|Year : 2012 | Volume
| Issue : 4 | Page : 505-510
Role of Virechana Karma in cure and prevention of recurrence of Vicharchika (Eczema)
Mandip Kaur1, Harimohan Chandola2
1 Assitant Professor, Department of Kaya Chikitsa, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurveda University, Jamnagar, Gujarat, India
2 Professor and Head, Department of Kaya Chikitsa, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurveda University, Jamnagar, Gujarat, India
|Date of Web Publication||12-Apr-2013|
Rishabh, 9/1, Patel Colony Chowk, Jamnagar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Mandip and Chandola reported that administration of Rasayana (Guduchi and Bhringaraja) after Koshtha Shuddhi with Aragvadha Hima and simultaneous giving of Shirishadi decoction orally and applying of Snuhyadi Lepa externally provided complete remission to 22.6% patients of Vicharchika (Eczema) and checked the recurrences of the disease in the 89.5% patients. As in this group, cure rate was not up to the expectation; therefore, it was thought desirable to see whether performing of Virechana Karma instead of Koshtha Shuddhi prior to the administration of the above drugs enhances the cure rate for the Vicharchika (Eczema) patients. For the present study, 39 patients of Vicharchika (Eczema) were registered, of which 32 patients completed the full course of the treatment. These patients were given Virechana after preparing with the proper internal Snehana, Abhyanga, and Svedana as per classical method. After the Samsarjana Krama, they were administered the Shirishadi decoction and Guduchi-Bhringraja Rasayana powder orally with simultaneous local application of Snuhyadi Lepa on the eczematous lesions. The results of this study showed that when Virechana Karma was performed prior to the administration of Guduchi-Bhringaraja Rasayana and Shirishadi decoction orally and SnuhyadiLepa externally, it not only increased the cure rate to 81.3% in the patients of Vicharchika (Eczema) but also checked the recurrences to great extent as only negligible number of the patients reported the recurrence.
Keywords: Eczema, Koshtha Shuddhi, Rasayana, Vicharchika, Virechana Karma
|How to cite this article:|
Kaur M, Chandola H. Role of Virechana Karma in cure and prevention of recurrence of Vicharchika (Eczema). AYU 2012;33:505-10
| Introduction|| |
Vicharchika (Eczema) is one of the Kshudra Kushthas (chronic skin disorder) and is included under Rakta Pradoshaja Vikaras (disorder due to blood vitiation). Being a type of Kushtha, recurrences and chronic course is common for this disease. Vicharchika can be correlated with eczema which is characterized by persistent or recurring skin rashes, running a chronic course, and has a tendency of exacerbations.  Hence, while selecting regimen for its total eradication, in addition to its own treatment, it is necessary to take care of its recurrences also. The main line of treatment described for Kushtha is repeated Shodhana (bio-purification), so that the disease can be eradicated from the root. Of Panchakarma, Virechana (systemic purification by giving purgative drug) is better for the skin diseases where Pitta and Rakta are mainly involved. 
Mandip and Chandola  carried out a clinical study to evaluate the role of Shirishadi decoction administered orally and simultaneously Snuhyadi Lepa applied externally in the management of the patients of Vicharchika (Eczema). This combination provided complete remission to 18.2% patients, marked improvement to 42.4% patients and moderate improvement to 36.4% patients, but with high recurrence rate of 80%.
To overcome the problem of high rate of recurrence, Mandip and Chandola (2010)  added Rasayana powder comprising of Guduchi (Tinospora cardifolia) and Bhringaraja (Eclipta alba) to the above regimen which was administered after performing Koshtha Shuddhi (drug given for mild purgation) with Aragvadha (Cassia fistula) and Hima (cold infusion). The results of that study showed that addition of Rasayana drugs provided complete remission to 22.6% and checked the recurrences of the disease in the 89.5% patients of Vicharchika (Eczema). However, there was not much difference in cure rate. Hence, it was thought to give Virechana to the patients of Vicharchika, prior to the administration of Shamana and Rasayana drugs to see whether Virechana enhances the cure rate to the patients of Vicharchika (Eczema) and checks its recurrences.
Hence, present study was carried out to ascertain whether performing Virechana Karma instead of Koshtha Shuddhi enhances the cure rate of the patients of Vicharchika (Eczema), keeping the other modalities same.
| Aims and Objectives|| |
- To evaluate the role of performing Virechana Karma prior to the administration of the Rasayana (Guduchi and Bhringaraja powder) and Shirishadi decoction orally and local application of Snuhyadi Lepa in curing Vicharchika (Eczema) and preventing its recurrence.
| Patients, Materials and Methods|| |
For this study, 39 patients of Vicharchika (Eczema) were registered from the OPD and IPD of Kaya Chikitsa department of IPGT and RA Hospital, Gujarat Ayurved University, Jamnagar. Of all, seven patients were dropped-out and 32 patients completed the prescribed course of the treatment.  These registered patients were properly informed regarding the procedure they would undergo and were admitted in the hospital indoor ward and were treated under direct supervision.
| Criteria of Diagnosis|| |
The diagnosis was mainly based on the clinical presentation of Vicharchika as mentioned in the Ayurveda literature and of Eczema described in Allopathic texts, i.e., skin lesion having itching, discharge, or dryness or thickening of the skin with hyper pigmentation and recurrence and running a chronic course.
- Patients below the age 16 years and more than 80 years were excluded
- Patients of Vicharchika having secondary infections.
- Patients suffering with diabetes mellitus.
- Patients of status eczematous condition.
Following investigations were done in the patients before and after the treatment, to rule out other pathologies and see the health status of the patients:
- Routine and microscopic examination of urine and stool.
- Routine hematological investigation for Total leukocyte Count, Differential Count, Hemoglobin %, Erythrocyte Sedimentation Rate.
- Skin scrap test was done to exclude ring worm in doubtful patients.
| Plan of the Treatment|| |
All the 32 patients of Vicharchika of this study were admitted in the hospital and at the outset were prepared by administering internal Snehana (oleation) with Ghrita (Clarified butter-Ghee) followed by Abhyanga (massage) and Svedana (fomentation) on 3 gap days (three days during which no medicine is given to the patient who had already undergone for internal oleation and has achieved symptoms of proper oleation. During these Gap days, whole body massage and fomentation is done and patient was kept on light food). Thereafter, Virechana was performed as per classical method by using Haritkyadi Kvatha containing Haritaki (Terminalia chebula Retz.), Aragvadha (Cassia fistula Linn), Draksha (Vitis vinifera Linn.), Kutaki (Picrorhiza kurroa Royle ex Benth) along with Eranda Taila (Castor oil) and Icchabhedi Rasa. After Samsarjana Krama (dietary regime to be followed after Virechana strictly for at least three days depending upon the type of purification in a particular patient), the patients were administered Shirishadi decoction orally in the dose of 30 ml and 6 g of Rasayana powder comprising of equal parts of Guduchi (Tinospora cordifolia) and Bhringaraja (Eclipta alba) twice daily with Ghrita (Clarified butter-Ghee) after meal. Simultaneously, after cleaning the lesions with warm water, SnuhyadiLepa was applied externally on the lesions twice a day.
| Duration of Treatment|| |
After Virechana and SamsarjanaKrama, the Shirishadi decoction, Rasayana drug, and Snuhyadi Lepa were administered for 60 days.
| Method of Preparation and Administration of the Drugs|| |
Method for virechana karma
Purva Karma (Snehana and Svedana)
Internal Snehana was done by administration of pure Ghee given in a single dose in the morning on empty stomach with warm water for 7 days or appearing of Samyaka Snehana Lakshana (symptoms of proper internal oleation like oiliness of skin, passing stool containing fat, feeling of aversion of Ghee), whichever was earlier. The initial dose of Ghee was 30 ml, which was increased daily depending upon the tolerance of the patient, but generally by 30 ml. The patient were observed for Samyaka Snehana Lakshana and on getting these symptoms, administration of Ghee was stopped and the patients were subjected to Abhyanga with Bala Taila and Vashpa Sveda (fomentation done by using vapor) by using Dashamoola Kvatha, twice a day for the three gap days. During all these days, light and liquid warm diet was given. Thereafter, on the fourth day morning, Virechana was performed.
In the morning of Virechana day, the patients were asked not to eat anything and they were prepared by performing Abhyanga with Bala Taila and Vashpa Sveda with Dashamoola decoction. Thereafter, the patients were taken to Virechana room at about 9.30 a.m. and the pulse, blood pressure, and respiration were noted to assess general condition of the patient. Then, Virechana Yoga comprising of 70 ml of Hartikyadi decoction along with 30 ml of Eranda Taila and 250 mg of Icchabhedi Rasa was administered. Number of motions were counted till the symptoms of Samyaka Virechana (symptoms of proper purgation like stopping of purgation on its own, passing of stool with mucus in the last one or two motions, feeling of lightness in the body, and later improvement in sign and symptoms of the disease) appeared.
After getting the symptoms of Samyaka Virechana, the patients were kept on Samsarjana Krama depending upon the type of Shuddhi (purification) achieved by the patients.
This decoction was prepared by taking equal parts of coarse powder of Shirisha (Albizzia lebbeck (Linn.) Willd), Nimba (Melia azadirachta Linn.), Sariva (Hemidesmus indicus R. Br.), Kantakari (Solanum xanthocarpum), Khadira (Acacia catechu Willd.), and Saptaparna (Alstonia scholaris R. Br.). To this powder, 16 times water was added and reduced to one-fourth by heating on slow fire.
For the preparation of Snuhyadi Lepa, thick stems of Snuhi (Euphorbia neriifolia Linn.) were taken. After removing the thorns, its pulp was taken out with knife and the hollow space thus obtained was filled with coarse powder of seeds of yellow Sarshapa (Brassica campestris Linn. Var) and pulp of Snuhi. It was kept in oven at fixed temperature (80°C) for about 4 to 5 days, till it became sufficient dry to make powder. Thereafter, it was taken out from the oven and ground to make it in the form of powder and then filtered through 80 sized sieves. To this powder, mustard (Sarshapa) oil was added in the ratio of 1:4 and filled in cleaned bottles with tight lid. Before using, it was mixed well and applied on the lesions twice a day.
Equal part of powder of Guduchi (Tinospora cordifolia Willd) and Bhringaraja (Eclipta alba Hassk) was used as Rasayana for the patients of this group.
| Assessment of the Effects of the Therapy|| |
To assess the effect of the therapy, suitable scores to each of the signs and symptoms of the disease were assigned. The overall effect of the treatment was assessed as follow:
Complete remission: 100% relief in the signs and symptoms along with plain skin surface with significant change of the color of the affected skin nearly to normal.
Marked improvement: 100% relief in the signs and symptoms but slight presence of pigmentation and/or thickening of the skin.
Moderate improvement: More than 50% relief in the signs and symptoms with marked improvement in pigmentation and thickening of the skin.
Improvement: Less than 50% relief in the signs and symptoms with slight improvement in pigmentation and thickening of the skin.
Unchanged: No relief in the signs and symptoms.
After completion of full course of the treatment, the patients were asked to report at the fortnight interval for follow-up study for the period of two months. During the visit, the patients were enquired for the relapse of the disease. The patients in whom the drug provided partial relief was enquired whether there was exacerbation in their symptoms during the period.
| Results|| |
Effect of Shirishadi decoction, Snuhyadilepa, and Rasayana after performing of Virechana Karma
After performing Virechana Karma, 32 patients of Vicharchika (Eczema) were treated simultaneously with Shirishadi decoction, Guduchi-Bhringraja Rasayana, and SnuhyadiLepa for the period of two months. The effects of the therapy on the main symptoms such as itching, discharge, hyper-pigmentation, and thickening of skin were evaluated every week of the treatment, which are depicted in [Table 1], [Table 2], [Table 3], [Table 4], respectively, and [Figure 1]. As evident from these tables, at the end of the therapy, significant relief was found in the symptoms of itching (100%), discharge (100%), hyper pigmentation (95.2%), and thickening of the skin (95.2%).
|Table 1: Week-wise improvement recorded in itching for 32 patients of Vicharchika (Eczema) |
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|Table 2: Week-wise improvement recorded in discharge for 32 patients of Vicharchika (Eczema)|
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|Table 3: Week-wise improvement recorded in hyper pigmentation of 32 patients of Vicharchika (Eczema)|
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|Table 4: Week-wise improvement recorded in thickening of skin of 32 patients of Vicharchika (Eczema)|
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It also provided significant improvement in the symptoms of burning sensation (100%), irritation (100%), disturbed sleep (100%), dry skin (100%), anorexia (100%), eruption (97.9%), bleeding (94.6%), constipation (93.6%), general debility (88.7%), cracking (88.0%), giddiness (88.0%), indigestion (84.9%), and blackouts (78.6%), as shown in [Table 5] and [Figure 2].
|Table 5: Effect of the treatment of other signs and symptoms of 32 patients of Vicharchika (Eczema) |
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The therapy significantly improved the Dushti symptoms of Vata (85.7%), Pitta (100%), Kapha (100%), Tvak (92.9%), Rakta vaha (94.0%), Mamsavaha (97.4%), and Svedavaha (97.2%) Srotasa, as shown in [Table 6]. It also significantly reduced eosinophil count by 64.6% [Table 7].
|Table 6: Effect of the treatment on the Dosha and Srotas Dushti of 32 patients of Vicharchika (Eczema) |
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|Table 7: Effect of the treatment on the hematological values of 32 patients of Vicharchika (Eczema) |
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In this group, complete remission was reported by 81.3% patients, marked improvement by 15.6% patients, and moderate improvement by 3.1% [Table 8].
|Table 8: Overall effect of Virechana, Shirishadi decoction, SnuhyadiLepa, and Rasayana on 32 patients of Vicharchika (Eczema) |
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In this group, only 8.3% patients reported recurrence of the disease, that also with few symptoms [Table 9].
| Discussion|| |
In view of chronic and recurring nature of Vicharchika, as observed in previous work one internal drug (Shirishadi decoction) and one external drug (Snuhyadi Lepa) is administered to evaluate efficacy of the combination. The results of this group (S Group) provided cure to 18.2% patients, with recurrence in 80% patients. 
As the cure rate was meager and recurrence rate was high in the above group, earlier works simultaneously administered Rasayana with the above combination. For this purpose, Rasayana drugs-Guduchi and Bhringaraja (taken in equal quantity) along with Shirishadi decoction and Snuhyadi Lepa were administered after Koshtha Shuddhi done with Aragvadha Hima. It has been reported that the therapy of this group (SR Group) provided cure in 22.6% patients of Vicharchika and checked the recurrence in 89.5% patients. 
In the above study, the simultaneous administration of the Rasayana after Koshtha Shuddhi though checked the recurrence of the disease in the 89.5% patients, cure rate was not up to the mark. Therefore, it was thought that instead of simple Koshtha Shuddhi, if classical Virechana is performed prior to the administration of the above mentioned Rasayana and Shamana drugs, then perhaps the cure rate may also be enhanced as Shodhana has been highly praised in the treatment of Kushtha.
Therefore, the present clinical study was undertaken to evaluate effects of performing of classical Virechana prior to the administration of Rasayana with Shirishadi decoction orally and Snuhyadi Lepa externally.
Comparison of the effects showed that the Koshtha Shuddhi and Rasayana group provided 95.8% relief in the symptom of itching after 8 weeks of the treatment,  whereas in present study where the Rasayana and Shamana drugs were given after Virechana, (SRV Group) these provided 100% relief in the symptoms of itching and that too within six weeks of the treatment and this cure was persistent up to the end of the treatment [Table 1]. Thus, addition of Virechana Karma to the treatment provided comparatively better and early relief in itching [Figure 3].
Both the groups provided statistically highly significant relief in the symptoms of burning sensation, but again, the relief provided by Virechana and Rasayana group was faster, i.e., within 2 weeks.
Similarly, Virechana and Rasayana group provided faster relief in the symptoms of dryness (4 th week) and discharge (5 th week) in comparison with Koshtha Shuddhi and Rasayana group.
Virechana and Rasayana also provided comparatively better relief in hyper pigmentation because in this group, 95.2% relief was obtained, while the relief in Koshtha Shuddhi and Rasayana was 77.7% [Figure 3].
Skin thickening was also relieved better in Virechana and Rasayana group because in this group, 95.2% decrease was noticed, while it was 65.7% in Koshtha Shuddhi and Rasayana group [Figure 3].
Comparison of the overall effects of the therapies
The simultaneous administration of Rasayana and Shirishadi decoction internally and Snuhyadi Lepa externally after Virechana provided complete remission to 81.3% patients of Vicharchika, while complete remission found in the earlier study where the above combination was administered after Koshtha Shuddhi was 22.6%  [Figure 4].
|Figure 4: Comparison of overall effect of S Group, SR Group, and SRV Group|
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Comparison of the results of follow-up study
The results of the follow-up study showed that recurrences of Vicharchika (Eczema) in Shamana group was in 80% patients, whereas recurrence reported in Shamana and Rasayana administered after Koshtha Shuddhi was only in 10.5% patients.  However, in the present study where Shamana and Rasayana were administered after Virechana, only 8.3% patients reported recurrence of the disease with few symptoms.
It is obvious from the foregoing that the Rasayana and Shamana drugs administered to the patients of Vicharchika after performing Virechana provided far better relief to the patients in comparison with when the above drugs administered only after Koshtha Shuddhi performed with Aragvadha Hima.
| Conclusions|| |
On the basis of the results of this study, it may be concluded that addition of Virechana Karma prior to the administration of Guduchi-Bhringaraja Rasayana, Shirishadi decoction, and Snuhyadi Lepa significantly increased the cure rate to 81.3% and checked the recurrence of Vicharchika (Eczema) because in this group, no recurrence was reported by 91.7% patients.
| References|| |
|1.||Agnivesha, Charaka, Dridhabala, CharakaSamhita Part II, ChikitsaSthana, Kushtha Chikitsa Adhyaya, 7/30, Hindi commentary by Kashiram Shastri and Gorakhnath Chaturvedi, Reprint. Chaukhambha Bharati Academy, Varanasi; 2006; 253.. |
|2.||Available from: hhtp://www.pagead2.googlesyndication.com/pagead/ads?client=Ca-pub-3339185, H: \plants\Eczema-Article.htm, [Last accessed on 2009 Feb 21]. |
|3.||Agnivesha, Charaka, Dridhabala, Charaka Samhita Part II, Chikitsa Sthana, Kushtha Chikitsa Adhyaya, 7/41, Hindi commentary by Kashiram Shastri and Gorakhnath Chaturvedi, Reprint. Chaukhambha Bharati Academy, Varanasi; 2006; 255. |
|4.||Ibid. Siddhi Sthana 2/13, pg 981. |
|5.||Kaur M, Chandola HM. Effect of Shirishadi Decoction and SnuhyadiLepa on the patients of Vicharchika (Eczema). AYU 2009;30:16-21. |
|6.||Kaur M, Chandola HM. Role of Rasayana in cure and prevention of recurrence of Vicharchika (Eczema). AYU 2010;31:33-9. |
|7.||Kaur M, Chandola HM. Role of Shamana and Rasayana Therapies in the Management of Vicharchika (Eczema), Ph.D. Thesis, Jamnagar: I.P.G.T. R.A.;2001. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]