Case-presentation: AYURVEDIC MANAGEMENT OF CHARMADALA (ECZEMA) – A CASE STUDY

 AYURVEDIC MANAGEMENT OF CHARMADALA (ECZEMA) – A CASE STUDY

*Dr. Alpesh Munjani1, 
**Dr. Bhagyashree Valvi2, 
***Dr. Anamika Soni3
*/**2nd year PG Scholar, Department of Kayachikitsa, Government Akhandanand Ayurveda College and Hospital, Bhadra, Ahmedabad, India.
Email – alpeshmunjani2012@gmail.com
Contact no – +91-8238223403
***Associate Professor, Department of Kayachikitsa, Government Akhandanand Ayurveda College and Hospital, Bhadra, Ahmedabad.



INTRODUCTION

Charmadala is one type of Kshudra kushtha with pitta-kapha dominancy. It is characterized by raktavarna (reddish discoloration), kandu (itching), sphota (blisters), twakadalana (scaling), ruk (pain), sparsh-asahatva (hyperalgesia).

रक्तं सकण्डु सस्फोटं सरुग्दलति चापि यत् ।

तच्चर्मदलमाख्यातं संस्पर्शासहमुच्यते ॥२४॥

(Ch. Chi. 7/24)

(1) Ayurveda describes every skin diseases involves tridosha and so treatment of skin disease also should be done according to doshika dominancy.

(2) There are wide of range of causative factors for skin diseases are given in Ayurveda and to avoid them is the primary line of treatment for it. In contrast to conventional medicine where glucocorticoids and immune-suppressants are only choice, Ayurveda has wide variety of shodhana and shamana treatment choice as per dosha-dushya involvement. In this case study, patient was treated with treatment principles of charmadala and showed significant relief in signs and symptoms.

CASE REPORT

A 46 years of male hindu patient visited OPD of kayachikitsa at government akhandanand ayurveda hospital on 20/08/2022 with the complains of ubhaya hasta evum pada pradeshe kandu evum twakadalana (itching and scaling in both hands and legs) and kandu paschyat lalima, shothotpatti evum puyastrava (redness, swelling and purulent discharge after itching) since last 5 years.

He was relatively healthy before 20 years. Then he developed itching in his left hand fingers associated with small blister formation – which was neglected by him and got recovered by itself within a week. Then he noticed that it is occurring repeatedly in both hands. So he consulted family physician and got relief by some ointments. He used that ointment by himself on re-occurrence for next 15 years. But condition got worsen in year 2019 – when this itching and scaling spread to his both lower limbs and itching & blister and pus formation became severe & painful. He consulted dermatologist, where he was prescribed anti-histamines and corticosteroids. He was said that there is no other treatment for this condition and he has to these medications lifelong. So he continued with these medications but after sometimes this treatment also became of no effect and patient’s condition got worsen day by day. So, he came at Kayachikitsa OPD for Ayurveda treatment.

Personal history revealed that patient is vegetarian and used to take black gram, pickle, curd and excessive spicy diet frequently and he is irregular in taking his meals. He takes 6-8 hours of irregular sleep with day sleep and night awaking due to his shifting duty. He had regular urinal and bowel history.

He had no relevant family history or past history. No history of HTN or DM.

He was taking tab. omnacortil 10mg, tab. betnesol 0.5mg, tab. avil 25mg by himself on the occurrence since last 5 years.

Patients all vitals were normal. BP: 130/80mmHg, Pulse: 76bpm, Respiratory rate: 18/min, Body weight: 56kg

Systemic examination did not showed any abnormalities.

On local skin examination of patient’s limbs, it revealed that blisters and discharge present on B/L upper limbs (especially palmer region & fingers) and lower limbs.

Colour – Reddish to pinkish in lower limbs, Brown to yellowish in upper limb

Temperature – Raised

Pain – on touch and on movement

Pus discharge – present on B/L palmer and right planter surface   

Line of treatment for charmadala was planned as per mentioned in Ayurveda classics viz. tikta ghritapana, virechana, parisheka, raktamokshana.(3)

 

Table – 1: Treatment given
	Medicine	Dosage	Time of administration	Anupana
1)     2)           3)   4)       5)   6)	Sudarshana Ghanavati Sanshamani vati   Pathyadi Kwath Guduchyadi Kwath + Kalamegha churna Punarnava churna   Kaishora guggulu   Hastapada parishek / Nimajjan Panchavalkala kwatha+ Tankana – 5 g.   Jalaukavacharana   Virechanakarma – 1st time	2 tab. 4 tab.   40 ml     5 g. 5 g.   4 tab   As per requirment	1 x 3 times After meal   1 x 2 times Before meal         1 x 3 times   1 x 2 times       3 times/week	Ushnodaka     -           Ushnodak
	Virechanakarma –2nd time

   

Table-2: Observations
Symptoms	BT (20/8/22)	After 1stsnehapana (15/09/22)	After 1stvirechana (18/09/22)	After 2ndsnehapana (5/10/22)	After 2ndvirechana (8/10/22)	On discharge (12/10/22)
Kandu (Itching)	+++++	++++	+++	++	+	-
Sphot (Blisters)	++++	+++	+	-	-	-
Ruk (Pain)	+++	++	+	-	-	-
Twakdalana (Scaling)	+++	++	+	-	-	-
Srava (Discharge)	++++	++++	-	-	-	-
Lalima(Redness)	++++	+++	++	+	-	-

 

Before treatment

After 1^stVirechana karma

           

DISCUSSION

Any manifestation on the skin can affect life quality of the patient in terms of deterioration of physical as well as mental health. Eczema usually has remission and exacerbation but identifying and avoiding etiological factors along with maintaining good health is helpful in avoiding it – which can be achieved by Ayurveda management. 

In this case, Excessive intake of vidahi ahara like achara-papad and spicy diet, guru and abhishyandi aahara like dadhi, dugdha, masha, along with nidra-viparyaya (divasvapana, ratrijagarana) – are found as causative factors – which caused pitta-kapha pradhana tridosha prakopa evum rasa, rakta, lasika dushti and sthanasanshraya in twak.

 

Samprapti ghataka

   

Dosha-                         Pitta- Kapha pradhana tridosha    

Dushya-                         Twak, Rakta, Mamsa, Lasika    

Srotas-                         Rasavaha, Raktavaha, Mamsavaha    

Sroto-dushti prakara- Atipravritti    

Agni-                         Dhatvagnimandhya    

Aama-                         Sama    

Rogamarga-                 Bahya    

Vyadhiswabhava-         Chirakari  

The given treatment makes samprapti-vighatana as per Ayurveda classics by its tiktarasa, agni-deepana, rasayana, rakta-prasadana and shodhana properties. It acts on impaired rasa, rakta and mamsa dhatu.

Sudarshana ghanavati and Sanshamani vati both have tikta rasa, pitta-kapha nashaka and aama-pachana properties. It also soaks kleda and strava of charmadala due to its ruksha guna. Pathyadi kwath, Guduchyadi kwath, Kalamegha, Punarnava have tikta rasa, ruksha anulomaka property and also causes agni-deepana and aamapachana. Kaishora guggulu was given as a rasayana, rakta prasadaka, vyadhi pratyanika chikitsa. As a part of external measures Panchavalkala kwath was given for washing affected part as it have astringent, antiseptic, antimicrobial and wound healing property. As a part of shodhana karma, virechana was given after panchatikta ghritapana for six days, which causes purification of the body by eliminating excess of pitta from the body. Second time virechana was given as part apunarudbhava chikitsa. Jalauka-avacharana was done on alternate day to draw out impure blood and to eliminate swelling at affected part.

CONCLUSSION

From above discussion it can be concluded that Ayurvedic treatment by identifying and avoiding etiological factors with proper shodhana and shamana can give complete relief in signs and symptoms of charmadala. Since this is a single case study, further more trials needed to be conducted on larger sample size to establish this as fact. 

****************************************************************************************************************************************************************************************************************************************** Above article was published in 'World Journal of Pharmaceutical Research'. www.wjpr.net

ArticleLink: https://www.wjpr.net/abstract_show/24234 ********************************************************************************************************************************************************

Presented by

Dr. Alpesh Munjani

Dr. Bhagyashree Valvi 

2nd year PG Scholar, 

P. G. Department of Kayachikitsa, 

Government Akhandanand Ayurveda College and Hospital, 

Bhadra, Ahmedabad- 380001, Gujarat, India.

Email – alpeshmunjani2012@gmail.com

Contact no – +91-8238223403

Guided by

Dr. Anamika Soni

Associate Professor

P. G. Department of Kayachikitsa

Government Akhandanand Ayurveda College and Hospital, 

Bhadra, Ahmedabad380001, Gujarat, India.

Uploaded by

Vd. Rituraj Verma

B. A. M. S.

Shri Dadaji Ayurveda & Panchakarma Center,

Khandawa, M.P., India.

Mobile No.:-

 +91 9669793990,

+91 9617617746

Edited by

Dr.Surendra A. Soni

M.D., PhD (KC) 

Professor & Head

P. G. DEPT. OF KAYACHIKITSA

Govt. Akhandanand Ayurveda College

Ahmedabad, GUJARAT, India.

Email: surendraasoni@gmail.com