(eczema) by panchatikta ghrita gugglu and lepa of

��

��

�� !!"#

$%&'()*+,-./001.203%0405.6)*01)7*%()7,.8(91)7,

:;<=>?;:;@AB=

CDEEFCGHHFIEJKFLFMMMNOPQQRNSDT

;;UVW:=;X;YZZ[\;:;A;X;]̂ _;:;̀\a;:;<@Ab

VOL 3

ISSUE 1 (2015) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINEINTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINEINTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINEINTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE

eISSN

2348-0173

Gaikwad M. D. et.al., A Clinical Study on the Management of Vicharchika (Eczema) by Panchatikta Ghrita Gugglu and Lepa of Gairika, Int. J. Ayu. Alt. Med., 2015; 3(1):21-27

Pa

ge2

1

Pa

ge2

1

RESEARCH ARTICLE eISSN 2348- 0173

Impact Factor (2014) – 0.815 by International Scientific Indexing (ISI) UAE

A CLINICAL STUDY ON THE MANAGEMENT OF VICHARCHIKA

(ECZEMA) BY PANCHATIKTA GHRITA GUGGLU AND LEPA OF

GAIRIKA

Gaikwad Madhavi Dattatray1*, Deshmukh Avinash Madhav2

1. Assistant Professor, Dept. of Rognidan and Vikrutivigyan, C.S.M.S.S. Ayurved College,

Aurangabad, Maharashtra, Contact No. +91 9970431387, Email: [email protected]

2. Associate Professor, Dept. of Rognidan and Vikrutivigyan, C.S.M.S.S. Ayurved College, Aurangabad, Maharashtra, Contact No. +91 9822363522, Email:[email protected]

Article Received on - 9th

Jan 2015

Article Revised on - 12th

Jan 2015

Article Revised on - 29th

Jan 2015

Article Accepted on - 18th

Feb 2015

All articles published in IJAAM are peer-reviewed and can be downloaded, printed and

distributed freely for non commercial purpose (see copyright notice below).

(Full Text Available @ www.ijaam.org)

© 2013 IJAAM

This is an Open Access article distributed under the terms of the Creative Commons Attribution License

(http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_US), which permits unrestricted non commercial

use, distribution, and reproduction in any medium, provided the original work is properly cited.

VOL 3


eISSN

2348-0173


Pa

ge2

2

Pa

ge2

2

RESEARCH ARTICLE eISSN 2348- 0173

*Corresponding Author

Gaikwad Madhavi Dattatray Assistant Professor, Dept. of Rognidan & Vikrutivigyan, C.S.M.S.S. Ayurved College, Aurangabad, Maharashtra, Contact No. +91 9970431387, Email: [email protected]

QR Code IJAAM

ABSTRACT: All skin diseases can be included under the umbrella of kustha roga. Vicharchika is a

variety of kshudra kustha. The features of eczema are somewhat similar with that of

vicharchika mentioned in ayurveda. Symptoms of vicharchika mentioned by

Charaka correlate with wet eczema & symptoms mentioned by Susruta correlate

with dry eczema. Due to its chronic and recurrent nature, it has a great impact on

the quality of life of the patients. The present study was aimed to compare the

effect of Panchatikta Ghrita Gugglu tablets along with local application of lepa

containing Gairika mixed with Karanja Tailam in patients of dry and wet eczema

(vicharchika). For this study, selected patients were divided into two groups-dry

group & wet group. 17 patients were registered under dry group and 20 patients

were registered under wet group. The duration of the study was 1 month with

follow up for 15 days. Dry group showed highly significant results in all signs and

symptoms. Insignificant results were recorded in wet group for shrava, vaivarnya

and raji, so it was concluded that trial formulation is quite effective in management

of dry eczema (vicharchika).

Key Words: Kustha, Vicharchika, Dry Eczema, Wet Eczema, Panchatikta Ghrita

Gugglu, Gairika, Karanja Tail.

INTRODUCTION

Skin is the largest protective organ of the body. A

healthy skin is the mirror image of a good health.

The colour of the skin is important biologically,

cosmetically and socially. The unbroken skin is the

nature’s dressing over the body. It acts as an

effective barrier against the entry of diseases. Skin

diseases though afflicts bodily but gives lot of

psychological conflicts and can harm affected

individual in a number of ways like discomfort,

disfigurement, disability and death. Though the

disease, vicharchika is not a life threatening, it

makes the patient worried due to its appearance,

severe itching, disturbing routine and its chronic

nature. Almost all the scholars of Ayurveda of

modern era consider vicharchika as eczema in

modern parlance. Vicharchika is described under

kshudra kustha in ayurvedic textual also

mentioned as a curable disease, yet the relapsing

nature of this disease makes it much harassment

for patient and troubles some for physician too.

Vicharchika as considered by Charaka, the ancient

medical authority, is characterized by kandu

(itching), shyavapidika (skin eruption with dark

discolouration), bahusrava (profuse discharge)

involving the domination of kapha which

correlates wet eczema. [1] Whereas Sushruta, the

father of surgery has mentioned the symptoms as

rajyo (thickening of skin), atikandu, ruja (pain) and

rukshata (dryness of skin) involving the

domination of pitta which correlates dry eczema. [2] A similar clinical presentation in modern

dermatology is seen eczema which is defined as a

non-contagious inflammation of the skin

characterized by erythema, scaling, oedema,

vesiculation and oozing. Eczema, or dermatitis, is a

reaction pattern that presents with variable

clinical and histological findings and is the final

common expression for a number of disorders,

including atopic dermatitis, allergic contact and

irritant contact dermatitis, dyshidrotic eczema,

nummular eczema, lichen simplex chronicus,

asteatotic eczema, and seborrheic dermatitis.

Primary lesions may include papules,

erythematous macules and vesicles, which can

coalesce to form patches and plaques. In severe

eczema, secondary lesions from infection or

excoriation, marked by weeping and crusting, may

predominate. Long-standing dermatitis is often dry

and is characterized by thickened, scaling skin

(lichenification). Eczema is a specific type of an

antigen-specific immune response and results due

to an antigen-antibody reaction. It is resultant of

delayed type hypersensitivity mediated by

memory T lymphocytes in the skin and the clinical

lesions may be acute (wet and oedematous) or

chronic (dry, thickened and scaly) depending on

the persistence of the insult. [3] The modern

treatments given for eczema have their own

limitations and side effects. The trial formulation

Panchtikta Ghrita Gugglu used for internal therapy

is taken from the reference found in

Bhaijyaratnavali [4] and the fine powder of Gairika [5] mixed with Karanja Tail [6] used for local

A CLINICAL STUDY ON THE MANAGEMENT OF VICHARCHIKA

(ECZEMA) BY PANCHATIKTA GHRITA GUGGLU AND LEPA OF

GAIRIKA

VOL 3


eISSN

2348-0173


Pa

ge2

3

Pa

ge2

3

application is anubhuta yoga (non-classical

formulation). The same trial drugs used in both dry

and wet group. Considering all these points, the

present study was planned with the aim to

evaluate the role of above trial drug in the

management of wet and dry eczema.

Aim and Objectives –

1. To find out an easily available and considerably

low cost, safe and effective remedy for the

treatment of vicharchika.

2.To evaluate the clinical efficiency of Panchatikta

Ghrita Gugglu orally and the fine powder of Gairika

mixed with Karanja tail used for local application

in the management of dry and wet eczema.

3. To compare the effects of above mentioned

therapy on dry and wet eczema.

4. To ascertain different clinical aspect of

vicharchika described in Ayurveda as well as

modern medical science.

Inclusion Criteria –

1. Age 16-70 yrs, irrespective of sex, religion, socio-

economic status.

2. The patients having the classical signs and

symptoms of Vicharchika (both dry and wet)

described in Ayurvedic classics.

3. Duration of lesion less than 1 year.

Exclusion Criteria-

1. Age less than 16 years and more than 70 years.

2. The lesion which is infected and having p

collection or secondary infection.

3.Known cases of systemic disease like Diabetes

Mellitus, Cancer, AIDS,TB etc…and other skin

diseases like scabies, psoriasis, lichen simplex

chronicus etc.

Materials and Methods-

For the present study, after institutional ethical

committee clearance, the patients having the

symptoms of vicharchika were randomly selected

from OPD of Rog nidan dept. R.A. Podar Ayurved

College, worli, mumbai. A special proforma was

made for assessing all the patients.

Grouping – Diagnosed patients were divided

into two groups.

1. Dry Group – patients with dry lesion (dry

eczema)

17 patients registered under this group. among

them 6 patients discontinued the treatment.

No. of. patients – 17

Completed patients – 11

Drop out patients – 6

2. Wet Group – patients with wet lesion (wet

eczema)

20 patients registered under this group. among

them 7 patients discontinued the treatment.

No. of. Patients – 20

Completed patients – 13

Drop out patients – 7

The patients of both groups were administered

internally Panchatikta Ghrut Gugglu tablets in a

dose 2 tablets of 500 mg twice a day after meal

with lukewarm water and fine powder of Gairika

mixed with Karanja Tail used externally for local

application. Required quantity as per the area of

distribution of the lesion, the lepa was used.

Duration of the study – One month. Follow up

was done for 15 days after the completion of the

treatment.

Criteria for assessment –

The following criteria or variables were assessed

before and after the drug administration-

1) Kandu (itching)

2) Pidika (skin eruption)

3) Shrava (profuse discharge)

4) Vaivarnya (depigmentation)

5) Raji (lichenification)

6) Rukshata (dryness)

Laboratory Investigations-

1. Routine hematological investigations- Hb%, TLC,

DC, RBC, ESR.

2. Urine – Routine and Microscopic examination

3. Random blood sugar.

Above examinations were carried out before and

after treatment to rule out the other associated

pathology as well as to assess and evaluate the

effect of therapy.

Dietary Restrictions –

The Patients were advised to follow the

pathyapathya available in Ayurvedic literature for

kustharog. [7] The Patient suffering from

Vicharchika were advised to take following types

of diet: Light and wholesome food, leafy vegetables

having bitter taste, old (not freshly harvested)

cereals, food preparations and medicated ghee

prepared by boiling with bhallataka, triphala and

nimba, meat of animals inhabiting arid land and

preparations of mudga mixed with patola. Intake of

heavy and sour food, milk, curd, excess salt, meat

of animals inhabiting marshy land, fish, guda

(jaggery) and tila (sesame) is prohibited for

patients of vicharchika.

Follow up –

A follow up study was carried out for fifteen days

after completion of treatment. For this purpose,

cardinal signs and symptoms were given scores

VOL 3


eISSN

2348-0173


Pa

ge2

4

Pa

ge2

4

according to their severity before and after the

treatment.

Statistical Analysis –

The information gathered on the basis of above

observations was subjected to statistical analysis

in terms of mean (X), standard deviation (S.D),

standard error (S.E), paired ‘T’test were carried out

at p<0.05,p<0.01 and p<0.001.

The obtained results were measured according to

the grades given below:

Complete Remission -100% relief

Marked Improvement -75%-99% relief

Moderate Improvement -51%-74% relief

Mild Improvement -25%-50% relief

Unchanged -<25% or no relief

OBSERVATIONS

Table 1: Distribution of 37 registered patients

Patients No. of. Patients

Total Dry group Wet group

Completed patients 11 13 24

Dropouts patients 06 07 13

Total 17 20 37

Table 2: Age wise distribution of 37 patients

Age Group

(years)

No. of. Patients Total %

Dry group Wet group

16-30 06 05 11 29.73

31-50 08 13 21 56.76

51-70 03 02 05 13.51

Table 3: Sex wise distribution of 37 patients

Table 4: Habitat wise distribution of 37 patients

Habitat No. of. Patients

Total % Dry group Wet group

Urban 14 15 29 78.38

Rural 03 05 08 21.62

Table 5: Desha wise distribution of 37 patients

Desha No. of. Patients


Aanup 15 13 28 75.68

Jagnal 00 01 01 02.7

Sadharan 02 06 08 21.62

Table 6: Ahara wise distribution of 37 patients

Ahara No. of. Patients


Vegetarian 06 07 13 35.13

Mixed 11 13 24 64.87

Table 7: Recurrence of disease wise distribution of 37 patients

Recurrence

of disease

No. of. Patients Total %

Dry group Wet group

Recurrence Present 14 12 26 70.27

Recurrence Absent 03 08 11 29.73

Sex No. of. Patients


Male 11 10 21 56.76

Female 06 10 16 43.24

VOL 3


eISSN

2348-0173


Pa

ge2

5

Pa

ge2

5

Table 8: Dosha Lakshana wise distribution of 37 patients

Dosha Lakshan No. of. Patients


Vata-Pitta 00 02 02 05.40

Pitta-Kapha 02 16 18 48.64

Kapha-Vata 12 01 13 35.14

Tridosha 03 01 04 10.81

Table 9: Rupa (signs and symptoms) wise distribution of 37 patients

Desha No. of. Patients


Kandu 17 20 37 100

Pidika 08 18 26 70.27

Shrava 00 20 20 54.05

Vaivarnya 17 20 37 100

Raji 15 04 19 51.35

Rukshata 17 00 17 45.95

Table 10: Distribution of 37 patients according to Part involve

Part involved No. of. Patients


Upper extremities 05 05 10 27.03

Lower extremities 11 12 23 62.16

Head, Neck, Face 01 02 03 08.11

Abdomen(middle) 00 01 01 02.70

Table No.11: Overall effect of Treatment in Dry Group

Sr.No Symptoms BT AT X SD SE T P

1 Kandu (n=11) 2.273 0.2727 2.003 0.6325 0.1907 10.488 <0.001

2 Pidika (n=8) 2.500 0.6250 1.875 0.6409 0.2266 8.275 <0.001

3 Vaivarnya(n=11) 2.273 0.5455 1.727 0.6467 0.1950 8.859 <0.001

4 Raji(n=9) 2.444 1.000 1.444 0.7265 0.2422 5.965 <0.001

5 Rukshata(n=11) 2.455 0.6364 1.818 0.6030 0.1818 10.00 <0.001

Table No.12 : Overall effect of Treatment in Wet Group

Sr.No Symptoms BT AT X SD SE T P

1 Kandu (n=13) 1.846 1.231 0.6154 0.6504 0.1804 3.411 <0.001

2 Pidika (n=11) 1.615 1.308 0.3077 0.4804 0.1332 2.309 <0.001

3 Vaivarnya(n=13) 2.231 2.000 0.2308 0.4385 0.1216 1.897 >0.001

4 Raji(n=10) 1.900 1.600 0.3000 0.4830 0.1528 1.964 >0.001

5 Shrava(n=13) 1.846 1.692 0.1538 0.3755 0.1042 1.477 >0.001

Table No.13 % Relief in Dry Group

Sr.No Symptoms % Relief

1 Kandu 88.00

2 Pidika 75.00

3 Vaivarnya 76.00

4 Raji 59.08

5 Rukshata 74.05

Table No.14 % Relief in Wet Group

Sr.No Symptoms % Relief

1 Kandu 33.33

2 Pidika 19.05

3 Vaivarnya 10.34

4 Raji 15.78

5 Shrava 08.33

Overall effect in Dry Group – 74.426%

Overall effect in Wet Group – 17.366%

RESULTS –

• The details of patients registered in dry group

and wet group are given in table 1.

• Out of 37 patients registered, 11 patients in

dry group and 13 patients in wet group

completed the study.

• Maximum number of patients i.e, 56.76%

were from the age group 31- 50 years,

56.76% were male, 78.37% patients were

from the urban area, 75.68% patients were

from the aanup desha, 64.87% patients were

taking mixed diet.

• Recurrences of disease (vicharchika) were

present in 70.27% patient.

VOL 3


eISSN

2348-0173


Pa

ge2

6

Pa

ge2

6

• 48.64% patients were of pitta-kapha dosha

lakshana, 35.13% patients were of kapha-vata

dosha lakshana.

• 62.16% patients reported the lower

extremities as the commonest site of

involvement.

• Chief complaints reported were kandu, pidika,

vaivarnya, raji in all patients. Shrava was

found in wet group only and rukshta was

found in dry group only. Kandu and vaivarnya

were reported in100% patient (all patients),

pidika was reported in 70.27% patients, raji

was reported in 51.35% patients, shrava was

reported in 54.05%, rukshata was reported in

45.95% patients.

• Highly significant results were found in all

signs and symptoms of dry group. Whereas

significant results were found in kandu and

pidika of wet group and insignificant results

were found in shrava, vaivarnya, raji of wet

group.

• Insignificant results were found in laboratory

parameter in both the group.

• In follow-up study, no recurrence was found

in 90% patients of dry group and recurrence

was noted in 10% patients at the end of 15

days.

• Paired t-test was applied on the cardinal

symptoms. Significant difference was found

between effects of therapies on both the

groups which suggested that dry group

showed equally good effect on all cardinal

symptoms. Therapy was effective in kandu,

pidika of wet group.

Effect of Therapy - Overall effect of therapy in dry

group was found 74.43% and in wet group was

found 17.73%.

Table No.15 Effect of therapy in symptoms of vicharchika in dry group and wet group of the patients selected for the study

in percentage of patients showing improvement (Paired t test)

Symptoms effect in dry group

(in %)

effect in wet group

(in %)

Kandu 88.00 33.33

Pidika 75.00 19.05

Vaivarnya 76.00 10.34

Raji 59.08 15.78

Rukshata 74.05 -

Shrava - 08.33

Table No.16 Overall effect of therapy on patients enrolled in the study and divided into dry & wet group, in number of

patients and corresponding percentage of patients showing varying degrees of improvement

DISCUSSION

• Out of both groups, dry group showed

improvement in all signs and symptoms.

Insignificant results were found in wet group.

Most of the patients had reported in the

chronic stage of vicharchika. Negligence in the

early stage of eczema is observed in patients.

Relapsing nature of vicharchika is most

common which suggest that long term

intensive therapy is necessary for eradication

of the disease.

• Panchatikkta ghrut gugglu orally and fine

powder of gairika mixed with karanja tail

used for local application is low cost, safe and

effective remedy for the dry vicharchika.

• On the basis of history, maximum number of

patients were having progressive tendency of

disease and which is due to continuous

irritation to the skin and may precipitate the

disease in further progress.

• Maximum number of patients i.e, 75% felt

more itching in lesion in winter and in 50% it

aggravated due to food taken. Humid, cool

atmosphere and spicy food is much

responsible for skin disorders. Thus above

data suggests that winter served excess

dryness in the skin, which may have

aggravated the eczematous condition. (Dry

Vicharchika)

• In classics, many kusthahara single and

compound preparations have been

mentioned, but none of them has been

specifically mentioned for oral use of

vicharchika, therefore depending upon its

Effects

dry group wet group

Number of

Patients %

Number of

Patients %

Complete Remission 1 9.10 0 0

Marked Improvement 5 45.45 0 0

Moderate Improvement 5 45.45 0 0

Mild Improvement 0 0 5 38.47

Unchanged 0 0 8 61.53

VOL 3


eISSN

2348-0173


Pa

ge2

7

Pa

ge2

7

symptoms and samprati a compound

preparation named as Panchatikkta Ghrut

Gugglu was selected for oral use. It contains

number of drugs which have properties like

kanduhara, kusthahara, vishahara, twakgami.

• The manifestation of eczema occurs in skin,

where in the sensitivity of the local cells is

disturbed. Further, ayurveda emphasizes on

managing the sthana (place of the lesion),

therefore Gairika mixed with karanja tail was

selected for external use as lepa (local

application on the lesion). It was anubhuta

yoga (non-classical formulation). Gairika is

well known rasadravya. Gairika and karanja

tail have properties like kanduhara,

varnaropak, raktaprasadan, vishahara,

vicharchikanashak.

CONCLUSION

From above study it was concluded that

Panchatikkta ghrut gugglu orally and gairika

mixed with karanja tail for external application is

choice of therapy for dry eczema (vicharchika)

REFERENCES 1. Charaka, Charaka Samhita of Agnivesa ‘Vidyotini’ hindi

commentary by Kasinatha Sastri edited by Gangasahaya

Pandeya, 4th ed. Chaukhambha Sanskrit Sansthan

Varanasi, India 1994. p.203

2. Susruta, Susruta Samhita of Maharshi Susruta ‘Ayurved-

Tattva-Sandipika’ hindi commentary edited by Kaviraja

Ambikadutta Shastri, 10th ed. Chaukhambha Sanskrit

Sansthan Varanasi,India 1996. p.248

3. Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser S,

Jameson JL, editors. Harrison’s Principles of Internal

Medicine. 16thed. New York, Chicago, New Delhi:

McGrow-Hill; 2005. p. 288-289.

4. Bhaisajyaratnavali ‘Vidyotini’ hindi commentary by

Kaviraja Ambikadutta Shastri, 12th ed. Chaukhambha

Sanskrit Sansthan Varanasi, India. 1996. p. 632.

5. Rasatargini by shrisadanandasharma ‘Rasavigyan’ hindi

commentary by Pandit Kashinathshartri Chaukhambha

Sanskrit Sansthan Varanasi. 2004. p. 596.

6. Bhaisajyaratnavali ‘Vidyotini’ hindi commentary by

Kaviraja Ambikadutta Shastri, 12th ed. Chaukhambha

Sanskrit Sansthan Varanasi, India. 1996. p. 653.

7. Charaka, Charaka Samhita of Agnivesa Text with English

translation and critical exposition based on Cakrapani

Datta’s Ayurved Dipika by Dr. Ram Karan Sharma and

vaidya Bhagwan Dash (Volume III) Chaukhambha

Sanskrit Series Office Varanasi, India 2005. p. 341-342

CITE THIS ARTICLE AS –

Gaikwad M. D. et.al., A Clinical Study on the Management of Vicharchika (Eczema) by Panchatikta Ghrita

Gugglu and Lepa of Gairika, Int. J. Ayu. Alt. Med., 2015; 3(1):21-27

Source of Support – Nil Conflict of Interest – None Declared

INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE

#401/8-A, 4th Floor, Shiv Shrishti Apt.

Nardas Nagar, TP Rd., Bhandup (W), Mumbai – 400078

E:[email protected], Web- www.ijaam.org

(eczema) by panchatikta ghrita gugglu and lepa of

Documents