom.

Whereas Kandu, Pidaka, Vaivarnya may considered as common major symptoms of

Sravi and Asravi Vicharchika.

EFFECT OF THERAPY

This clinical work is designed to carry out a comprehensive literary study on

Vicharchika and also to evaluate the effect of oral medication with Gandhaka Churna

in Vicharchika. Significant remission in the cardinal symptoms was observed that

included Kandu, Pidaka, Vaivarnya, Bahusrava, Daha and Rukshata. Improvement in

SCORAD index was also recorded. The results thus obtained were statistically

significant.

The Effect of Therapies on Individual Signs and Symptoms

Kandu: morbidity of Kapha Dosha as well as Vata Dosha is responsible for the

symptom Kandu in lesions of Vicharchika. Hence the regimens that alleviate these

two Dosha are likely to be effective in relieving the symptom Kandu. Further the

abnormality of Rakta Dhatu contributes in the establishment of the Kandu in

Vicharchika.

Discussion


Needless to say, the medicaments that rectify the abnormality of Rakta Dhatu tend to

aid remission of the symptom Kandu. Gandhaka Churna is said to be effective in

alleviation of Kapha Vata Dosha and rectifier of Rakta Dhatu as well. The reduction

in the severity of Kandu as indicated by the reduction in the severity VAS score of

Kandu by 66.45% proves its efficacy in normalisation of Vata Kapha Dosha and

Rakta Dhatu. Added to this the Gandhaka, the major ingredient of Gandhaka Churna

has known Kandhughna effect.

Srava: Morbid Pitta Dosha in association with Kapha Dosha is responsible for the

discharge from the lesions in Patients of Vicharchika. Hence forth, treatment aimed at

clearing the morbidity of Pitta and Kapha Dosha in the skin should reduce or stop the

discharge from the lesions. The reduction by 68.96% in discharge from the skin

lesions in 20 Patients treated with Gandhaka Churna confirms the therapeutic benefit

by normalising the Pitta and Kapha Dosha. The ingredients of Gandhaka Churna like

Kakamachi and Bhringaraja have the unique therapeutic effect of reducing the Srava.

Vaivarnya: Aruna and Shyava coloration of the lesion is due to the morbid Vata

Dosha in Patients suffering from Vicharchika. In contrast to this, reddish coloration is

due to the morbidity of Pitta Dosha. De- pigmentation accounts for the vitiation of

Kapha Dosha in the skin. Vaivarnya is rectified by 31 % in Patients of Vicharchika

treated with Gandhaka Churna. This clearly indicates the appreciable therapeutic

improvement in regards to Vaivarnya in Patients of Vicharchika. Kakamachi and

Bhringaraja are known for its effect in rectifying the Vaivarnya of the skin. This is

proved by this clinical study as the Patients had satisfactory correction of the

symptom Vaivarnya.

Pidaka: Morbid Kapha Dosha afflicting the Mamsa Dhatu accounts for the eruption

of Pidaka in Patients suffering from Vicharchika. Thus alleviation of Kapha Dosha is

the rationale of treating Pidaka in the Vicharchika. The reduction in the symptom

score of Pidaka by 44.44% in Patients treated with Gandhaka Churna proves its

efficacy in rectifying Kapha Dosha and eventually remission of Pidaka. Further this

improvement is statistically significant as shown by the paired t test.

Daha: In the Patients of Vicharchika the morbidity of Pitta Dosha involving the Rakta

Dhatu is responsible for the occurrence of Daha. Reduction in the symptom Daha by

Discussion


66.70% proves the therapeutic efficacy of Gandhaka Churna in Patients suffering

from Vicharchika.

Ruksha: Vata Dosha is invariably involved in all the Maha Kushta as well as

Kshudra Kushta. The morbid Vata Dosha involving he Rasa Dhatu in the Tvak leads

to Rukshata in the lesions of Vicharchika. Alleviation of Vata Dosha and normalising

the Rasa Dhatu helps in relieving the symptom Rukshata. In the present study

reduction in the Rukshata by about 39 % proves the effect of Gandhaka Churna in this

regard in Patients suffering from the Vicharchika.

In a nut shell, 20 Patients of either sex suffering from Vicharchika between the age

group of 16 to 70 were subjected to single blind clinical study of pre test post test

design, treated with oral medication of Gandhaka Churna in a dose of 500 mg twice a

day for 28 days with an anupana of milk. The study showed statistically significant

improvement in almost all the outcome measures of Vicharchika that included Kandu,

Srava, Vaivarnya, Loss of Sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification, Extent

of body region affected, and SCORAD. This implies that the Gandhaka Churna is

effective in the correction of all the morbidities of Vata, Pitta, Kapha, Rasa, Rakta,

Mamsa and Lasika that are invariably involved in Vicharchika. Though this is the

fact, it is also true that the improvement observed is not complete. As the Vicharchika

is caused due to Bahu Doshavastha, Shodhana is essential to cure the illness. In the

present study only the Shamana medication with Gandhaka Churna is tried giving

partial improvement. Needless to say the Shamana medication with Gandhaka Churna

with prior Shodhana treatment may ensure complete remission of the illness

Vicharchika. On the other hand, Vicharchika is a chronic lingering disease, the

Gandhaka Churna is tried only for 28 days showing partial response. Therefore it may

be suggested to increase the duration of treatment until complete remission of the

illness. From this discussion it can be confidently said that, Gandhaka Churna is very

effective in the treatment of Vicharchika Roga, and for better results the pre-treatment

with Shodhana and longer duration of Shamana with Gandhaka Churna ensures best

results. Also this study paves for further planning of the clinical study to know the

additional effect of Shodhana treatment which is essential in the treatment of chronic

lingering disease like Vicharchika.

Conclusion


CONCLUSION

20 patients of either sex suffering from Vicharchika between the age group of 16 to

70 years who attended the SDM Ayurveda Hospital were subjected to single blind

clinical trial of pre test post test design. The patients were treated with oral medication

of Gandhaka Churna in a dose of 500 mg twice a day for 28 days with an anupana of

milk. After completion of the study the following are the conclusions drawn.

Vicharchika is a Kshudra Kushta caused due to the morbidity of all the three

dosha involving Tvak, Rakta, Mamsa and Lasika.

Minimal or no Purvarupa and less severe Rupa characterises Ksudra Kushta

and so also Vicharchika.

Morbid Kapha Dosha predominates the Samprapti of Vicharchika and the

same is reflected in Rupa.

Viruddha Ahara and Viruddha Vihara is main cause for the disease

Vicharchika.

Atma Asatmya is one of the common Nidana for Vicharchika and comes

under Atma Satmya Viruddha Nimittaja Vyadhi.

The clinical symptoms of Vicharchika are akin to atopic dermatitis to a larger

extent.

Acute Atopic Dermatitis simulates the Sravi Vicharchika and Chronic Atopic

Dermatitis simulates the Asravi Vicharchika.

Gandhaka Churna is effective in reducing the severity of symptoms of

Vicharchika. Marked reduction in the mean VAS score of outcome measures –

Kandu, Srava, Vaivarnya, Loss of Sleep, Ruja, Daha, Pidaka, Ruksha,

Lichenification and extent of body region affected are recorded and are mostly

statistically highly significant.

Gandhaka Churna effectively reduces the severity of Vicharchika. Severity of

Vicharchika as assessed by SCORAD index showed statistically significant

reduction.

Comparatively better response may be expected if this treatment is added with

Shodhana treatment or by increasing the duration of medication with

Gandhaka Churna.

Summary


SUMMARY

Vicharchika is a chronic relapsing skin disorder which in reality challenge to the

whole medical field as the complete cure to this illness is a remote possibility. No

doubt the illness is not fatal, but the illness Vicharchika pose embarrassment to the

human community due to the intolerable itching, discoloration and disfigurement.

More to add, this illness Vicharchika is one among the eleven Kshudra Kushta and is

characterised by itching, profuse discharge, papulation with discoloration, dryness of

the skin, cracking and pealing of skin, Lichenification and pain. Nevertheless,

Recurring skin rashes, redness, skin oedema, itching, dryness, crusting, flaking,

blistering, cracking, oozing, or bleeding are the typical clinical manifestations of

Atopic Dermatitis. Atopic Dermatitis is an outcome of Hypersensitivity reaction there

is no definite treatment for the same. Shodhana and Shamana measures are proved to

be efficacious in the treatment of Vicharchika. Review of previous work done reveals

that meagre numbers of clinical trials have been carried out establishing the evidence

of effect of Shamana therapy in the management of Vicharchika. Hence any attempt

of clinical work in this regard is justified. With is intension the present study entitled

“A clinical study to evaluate the therapeutic effect of Gandhaka Churna in

Vicharchika” is planned.

Objective

i. Assay of the literature exploring the equation of Vicharchika and Atopic

Dermatitis as well as establishing the modality of treatment of Satmya

Viruddha Nimittaja Vyadhi with special reference to Vicharchika.

ii. To explore the therapeutic effect of Gandhaka Churna on the activity of the

disease in patients suffering from Vicharchika / Atopic Dermatitis.

iii. To evaluate the remission of the symptoms of Vicharchika / Atopic

Dermatitis in patients treated with Gandhaka Churna.

Design of Study

A single blind clinical study with pre test and post test design.

Settings

SDM Hospital of Ayurveda , Udupi, Karnataka.

Summary


Diagnostic Criteria

• Presence of symptoms of Vicharchika that include Kandu, Pidaka,

Bahusrava, Ruja and Ruksha.

• Criteria of Hanifin and Rajka for the Diagnosis of Atopic Dermatitis.

Inclusion Criteria

• Patients fulfilling the criteria of diagnosis with no restriction of sex and

religion.

• Patients aged between 16 – 70 years.

Exclusion Criteria

• Patient with any other systemic illness like Diabetes Mellitus.

• Patient suffering from Allergic manifestation like Bronchial Asthma.

• Children and elderly patients beyond the age group of 16 to 70 years.

Outcome Measures

• Kandu, Ruja, Bahusrava, Pidaka, Vaivarnya, Rukshana, Daha were

assessed by adapting Visual Analogue Scale.

• SCORAD Index for Severity Scoring of Atopic Dermatitis.

Intervention

Selected 20 patients were treated with oral administration of Gandhaka Churna with

dose of 500mg twice daily before intake of food during morning and night continued

for 28 days. 100ml milk is used as anupana along with Gandhaka Churna.

Observation & Results

30 % of patients of Vicharchika were in the age group 46-55; 70% were males and

remaining 30% were females; 20% of patients were either students or housewives;

80% were Hindu; 50% had higher secondary education; 65% of patients were

married; 60% belonged to the middle socio economical class and 85% patients were

from urban area.

Summary


It is observed that 50% of the patients presented with Pittakapha Prakruti; Madhyama

Sara was recorded in 90%; Sama Pramana was identified in 95% of patients; 65% of

them had Madhyama Satva; Avara Satmya was identified in 55%; Pravara Vyayama

Shakti was revealed in 70%;50% belonged to Madhyama Ahara Shakti and 70%

subjects had no addiction.

Exploration of nidana in 20 subjects revealed that 80% had erroneous food habits as

causative factor. Minimal number of Purvarupa of Kushta was identified in only 25 %

of patients of Vicharchika. All the 20 patients presented with Vaivarnya and Pidaka as

leading presenting symptom.


Kandu (Itching). The mean VAS score for Kandu prior to the treatment was 8.05

which reduced to 2.700 after the treatment with mean difference of 5.350. The

analysis by applying the paired t test proved the statistical significance of the

improvement as P=<0.001.

The mean VAS score of Discharge (Srava) reduced from initial value of 4.350 to

1.350 after the treatment, with a difference of 3.000.

The mean VAS score of Vaivarnya prior to the treatment was 7.900. After the

treatment the same reduced to 5.450.

An initial mean VAS sleep score was 6.400 in 20 patients suffering from Vicharchika.

The value dropped to 2.950 following the treatment thus recording good improvement

by the medication.

The severity of pain reduced to a larger extent by the medication with Gandhaka

Churna in all the 20 patients. The mean VAS score prior to the treatment was 6.143

which reduced to 2.714 with mean difference of 3.429 after treatment.

The eruption of papules reduced markedly following the treatment with Gandhaka

Churna. The mean score Pidaka prior to the treatment was 2.250, which reduced to

1.250 with mean difference of 1.000 after treatment.


SCORAD. The mean score prior to the treatment was 47.000 which reduced to 26.350

with mean difference of 20.650 after treatment.

Summary


All these outcome measures were analysed by paired t test and the improvement

found by the medication was statistically highly significant confirming the efficacy of

Gandhaka Churna in the remission of Vicharchika.

Discussion

20 Patients of either sex suffering from Vicharchika between the age group of 16 to

70 were subjected to single blind clinical study of pre test post test design, treated

with oral medication of Gandhaka Churna in a dose of 500 mg twice a day for 28 days

with an anupana of milk. The study showed statistically significant improvement in

almost all the outcome measures of Vicharchika that included Kandu, Srava,

Vaivarnya, Loss of Sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification, Extent of

body region affected, and SCORAD. This implies that the Gandhaka Churna is

effective in the correction of all the morbidities of Vata, Pitta, Kapha, Rasa, Rakta,

Mamsa and Lasika that are invariably involved in Vicharchika. Though this is the

fact, it is also true that the improvement observed is not complete. As the Vicharchika

is caused due to Bahu Doshavastha, Shodhana is essential to cure the illness. In the

present study only the Shamana medication with Gandhaka Churna is tried giving

partial improvement. Needless to say the Shamana medication with Gandhaka Churna

with prior Shodhana treatment may ensure complete remission of the illness

Vicharchika. On the other hand, Vicharchika is a chronic lingering disease; the

Gandhaka Churna is tried only for 28 days showing partial response. Therefore it may

be suggested to increase the duration of treatment until complete remission of the

illness. From this discussion it can be confidently said that, Gandhaka Churna is very

effective in the treatment of Vicharchika Roga, and for better results the pre-treatment

with Shodhana and longer duration of Shamana with Gandhaka Churna ensures best

results. Also this study paves for further planning of the clinical study to know the

additional effect of Shodhana treatment which is essential in the treatment of chronic

lingering disease like Vicharchika.

Conclusion

Gandhaka Churna is effective in reducing the severity of symptoms of Vicharchika.

Marked reduction in the mean VAS score of outcome measures – Kandu, Srava,

Vaivarnya, Loss of Sleep, Ruja, Daha, Pidaka, Ruksha, Lichenification and extent of

body region affected are recorded.

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Pp.738; p.150-151.









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33) Vriddha Vagbhata, Ashtanga sangraha with Shashilekhayakhya commentary by

Indu, Edited by Dr.Shivaprasad Sharma, Varanasi, Chaukhambha Sanskrit

series office, 2008; Pp.965, p.408.






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Sansthan;2005. Pp.824; p.283.






Sansthan;2005. Pp.824; p.283.




Sansthan;2005. Pp.824; p.288.




Pp.738; p.451.




Sansthan;2005. Pp.824; p.283.










Pp.738; p.451.




Sansthan;2005. Pp.824; p.283.












Pp.738; p.195.




Pp.738; p.218.




Sansthan;2005. Pp.824; p.283.










64) Vriddha Jivaka, Kashyapa Samhita with Vidyotini Hindi Commmentory,

Edited by. Pandit Hemaraj Sharma, Varanasi: Choukhambha Sanskrit





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66) Dr.Shah.N.Siddharth, API Text Book of Medicine, Edited by Aspi. R.Bilimoria,

Sandhya . A. Kamath, Dilip R. Karnad et.al, 8th ed, vol II, Mumbai,

Association of Physicains of India: 2008, Pp.1624, p.1381.






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Edited by Pandit Hemaraj Sharma, Varanasi: Choukhambha Sanskrit





Shastri, Varanasi, Prachya Prakashan, Reprinted in 1985; Pp.456; p.366.




Pp.738; p.107.




Pp.738; p.561.






Pp.738; p.219.




Sansthan;2005. Pp.824; p.288.




Pp.738; p.218.




Pp.738; p.219.




Pp.738; p.62.




Sansthan;2005. Pp.824; p.283.




Pp.738; p.452.




Sansthan;2005. Pp.824; p.443,446.






Pp.738; p.453.




Pp.738; p.455.

86) Yogaratnakara, with Vidyotini Hindi commentary,Uttarardha; edited by

Bhrahma Shankara shastri, Varanasi: Chaukambha Prakashan; 2007,

Pp.504, p.215.




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88) Agnivesha, Charaka Samhita revised by Charaka & Dridabala,with Ayurveda

Dipika comentary by Chakrapanidatta and Jalpa Kalpa Taru Commentary

By Gangadhara,Vol.3 2nd edition. Varanasi: Choukhamba Sanskrit

Sansthan; 2002. Pp.3828; p.1707.

89) Vriddha Vagbhata, Ashtanga Sangraha with Shashilekhayakhya commentary by






Pp.738; p.134.




Pp.738; p.134.




Pp.738;p.237.






Pp.738; p.151.




Pp.738;p.51.




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Pp.738; p.151.




Pp.738; p.151.




Pp.738; p.151.




Pp.738; p.151.




Pp.738; p.455.






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106) Pandeya Vivekanada. Sahasra yoga. New Delhi: Vangmaya anusandhana Ekak

Kendreeya Ayurveda Evam Sidda Anusandhana Parishad;1990 . Pp. 621

p.181.

107)Plants of Ayurveda(Version 1.0) , CD-R)M on Dravyaguna, Sponsered by

Ministery of Environmental And Forests, Government Of India, New

Delhi And RGUHS, Bangalore, Karnataka, Designed and developed by

Foundation for revitalization of Local Health Traditions, Bangalore.

108) Plants of Ayurveda(Version 1.0) , CD-R)M on Dravyaguna, Sponsered by




109) Plants of Ayurveda(Version 1.0) , CD-R)M on Dravyaguna, Sponsered by






110) Sharma Sadananda, Rasa Tarangini, with Rasavijnana Hindi commentary by

Kashinatha Shastri, 11th edition. Delhi: Motilal Banarasidas; 1979. Pp772;

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111) Sharma Sadananda, Rasa Tarangini, with Rasavijnana Hindi commentary by

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Pp.738; p.132.




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Annexure

S.D.M. COLLEGE OF AYURVEDA & HOSPITAL, UDUPI.

DEPARTMENT OF P.G. STUDIES IN KAYA CHIKITSA

Patient Inclusion/Exclusion Form

Case Number ( )

Name: Age: Sex : M/F Address:

Screening of the Patient

Kandu Sraava Vaivarnya Pidaka Rookshata Relapsing Symptoms

P A P A P A P A P A P A

Site of lesions Scalp, Face Neck ,Trunk, Hands, Wrists, Ankles, Feet , Fingers,Toes

Exclusion Criteria

Diabetic Mellitus RBS : ____ mg/dl YES NO

Bronchial Asthama

Case : ACCEPTED REJECTED SI No:

Case Number ( )

Name: Age: Sex : M/F Address:

Screening of the Patient

Kandu Sraava Vaivarnya Pidaka Rookshata Relapsing Symptoms

P A P A P A P A P A P A

Site of lesions Scalp, Face Neck ,Trunk, Hands, Wrists, Ankles, Feet , Fingers,Toes

Exclusion Criteria

Diabetic Mellitus RBS : ____ mg/dl YES NO

Bronchial Asthama

Case : ACCEPTED REJECTED SI No:


Annexure

²æÃ zsÀªÀÄð¸ÀÜ¼À ªÀÄAdÄ£ÁxÉÃ±ÀégÀ D0iÀÄÄªÉðÃzÀ ªÀÄºÁ«zÁå®0iÀÄ, PÀÄvÁàr GqÀÄ¦

«ZÀaðPÀ gÉÆUÀzÀ ªÉÄÃ¯É UÀAzsÀPÀ ZÀÆtð ¥Àæ0iÉÆÃUÀzÀ CzsÀåAiÀÄ£À

C¨sÀåyð ¸ÀªÀÄäw ¥ÀvÀæ

------------------- JA§ £Á£ÀÄ F ªÉÄÃ®ÌAqÀ AiÉÆÃd£ÉAiÀÄ ¸ÁgÁA±ÀzÀ «ªÀgÀuÉ

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¨sÁUÀªÀ»¸ÀÄ«PÉ £À£ÀUÉ ¯Á¨sÀzÁAiÀÄPÀªÁUÀzÉ EgÀ§ºÀÄzÀÄ JAzÀÄ £Á£ÀÄ w½¢zÉÝÃ£É.EzÀgÀ GzÉÝÃ±À

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AiÉÆÃd£ÉAiÀÄ°èM¼À¥ÀqÀ®Ä £Á£ÀÄ ¸ÀªÀÄäw ¸ÀÆa¸ÀÄwÛzÉÝÃ£É.

£Á£ÀÄ AiÀiÁªÀÅzÉÃ PÁgÀtªÀ£ÀÄß PÉÆqÀzÉÃ F AiÉÆÃd£É¬ÄAzÀ AiÀiÁªÀÅzÉÃ ¸ÀAzÀ¨sÀðzÀ°è »AzÉ

§gÀÄªÀ D¢üPÁgÀªÀ£ÀÄß ºÉÆA¢gÀÄªÀ §UÉÎ w½¢zÉÝÃ£É.

¢£ÁAPÀ:

¸ÀÞ¼À : ªÀåQÛAiÀÄ ºÀ¸ÁÛPÀëgÀ

¢£ÁAPÀ:

¸ÀÞ¼À :

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Annexure

Patient’s Consent Letter Form

I ………………………………….. aged…………….. years

R/O………………………….. is exercising my free power of choice, hereby give my

consent to be included as a trial subject in the clinical research subject ‘A clinical

study to evaluate the therapeutic effect of gandkaka churna in vicharchika’. I

understand that I may be treated with drug for the disease with which I am suffering. I

have been informed to my satisfaction the aim, objective of the clinical trial,

ingredients of the trial drug treatment and follow up including laboratory

investigations to monitor and safeguard my body functions as when required. I am

also aware of the right to opt out of the trial at any time during the course of my

treatment .I will not make any compensatory claim for any hazardous effects on me

during the treatment.

Date……………

Patient’s signature

Patient has signed the decleration and has given consent.

Signature of the research scholar

……………………………………………..


Annexure

SDM COLEGE OF AYURVEDA AND HOSPITAL, UDUPI

DEPARTMENT OF KAYA CHIKITSA IN P.G. STUDIES

RESEARCH PROFORMA FOR M.D. (AYU) THESIS

“A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF

GANDHAKA CHURNA IN VICHARCHIKA”

Scholar:

Dr. YOGEESHA ACHARYA

Atura Vivara

Name- Sl.No:

Age: yrs OPD/IPD:

Sex: M/F Date:

Religion – H/M/Ch Ward/Bed No:

Education – UE/P/M/HS/GR/PG D.O.A:

Marital Status – M / UM/ W / D D.O.D :

Socio-economic Status : VP/ LM / M / UM / R Treatment Started on :

Occupation – Treatment Completed on:

Place – U / R

Postal address -

Vedana Samuchraya-


Pradhana vedana Duration Site

1 Vedana-kandu/daha/ruja

2 Pidaka

3 Vaivarnya- shyavata/rakta/Krishna

4 Srava-tanu/gadha/bahu/alpa

5 Ruksha/kharatva

6 Raji

7 Shotha/bahalatva

8 Relapsation

Annexure

Anubandhi vedana-

History of Present Illness-

Pidaka/ Skin lesion

Onset of skin lesion-Sudden/Gradual/Insidious

Duration-Acute/sub acute/chronic

Progress and present status-

Site of onset-head&neck/face/arms/hands/wrists/trunk/legs/feet

Characterof lesion-Nummular/anular/cricinate /arcuate/ gyrate/linear/grouped/

reticulate

No of lesions-At beginning/Present

Extent of the lesion: head&neck/face//trunk/arms/hands/wrists

/legs/feet/fingers/ toes

Factor aggravating the symptoms: chemicals/dyes/earrings/necklace/chappals/

dust/pores/pollens/ spring/autumn

Factor reliving the symptoms:

Kandu/ Pruritis

Course : Progressive / Episodic / Continuous

Severity : Mild, localized, relieved spontaneously or any local measures

Intense or widespread. Relieved by systemic methods or

spontaneously.

Intense or widespread. Poorly controlled by treatment

Site : head&neck/face//trunk/arms/hands/wrists /legs/feet/fingers/ toes

Aggravating Factor : Seasonal / Diurnal / Nocturnal / dust/pores/pollens/food

Relieving Factor : Seasonal / Diurnal / Nocturnal

Srava/Discharge

Onset of Discharge - Sudden/Gradual/Insidious

Duration-Acute/sub acute/chronic

Site of Discharge - head&neck/face/trunk/arms/hands/wrists/legs/feet/fingers/

toes


Annexure

Character of Dischrge – Serous/purulent-Profuse/moderate/less

Aggravating Factor : Seasonal / Diurnal / Nocturnal / dust/pores/pollens

chemicals/food

Relieving Factor : Seasonal / Diurnal / Nocturnal

Vaivarnya/Discolouration

Onset of Discolouration - Sudden/Gradual/Insidious

Duration:

Site of Discolouration:

Colour: Black/Red/Shyava

Vedana/Pain :

Character : Ruja/ Daha :

Onset : Sudden / Gradual

Site : head&neck/face//trunk/arms/hands/wrists /legs/feet/fingers/ toes

Course : Progressive / Episodic / Continuous

Aggravating Factor :Food / spring/autumn

Relieving Factor :

Treatment taken so far:

Type Variety Duration Effect

Ayurveda Shodhana/shamana

Allopathy Oral/parental

Other

History of past Illness-

DM HTN

BR.ASTHAMA Skin diseases

Family history


Family Age Living/dead Health status Allergy like asthma Allergy like eczema

Father

Mother

Brother

Annexure

Socio economic history

Sister

Son

Daughter

H/W

Personal History

Ahara

Appetite- G/M/P

Diet- Nature- Veg/Mix/Non-veg

Break Fast-

Mid Morning-

Lunch-

Snacks in Evening-

Habits- Samshana / Vishamashana / Adhyashana / Anashan / Pramitashan

Fruits- Regular/ occasional

Rasapradhana- M / A / L / K / T / KS / SR

Any sp.allergy of perticular rasa/food:

Supplementary Diet – tea / coffee / milk / cold drinks

Water Intake – Every morning / during or After Lunch/ Dinner

Day + Night – It’s Total

Cold Beverages – Regular / Occasional

Butter milk/Curds: Regular / Occasional

Spicy Foods- Regular / Occasional

Fried Items- Regular/ Occasional

Junk Foods- Regular/ Occasional

Ice Cream- Regular/ Occasional

Fish/milk: Regular / Occasional

Vihar

Occupational History- Nature of Work- Physical/ Mental/ Sedentary/

Moderate/ Heavy Time of Work- Day/ Night


Contact:chemicals Day-Night hrs

Annexure

Exercise- Regular/ Irregular/ Occasional/ Only Routine Work

Vishrama- Proper/less/excessive

Sleep- Sound/ Irregular/ Disturbed/ Delayed/ Staying Asleep

Night- hrs Days- hrs

Addictions- No Habits/ Smoking/ Tobacco/ Alcohol/ Others

Bowel- Regular/ Irregular/ Constipated/ Loose Soft

No. of Frequency- /times days

Micturition- Regular/ Irregular/scanty/excessive

Times/day Times/night

Snana-daily/irregular

Psychological Factors-

Stress Evaluation: Sadness/ Guilt/ Anxiety Somatic/ Anxiety Psychic/ Insomnia/

Retardation :Work & Activities/Loss of Insight/ Decreased Appetite/

Hair Loss/ Hair graying

. Obstetric History- Gravida- Parity-

Live- Dead-

Gynecological History- Menarche : yrs

Menstrual Cycle- /days

Regular/ Irregular

Menopause: yrs

Associated Symptoms

Atura Bala Pariksha-

1. Prakruti : V/P/K/VP/PK/KV/Sama

2. Vikruti :

3. Sara : Pravara / Madhyama / Avara

4. Pramana : Sama / Madhya / Heena

5. Samhanana : Pravara / Madhyama / Avara

6. Satwa : Pravara / Madhyama / Avara


7. Satmya : Pravara / Madhyama / Avara

Annexure

8. Vyayama Shakti : Purvakalina - Pravara / Madhyama / Avara

Adhyatana - Pravara / Madhyama / Avara

9. Ahara Shakti : Abhyavaharana : Purvakalina - Pravara / Madhyama /Avara


Jarana: Purvakalina - Pravara / Madhyama / Avara


10. Vaya : Vruddhi/Yauvana / Sampurnata /Parihani

Ashtasthana Pareeksha-

Nadi-

Mala-

Mootra-

Jihwa-

Shabda-

Sparsha-

Drik-

Akrut-

I. General Examination-

1. Built-

2. Nourishment-

3. Nails-

4. Conjunctiva-

5. Cyanosis-

6. Deformities-

7. JVP- Normal/ Raised

8. Oedema- Present/ Absent ; Pitting/ Non Pitting

Region-

9. Lymph Nodes- palpable/nonpalpable

10. Pulse-

11. Respiratory rate-


12. Blood pressure- mm of Hg

Annexure

13. Temperature-

II. Systemic Examination-

Respiratory System –

Cardiovascular System –

Central Nervous System –

Gastrointestinal System –

Skin Examination- INSPECTION:

1) Extent&Distribution-

Symmetrical/asymmetrical/localized

2) Color of skin: Hypo pigmentation –

Hyper pigmentation – Color-

Generalised/ liocalised

Persistent/ Intermittent

3) State of skin: Sweating- absent/increased/decreased/normal/local/general

Cold & Clammy skin- P/A

Greasiness- P/A

Wrinkling- P/A

Tense skin- P/A

Elasticity- N/I/D

Thickness- N/I/R

Primary lesions

Primary

lesion

Shape Size Colour Distribution Margin Surface

Macule

Papule

Vesicle

Nodule

Pustule

Plaque


Annexure

Secondary lesions

Secondary

lesions

Shape

Size

Colour

Distribution

Margin

Surface

Excoriation

Scaling

Crusting

Erosion

Investigations –

Hematological investigation –

TC: DC: ESR: HB%: RBS: FBS:

Any relevant investigation –

Nidana

Aharaja

Viruddha ahara- lavana+dugdha milk+amla dravya

Tila+guda+dadhi matsya+dugdha

Garishta ahara- curd,fish,fermented food,drava,guru,sneha bahula,gramya anoopa

uadaka mamsa sevana

Fast foods – idli,dosa,pizza,burger,sandwitch

Asatmya ahara- sour food like cocum,pickle,vinegar,cold drinks,backing

powder,ushna-teekshna ,vidahi ahara,mulaka,garlic,onion,excessive intake of tila

lavana amla and navannapana,

Viharaja

Vega dharana,ati vyayama after eating,Panchakarma apachara, after excersise/sun

exposure/fear taking cold water Exposure to sun after heavy meal,divasvapna,Living

in polluted environment,Allergy to any substance-

Manasika- bhaya,chinta shoka krodha etc


Annexure

Purva roopa:

Asvedanam Kharatva Daha

Atisvedanam Ushmayana Tvakparooshata

Vaivarnya Gourava Romaharsha

Kandu Sparsha ajanatva Angapradeshasvapa

Toda Unnata Krishnata

Atishlakshna Kotha Sheegrautpattichirasthita

Suptata Sharma Nimittealpeapikopanam

Paridaha Klama

Lomaharsha Vranadhikata

RUPA

Vata Pitta Kapha

Roukshya Daha Sheetata

Shosha Raga Shveta varnata

Toda Paka Utseda

Ayama Parisrava Snigdhata

Parushata Visragandha Kandu

Kharata Kleda Sthirata

Harsha Angapatana Gouravata

Shyava arunata Tvak swapa Kleda

Sparsha hani Krimi utpatti

Pidikodgama Ghana

DUSYATAHA PARIKSHA

RAKTA-atisveda,romaharsha,kandu,durgandha,supti

Lasika – alpasveda,avila mutrata,daurgandhya,kotha,kandu

Tvak – sparshahani,rukshata,sveda,kandu vaivarnya

Mamsa - bahala,toda,sphota, sthira, karkasha


Annexure

SAMPRAPTI GHATAKA

Nidana : Aharaja/Viharaja/ Manasika

Dosha : V/P/K

Dushya : Tvak/Rakta/mamsa/laseeka

Srotas : Rasa/Rakta/Mamsa

Sroto dusti :

Agni : vishama /tikshns/manda/sama

Ama : Jatharagni / Dhatwagni

Udbhava sthana : Amasaya / Pakwasaya / Ama pakwasaya

Sanchara sthana :

Vyakta sthana :

Roga marga : Bahya

VYADHI VINISCHAYA

Vicharchika: Ati kandu/shyava pidaka/ bahusrava/atiruja/raaji/ruksha/daha

SADHYASADHYATA :

UPADRAVA :

CHIKITSA:

Oral administration of Gandhaka churna( capsule) 500mg bd before food.

Anupana –100ml milk 28 days medication

Diet & regimen: Avoid hot oily spicy food

Avoid contact with causative factor

Adverse effect during treatment – yes/no

FOLLOW UP INTERVIEW :


Annexure

ASSESSMENT CRITERIA :

SUBJECTIVE

Fallow up period Symtoms BT 7th Day 14th Day 21st Day 28th Day

6th week 8th week

Itching

Discharge

Discolouration

Sleep loss

Pain

Burning

OBJECTIVE

Fallow up period Signs BT 7th Day 14th Day 21st Day 28th Day

6th week 8th week

Papulation

Dryness

Lichenification

Excoriation

Body region


Annexure

The SCORAD Index for Severity Scoring of Atopic Dermatitis

PARAMETERS POINTS

BT 7 dayth 14 dayth 21 days 28 dayth 6 weekth 8 weekth

Body Region (A)

Erythema

Papulation

Oozing (B)

Excoriation

Lichenification

Dryness

Pruritis

Loss of sleep (C)

SUM

SCORAD index = (A / 5) + (7 * B / 2) + C

Signature of the Guide Signature of the Scholar


Visual Analogue Scale

Symptom BT 7th day 14th day

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

21st day 28th day

Discharge

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

7th day BT 14th day

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

21st day 28th day

Itching

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

BT 7th day 14th day

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

21st day 28th day

Loss of sleep

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

BT 7th day 14th day

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

Discolouration

21st day 28th day | | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

121

Symptom BT 7th day 14th day

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | |

0 1 2 3 4 5 6 7 8 9 10

21st day 28th day

Pain

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

BT 7th day 14th day

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

| | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10

21st day 28th day

Burning

| | | | | | | | | | | | | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10

122

Parada Gandhaka

Bakuchi

Bhringaraja Kakamachi

Capsules of Gandhaka Churna

vicharchika gandhaka kc015-udp

Education

rajiv gandhi

visual analogue

post graduate

bonafide research

dissertation

gandhaka churna

statistical

therapeutic