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Introduction

Most common skin ailment encountered during clinical practice is Vicharchika and its incidence is alarmingly rising is quite a concern on healthcare of the public.1 This condition has two forms one which is Ruksha or dry form and other being the Sravi or the moist form based on its clinical presentation. Most common skin ailment encountered during clinical practice is Vicharchika and its incidence is alarmingly rising is quite a concern on healthcare of the public.2 This condition has two forms one which is Ruksha or dry form and other being the Sravi or the moist form based on its clinical presentation . The characteristic feature of Vicharchika is skin lesions of varying size with inflammation, severe itching sensation, with bleeding in some cases, and this condition is as distressing as it causes disfigurement by affecting cosmetic look of an individual.3 It also affects quality of life and increases the economic burden of an individual. Recurrence is by far the most common complaint associated with this ailment. In this case study, a case of Sravi Vicharchika in acute form was dealt with Ayurvedic treatment and the outcome of it is being presented. Based on the Doshic dominance internal medications will be planned, in Vata Pitta dominance all the features of inflammation will be evident and correspondingly Vata Pitta shamaka dravya are to be used. The characteristic feature of Vicharchika is skin lesions of varying size with inflammation, severe itching sensation, with bleeding in some cases, and this condition is as distressing as it causes disfigurement by affecting cosmetic look of an individual . It also affects quality of life and increases the economic burden of an individual. Recurrence is by far the most common complaint associated with this ailment. In this case study, a case of Sravi Vicharchika in acute form was dealt with Ayurvedic treatment and the outcome of it is being presented. Based on the Doshic dominance internal medications will be planned, in Vata Pitta dominance all the features of inflammation will be evident and correspondingly Vata Pitta shamaka dravya are to be used.

Case details:

A 47 year old male patient visited the OPD with presenting complaints of severe itching sensation, pain, swelling and wound on left hand since 10 days, patient also reported to have few episodes of fever. After the complete history taking it revealed, he had past history of skin lesions with itching with sometimes scaling since past eight years, but patient was not on regular medications, whenever the symptoms shoot up, he was approaching a local physician and symptomatic medications were administered during that period. None of the patient’s family members had this ailment or similar other dermatological complaints. Patient reports to have no other medical or surgical illness apart from the present complaints. Patient had mentioned to have tobacco chewing addiction since past 20 years.

Clinical examination revealed, patient is moderately built moderately nourished with no other signs of any systemic illness. On local examination, severe degree of inflammation with multiple irregular sized, shaped ulcers and vesicles with bleeding, with slight pus discharge on left hand. Entire left hand was completely affected by the inflammation which was evident by the rubor, calor, tumor and function laesa. The left hand was warm, with few bleeding points and high degree of tenderness.[Fig No.1] The draining lymph nodes were slightly inflamed.

Treatment adopted:

Prior to treatment plan, this condition was diagnosed as Sravi Vicharchika as the patient had the similar episode of eczematous lesions which was relapsing and currently he presented with acute episode of inflammation denoting the aggravation of the condition. The features of moist surface with bleeding, pus discharge, inflammation, and also eczematous lesions on both palmar and dorsal surface of left hand enabled in diagnosing the ailment with Vata pitta dominance. The condition was progressive with rapidly striving for suppuration denoted the Vata and pitta dosha’s involvement.

The treatment planned for this condition was Panchavalkala Kashaya Prakshalana [Fig No 2], Jalaukavacharana [Fig No 3], topical application of Tiktakaghrita and internal administration of Panchatiktaghrita guggulu, Samshamani Vati, Triphala Churna and Manjishtadi Ghanavati, posology of the same is tabulated in Table No. 01.

Table No. 1 Depicts the drug administered with the posology:

Table no.2 illustrates the patient photos from starting of treatment to changes observed:

Discussion

Panchavalkala kashaya aided in restoring hygiene and reduce the microbial load4, while Jalaukavacharana is assisted in completely checking the inflammation and suppuration process which was apparent in the pictures. With the just one sitting of Jalaukavacharana, gross reduction in pain, itching, inflammation, pus discharge and redness was observed. [Fig. No.4] Patient appreciated the clinical changes observed after the therapy and he was advised to take same medications for a period of 15 days and was asked to visit for further follow up.

Sravi Vicharchika is an inflammatory condition characterized by unpredictable degree of vesicular lesions with considerable intensity of exudation and scaling, which may get worsened by secondary infection. 5 As per Ayurvedic doctrines, dermatological ailments have indivisible relation with Raktadosha as these ailments get reduced by bloodletting therapy. 6,7

Raktamokshana is a prime modality in Ayurvedic surgical science and several studies denote its multifaceted positive outcome on various ailments especially in skin disorders.8 In this case, Jalaukavacharana was chosen as it is most convenient form among the other forms and it is specified for Pitta dominated condition.9,10 The drugs administered internally targeted mainly to check the suppuration process and alleviate the aggravated Vatapittadosha thereby relieving the inflammation and that was evident as depicted in the Pictures tabulated in Table No 2.

Conclusion

Vicharchika haunts the outlook of an individual and affects the quality of life. Among the subtypes of Vicharchika, in this case, Sravi Vicharchika was encountered in clinical practice. Positive clinical results can be achieved by employing the treatment modality as advocated in Ayurvedic treatises. Raktamokshana is by far the best modality in achieving success in this disease. Vata Pitta shamaka dravya usage has assisted in the positive outcome. Along with application of treatment modality, certain life style changes have to be stressed.