|Year : 2020 | Volume
| Issue : 4 | Page : 153-157
Efficiency of Ayurveda modalities in the management of Switra (Vitiligo): A case report
Jitendra Varsakiya1, Divyarani Kathad2, Ritu Kumari1
1 Department of Kayachikitsa, Ch. Brahm Prakash Ayurveda Charak Sansthan, New Delhi, India
2 Department of Shalakya Tantra, Akhandanand Ayurved College, Ahmedabad, Gujarat, India
|Date of Submission||16-Jul-2020|
|Date of Acceptance||06-Feb-2021|
|Date of Web Publication||18-Mar-2021|
Dr. Jitendra Varsakiya
Department of Kayachikitsa, Ch. Brahm Prakash Ayurveda Charak Sansthan, Khera Dabar Najafgarh, New Delhi - 110 073
Source of Support: None, Conflict of Interest: None
Beauty and attraction of an individual depend on skin condition. However, there are certain pathologies which wipe out this beauty and attraction by altering skin health. Vitiligo is a condition, which means “to have white skin.” In Ayurveda, it is referred as Switra or Kilasa and cited under the category of Kushta rogas (~skin diseases). It is caused by the imbalance of all the three Doshas (~three regulatory functional factors of the body) vitiating Rakta (~blood tissue), Mamsa (~muscle tissue), and Medas (~fat tissue). A 32-year-old male came to the outpatient department with complaints of chalky white patches with hypo-pigmented border without itching over the chest and face for two years, gradually spreading over the chest. The patient was treated with Ayurvedic oral medications and Virechana karma (~therapeutic purgation) along with the instructions of Pathya (~wholesome diet and lifestyle) and Apathya (~unwholesome diet and lifestyle). After treatment, there was repigmentation of skin without any side effects. The treatment modalities showed color changes of patches from chalky white to pinkish inferring that Ayurveda has treatment approaches to manage condition like Switra (~vitiligo).
Keywords: Bakuchi churna, Switra, Virechana, Vitiligo
|How to cite this article:|
Varsakiya J, Kathad D, Kumari R. Efficiency of Ayurveda modalities in the management of Switra (Vitiligo): A case report. J Ayurveda Case Rep 2020;3:153-7
|How to cite this URL:|
Varsakiya J, Kathad D, Kumari R. Efficiency of Ayurveda modalities in the management of Switra (Vitiligo): A case report. J Ayurveda Case Rep [serial online] 2020 [cited 2021 Apr 15];3:153-7. Available from: http://www.ayucare.org/text.asp?2020/3/4/153/311503
| Introduction|| |
Vitiligo is a common, acquired, discoloration of the skin, characterized by well-circumscribed, ivory or chalky white macules. Vitiligo occurs worldwide with an overall prevalence of 0.5%–2%. However, its incidence ranges from 0.093% to 8.8% across the different countries of the globe.,, The highest incidence of the condition has been recorded in the Indian subcontinent. Adults and children of both sex are equally affected, although the greater number of reports among females is probably due to the greater social consequences to women and girls affected by this condition. The proportion of patients with a positive family history varies from one part of the world to another. In India, it ranges from 6.25% to 18%. Topical or systemic corticosteroids, tacrolimus (immunosuppressive drugs), and pimecrolimus (immunomodulating agent of calcineurin inhibitor class) are used extensively in the management of vitiligo in the contemporary medicine that reported to be useful in rapidly progressive vitiligo. They have fair control over the disease, but after long-term use, manifest complications, and they are not cost-effective too., Ayurveda treatment strategies can be useful in such conditions.
In the Ayurvedic literature, Switra is considered as Tridoshaja (~three regulatory functional factors of body). It is said to be Aparishravi (~not having discharge) which has similar etiological factors as Kushta (~skin diseases). Here, a case of Switra managed with Shodhana karma (~bio-purification therapy) and combination of drugs is presented.
| Case Report|| |
In January 2018, a Hindu, married, 32-year-old male patient, cobbler by profession, visited the outpatient department complaints of chalky white patches with hypo-pigmented border without itching over the chest and face for two years, gradually spreading over the chest. White pigmentation of the skin, the lesions started from lips, gradually spreading to chest region. He was suffering with this problem for two years. For this issue, he has consulted many allopathic physicians in his locality, but no improvement was noticed. No documents were produced by the patient against the previous treatment. The patient was nonvegetarian, addicted to tobacco, and alcohol. There was no family history of vitiligo. No other medical history was revealed.
Diagnosis was made on the basis of characteristic features of vitiligo. Trichrome, having three shades, i.e., central part is depigmented, surrounded by a hypo-pigmented rim and normally pigmented skin around it. This condition is comparable to Switra. When the morbid Doshas (~regulatory functional factors of body) are more potent, the patient should be treated with Shodhana (~cleansing therapy). The patient was diagnosed with Medoshrita switra due to its appearance of chalky white patches.
| Timeline|| |
Before Shamana chikitsa (~palliative procedures), Shodhana chiktsa was done to clear the Srotas for the better efficacy of medications. For Shodhana chikitsa, Virechana karma (~therapeutic purgation) was done in March 2018. The patient was given 2 g each powders of Haritaki (Terminalia chebula Retz.) and Shunthi (Zingiber officinale Roscoe.) twice a day for Deepana (~enhancing metabolic fire) and Pachana (~enhancing digestion). Panchatikta ghrita for Abhayantara snehana (~therapeutic internal oleation) for five days in increasing dose (of 30, 60, 90, 120, and 150 ml) was given on the empty stomach with lukewarm water. After five days of Abhyantara snehana, Samyak sidhhi lakshana (~symptoms of proper internal oleation) including softness and unctuousness of skin, passing stool softly. For the next three days, Sarvanga abhyanga (~therapeutic message) was done with Jatyadi taila followed by Sarvanga bashpa swedana (~sudation therapy) with Dashmoola kwatha. Virechana was done with Trivritta avaleha (60 ml with lukewarm water between 10 and 11 AM). 24 Vegas were noticed inferring Pravara shudhhi. For this, seven days plan of Sansarjana karma included with Peya (~watery gruel prepared from Barley) for first three diets, followed by Vilepi (~thick gruel of rice), Yusha (~soup prepared from green gram), and Mamsarasa (~Mutton soup) for succeeding three diets each, in that order. During the course of treatment, the patient was advised to take only Pathya aahara (~wholesome food), Vihara, and avoid Apathya (~unwholesome food).
After the completion of Samsarjana krama, oral medications, i.e., Samshamani vati, Aarogyavardhini vati, and local application of Bakuchi churna (powder of Psoralia corylifolia Linn.) with Gomutra were advised.
Light food which digests on proper time was advised. The patient was advised to take home cooked fresh vegetables. Seasonal fruits, green vegetables such as Vastuk (Chenopodium album Linn.), Methika (Trigonella foenum-graecum Linn.), Patola (Trichosanthes dioica Roxb.) Shunthi (Zingiber officinale Roscoe.), and Amalaki (Phyllanthus emblica Linn.) were prescribed. 15-20 min of Pranayama including Ujjai, Nadi shodhana, and Kapala bhati were also advised to be done under the supervision of Yoga instructor.
Curd, fish, canned food, junk foods, milk and milk products, heavy diet, consumption of food at inappropriate time, and late sleep were prohibited.
| Follow Up and Outcome|| |
Gradually, the patient started feeling relief and re-pigmentation was noticed after four weeks. Size of the patches shrunken as repigmentation was started. After the time period of nine months, normal skin color was achieved [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6].
| Discussion|| |
Bakuchi beeja churna (seed powder of Psoralia corylifolia Linn.) is useful in skin diseases. The bioactive compound “Psoralen” of this powder has an ability to stimulate the development of melanin and used to treat luecoderma. Its use in the management of Vitiligo is recommended in the Ayurveda texts. The drug appears to have a purely local action with a specific effect on the arterioles of the sub capillary plexuses, which are dilated so that the plasma is increased in this area. The skin becomes red and the melanoblasts (pigment-forming cells) are stimulated. The photo conjunction involves thymine dimer adducts on the opposite strands of DNA. Psoralen has been found to intercalate into DNA, where they form mono-and di-adducts in the presence of long wavelength ultraviolet light and thus are used in the treatment of hypo-pigmented lesions of the skin, such as Leukoderma. Psoralen, when administered orally at a dose of 4 mg/g and exposed in sun, pigment deposition was noticed. The furanocoumarins, which contain psoralens, promote pigmentation. The powder is used internally for leprosy and leukoderma and externally in the form of paste and ointment.
Samshamani vati contain Guduchi (Tinospora coraliifolia [Wild.] Miers.) described as one of the best Rasayana (~rejuvenation) drug, and among its many uses, it is effective in skin diseases also. It also has Tridosha shamaka (~pacification of vitiated three Doṣhas) and Dahanashana (~pacify burning sensation) properties. Guduchi possesses Tikta, Kashaya rasa (~bitter and astringent taste) and Guru (~heaviness) Snigdha (~sliminess/unctuousness) Guna (~properties) and Madhura vipaka (~sweet bio-transformed Rasa). Recent experiments demonstrated wide spectrum activities of Guduchi, including antioxidation, anti-inflammation, anti-microbial, and immune stimulation effect, etc. The antioxidant effect is mediated through different mechanisms, including DPPH radical scavenging assay, superoxide anion scavenging assay, hydroxyl radical scavenging assay, and ABTS radical scavenging method.
Arogyavardhini vati is said to be useful Kushta nasaka (~alleviating skin disorders especially in Mandala kushta). Aarogyavardhini vati does the Shoshana (~assimilation) of exacerbated Snigdha dravyas (~unctuous substances) present in the body. It also does the Pachana (~digestion) of Drava (~liquid) and Kleda (~clammy) and does the Raktavardhana (~improve blood quality). It reduces Dravatva, Snigdatva in Meda dhatu. It has shown significant free radical scavenging activity as compared to Vitamin C. Cow urine is an effective co-remedy for oxidative stress. The antioxidant action is attributed to the free radical scavenging activity of its components, and these components may prevent the aging process.
Importance of Shodhana
In classics Kushta enlisted under Raktaja vyadhi, Pitta is Mala of Rakta and both Pitta and Rakta are interdependent as well as involved in Switra. Virechana is a line of treatment for Pittaja and Raktaja vyadhi and involvement of Rakta and Pitta are very clear in Switra. It has been reported that Virechana along with Shamana chikitsa and Rasayana therapy (~rejuvenation and revitalization therapy) enhances the results in many folds in skin diseases. Haritaki and Shunthi churna used as Deepana pachana dravya to enhance Agni (~digestive/metabolic factors) and help in Ama pachana. Shunthi churna is also used as Vata kapha hara dravya. Panchatikta ghrita helps in cleansing the cells as Ghrita enhances the trans cell membrane transportation because the physiological constituent of cell membrane and Ghrita is same, i.e., lipids. After external Snehana and Swedana toxins mobilizes from different channels to gut which will be cleansed by purgation.
Importance of Sansarjana karma
Main aim of Sansarjana karma is mean to gradual increment of strength of Agni. Manda, Peya, Vilepi, Yusha, and Mamsa rasa are prescribed in an order. This order is not only the basis of Laghu (~light) to Guru (~heavy) order but these neutraceuticals are also in order to enhance Agni by their properties. Once the state of Agni gets normalizes, normal food can be advised. Food items, which has pleasant effects on the body and mind without causing any untoward effects is called as Pathya. In this case, Pathya Aahara– Vihara (~diet and life style) is advised during the treatment. Diet which has predominant Madhura, Tikta, Kashya rasa and Laghu, Sheeta guna was advised.
| Conclusion|| |
On the basis of the results observed in this case, using Samshamani vati and Arogyavardhini vati internally and Bakuchi churna with Gomutra externally after Virechana karma can be a good choice in the management of Switra. No side effects were noticed during the treatment period. As the results are encouraging, attempts can be made to see results in similar cases.
This is a case report which is reporting the effect of prescribed set of drugs on single subject. As the course and prognosis of vitiligo varies greatly, so the author recommends to test this set of medication for a trail which consists more subjects. Furthermore, in case report, there is no comparative group, so, we were not sure about the result of this set of medicine against the established drugs of vitiligo.
Declaration of patient consent
Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Krüger C, Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. Int J Dermatol 2012;51:1206-12.
Sehgal VN, Srivastava G. Vitiligo: Compendium of clinico-epidemiological features. Indian J Dermatol Venereol Leprol 2007;73:149-56.
] [Full text]
Lu T, Gao T, Wang A, Jin Y, Li Q, Li C. Vitiligo prevalence study in Shaanxi Province, China. Int J Dermatol 2007;46:47-51.
Behl PN, Aggarwal A, Srivastava G. Vitiligo. In: Behl PN, Srivastava G, editors. Practice of Dermatology. 9th
ed. New Delhi: CBS Publishers; 2003. p. 238-41.
Shah H, Mehta A, Astik B. Clinical and sociodemographic study of vitiligo. Indian J Dermatol Venereol Leprol 2008;74:701.
] [Full text]
Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, et al
. Vitiligo: Concise evidence based guidelines on diagnosis and management. Postgrad Med J 2010;86:466-71.
Leone G, Tanew A. UVB total body and targeted phototherapies. In: Picardo M, Taieb A, editors. Vitiligo. 11th
ed. Berlin-Heidelberg: Springer; 2010. p. 353-61.
Vaidhya YU, editor. Commentary Vihyotini of Atridev Gupta Astanga hridayam of Vagbhata, Nidana Sthana. Ch. 14., Ver. 37. Varanasi: Chaukhambha Prakashan; 2014. p. 369.
Khanna N. Disorders of pigmentation. In: Illustrated synopsis of dermatology and sexually transmitted diseases. 4th
ed. India: Elsevier; 2011. p. 150.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Sutra Sthana. Ch. 7., Ver. 41. Varanasi: Chaukhambha Prakashan; 2011. p. 207.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Sutra Sthana. Ch. 13., Ver. 58. Varanasi: Chaukhambha Prakashan; 2011. p. 85.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Siddhi Sthana. Ch. 01., Ver. 11. Varanasi: Chaukhambha Prakashan; 2011. p. 678.
Chopra B, Dhingra AK, Dhar KL. Psoralea corylifolia
L. (Buguchi) Folklore to modern evidence: Review. Fitoterapia 2013;90:44-56.
Vaidya PN, editor. Dravyaguna Prakashini Hind commentary on Rajnighantu, Shatahvyadi Gana. 1st
ed., Ver. 67. Varanasi, India: Choukhambha Krishnadas Academy; 1998. p. 7.
William B. New Manual of Homeopathic Materia Medica and Repertory. 9th
ed. New Delhi: B. Jain Publishers Pvt. Ltd; 2002. p. 1129.
Vaidya AD. Reverse pharmacological correlates of ayurvedic drug actions. Indian J Pharmacol 2006;38:311-5. [Full text]
Sebastian P. Ayurvedic Medicine: The Principles of Traditional Practice. Vol. 2. New York: Elsevier Health Sciences; 2006. p. 135-6.
Panda H. Herbs, Cultivation and Medicinal Uses. New Delhi: National Institute of Industrial Research; 2000. p. 479-81.
Chunekar KC, Pandey GS. Guduchyadi Varga. Bhavprakash Nidhantu. Varanasi: Chaukhambha Bharati Academy; 2006. p. 269.
Sharma PV. Dravya Guna Vigyana. Ch. 9.,342., Vol. II. Varanasi: Chaukhambha Bharti Academy; 2013. p. 761-763
Ilaiyaraja N, Khanum F. Antioxidant potential of Tinospora cordifolia
extracts and their protective effect on oxidation of biomolecules. Pharmacogn J 2011;3:56-62.
Tiwari M, Dwivedi UN, Kakkar P. Tinospora cordifolia
extract modulates COX-2, iNOS, ICAM-1, pro-inflammatory cytokines and redox status in murine model of asthma. J Ethnopharmacol 2014;153:326-37.
Bonvicini F, Mandrone M, Antognoni F, Poli F, Gentilomi GA. Ethanolic extracts of Tinospora cordifolia
and Alstonia scholaris
show antimicrobial activity towards clinical isolates of methicillin-resistant and carbapenemase-producing bacteria. Nat Prod Res 2014;28:1438-45.
Sengupta M, Sharma GD, Chakraborty B. Effect of aqueous extract of Tinospora cordifolia
on functions of peritoneal macrophages isolated from CCl4 intoxicated male albino mice. BMC Complement Altern Med 2011;11:102.
Krishnaiah D, Sarbatly R, Nithyanandam R. A review of the antioxidant potential of medicinal plant species. Food Bioprod Process 2011;89:217-33.
Tripathi I. editor. Hindi Commentary Rasaprabha of Vagbhattacharya. Rasa Ratna Samuchhya, Visarpakushthaswitradi Chikitsach. Ver. 87-93. Varanasi: Chaukhambha Sanskrit Sansthan; 2020. p. 252.
Sarasheti RS, Simpi CC, Sandeep NM. Screening of free radical scavenging activity of Arogyavardhini Vati. Int J Res Ayurveda Pharm 2013;4:555-9.
Jarald E, Edwin S, Tiwari V, Garg R, Toppo E. Antioxidant and antimicrobial activities of cow urine. Glob J Pharmacol 2008;2:20-2.
Kaur M, Chandola H. Role of Virechana Karma in cure and prevention of recurrence of Vicharchika (Eczema). AYU 2012;33:505-10.
] [Full text]
Ministry of AYUSH. GOI. The Ayurvedic pharmacopoeia of India. In: The Ayurvedic Pharmacopoeia of India. 1st
ed. Pharmacopoeia Commission of Indian medicine Delhi: The Controller of Publications; 2001. p. 104.
Mangal G, Mangal G, Sharma RS. Clinical efficacy of shodhana karma and shamana karma in Mandala Kushta (Psoriasis). AYU 2012;33:505-10.
Singh RH. Kayachikitsa. Vol. II., Ch. 11. Varanasi: Chaukhambha Sanskrit Pratisthan; 2016. p. 334.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]