Efficacy of Edagajadi Lepa in Vicharchika (Eczema): A Diagnostic Analytical Review
In the present era skin ailments are becoming major hazard for mental diseases more than physical harm as skin distributes the cosmetic harmony. Dermatological problems contribute to about 30% of all the out-patient visits. Low socioeconomic conditions, poor standards of hygiene, malnutrition, overcrowding and abuse of over the counter cosmetics contribute to the occurrence of skin ailments. In Ayurvedic Dermatology Kushtha has been taken as the supreme word for all the skin diseases in Ayurveda. It covers up all the skin manifestation under 18 types of Kushtha which is further classified as “Maha Kushtha” and “Kshudra Kushtha”. Vicharchika is one of the serious problems of mankind even in the highly advanced era of sophisticated treatment, which has been classified under Kshudra Kushtha. It is characterized by skin eruptions with dark colouration, itching and profuse discharge. The clinical condition of Vicharchika can be corelated to Eczema. Ayurveda describes a multitude of treatment modalities for skin diseases. One of them is the topical use of medicaments over the skin for topical absorption which allows faster absorption and better management of skin diseases.
Introduction
In Ayurveda all skin ailments are described under broad heading Kushtha. Kushtha is one of the Ashtamahagada [1] which affects Twak, Rakta, Mamsa, Lasika and Tridosha which makes them difficult to treat. Different Acharyas classified Kushtha broadly into Maha Kushtha and Kshudra Kushtha. Vicharchika is one among the Kshudra Kushtha indicating the low intensity of vitiation of the doshas while its inclusion in Sadhya Kushtha highlights the prognosis [2]. In the contemporary view of Vicharchika it can be correlated to Eczema. The prevalence of Eczema is estimated to be 15-20% in children, 1-3%in adults and the incidence has increased by 2-3-fold during the past decades in the industrialized countries. In India the point prevalence of Eczema is 6.75%. Effective therapeutic agents in contemporary medicine are limited in number. It consists of antihistamine pills, oral and topical corticosteroids, topical immunomodulators and phototherapy by UV and UVB rays. These drugs can give only symptomatic relief and cannot completely cure the diseases and have long- term toxic side effects. So now a day whole world is turning towards Ayurveda for safe and complete cure of diseases. Ayurveda offers a rich treasure of therapies both for internal and external use in skin ailments. In Ayurveda treatment of diseases is of 3 types:
- Antahparimarjan
- Bahirparimarjana
- Shastrapranidhana Out of these Lepa Kalpana is included in Bahirparimarjana Chikitsa.
For topical application in Vicharchika the Lepa is very common and found to be highly efficacious in skin disorders as it is easy to use and imparts long lasting effect. It controls Doshas at localized level and offers instant relief as skin provides large surface area so that the maximum amount of drug reaches to the site of action. A simple formula of Edagajadi Lepa comprising of Eight easily available drug is mentioned in Chakradatta is effective in Vicharchika and Dadru which is very common in prevalent population [3].
Disease Review
According to Acharya Charaka Vicharchika is characterised by skin manifestation having the Lakshanas Kandu, Pidika, Shyava Varna and Bahu Srava with predominance Kaph Dosha [2] According to Acharya Sushruta skin is dry with severe itching and marked linings are present in Vicharchika with the predominance of Pitta Dosha [4]. Acharya Madhava, Vagbhata and Bhavmishra have described almost same definitions as Acharya Charaka.
According to the World Allergy Organization Eczema is an inflammatory, chronically relapsing, non-contagious and extremely pruritic skin disease. The common symptoms involved in eczema are erythema, induration, papulation, oedema, excoriations and lichenification. Specific Samprapti of Vicharchika are not mentioned in Samhitas, hence Samprapti of Kushtha can be accepted as Samprapti of Vicharchika. All types of Kushtha develops due to the vitiation of Tridoshas, after Nidan Sevan it leads to Doshyadushti, so Tvaka, Rakta, Mamsa, Ambu becomes weak then this complex of seven Dushya i.e., Tridosha, Tvaka, Rakta, Mamsa, Lasika (Saptko Dravya Sangraha) leads to manifestation of Kushtha [5].
Bahirparimarjana Chikitsa: Lepa Kalpana
The procedure or medications which make use of the contact with the skin as in form of Abhyanga, Sveda, Lepa, Pradeha, Parisheka, Unmardana etc and bring about the alleviation of the ailment at the level of the skin are combinedly called as Bahirparimarjana Chikitsa. The formulations that are prepared by grinding of Adra Dravyas (wet ingredients) or by Shuska Dravyas with addition of liquid media for topical use are known as Lepa. Alepa, Lipta, Lepana are the synonyms of Lepa. Wherever the treatment of Kushtha has been described in texts of Ayurveda, description of Lepa Kalpana has also been done without any exception.
Acharya Charak has mentioned about Lepa Kalpana in a Sutra Sthana “Aragvadhiya Adhyaya”. Whereas Lepa Kalpana is described in Sushruta Samhita, Ashtanga Hridya and Shrangdhar Samhita also.
Bhrajaka Pitta, Saman, Vyana Vayu and Sleshaka Kapha plays important role in absorption and metabolism of Lepa. Bhrajaka Pitta metabolizes the active principles of drugs that have been applied over the skin with the support of saman and Vyan Vayu.
According to the Acharya Sushruta there are three types of Lepa Kalpana [6]
- Pralepa
- Pradeha
- Alepa Alepa is suitable for Vicharchika as per the symptoms of diseases. Alepa poses the property of pacifying and restoring Rakta and Pitta to their normal condition.
According to Sharangdhara, there are three types of Lepa classified according to their Karma [7]
- Doshaghna (anti Doshika)
- Vishghna (anti-poisonous)
- Varnya (for healthy and glowing skin)
- Doshaghna Lepa can be used for Vicharchika.
Lepa Pramana
Acharya Sushruta mentioned Pramana of Lepa should be as “Mahishadracharmotsedha” (newly flared skin of buffalo). The thickness of buffalo’s skin may be considered as 2.8 to 3.2 mm. Sharangdhara specifies the thickness of Doshaghna as ¾ Angula i.e., 0.48cm approx.
Duration
A Lepa act to treat the disease as long as it contains humidity whereas harms the skin when it gets dry.
Procedure
Edagaja (Chakramarda) Beeja, Tila, Sarshapa, Magdhika (Pippali), Saindhava Lavana, Bida Lavana, Sauvarchala Lavana are taken in equal quantities and made into fine powder and kept in Dadhimastu for three days and the same applied cures Vicharchika, Dadru, Kushtha [8].
The quantity of Lepa is based on the size of the lesion. The Edagajadi Lepa is applied to lesion in the following manner: 1. Cleaning the lesion with sterile swabs dipped in clean warm and the area was allowed to dry up. 2. Apply Edagajadi Lepa over the skin lesion with the help of spatula in the direction of hair root and not to extend it over the normal skin. The thickness of Lepa was that of Adra Mahish Charma.
3. Allow the Lepa to dry up after which the area was moistened with and cleaned it with warm water and mopped up with dry sterile gauze. 4. Then dressed the area with plain gauze to avoid exposure to dust etc.
Probable Mode of Action of Edagajadi Lepa
Most of the drug in Edadgajadi Lepa is Katu, Tikta Ras Pradhana, Katu Vipaka and Ushna Virya which helps in pacification of Kapha.It synergistically to bring about Srotoshodhan and establish a Niramavastha.This in turn aids in absorption of the active constituents of the Lepa by the orifices of the Siras (Siramukhas).
- Edagaja/ Chakramarda: It is said to act best in sour media. So, the Lepa prepared by soaking the constituent drugs in Dadhi Mastu. Chrysophanic acid present in Edagaja is indispensable in treatment of skin disorders.
- Sarshapa: The sulphur content present in Sarshapa act as Kushthaghna.
- Kustha: By its Kapha Vatashamak action it brings about Kushthaghna, Kandughna and Varnya action.
- Magadhika/Pippali: Due to Yogavahi Guna it promotes the action of the other drugs.
- Saindhava, Bida and Sauvarchala Lavana bring about drying of the lesion thereby reducing the Srava. It cleanses the skin and opens up clogged pores and removes dead cells from the skin.
Apart from the Trilavanas, all the drugs have Ushna Virya which may bring about a local increase in the tissue metabolism, thereby increasing the blood flow and defense factors. These may bring about a reduction in the clinical features. The Kshara Guna present in Tila, Pippali and the Trilavanas may bring about an exfoliative action on the dead tissue on the epidermis of the skin. The powdered are soaked in Dadhimastu/whey which is rich protiens and immune boosting factors, thus providing to be a local booster of immunity. Thus, the action of the constituent drugs of Edagajadi Lepa may get fortified by being soaked in Dadhi Mastu. Each of the drugs complementing one another by their pharmacological action may bring about a synergetic action in relieving the clinical features of Vicharchika.
Route of Administration of Drug
Absorption is defined as the passage of a drug from its site of administration into the plasma. It must therefore be considered for all routes of administration except for intravenous route.
Cutaneous Administration
In clinical practice, cutaneous administration is used mainly when local effect on the skin is required (example – topically applied steroids) appreciable absorption may nonetheless occur and lead to systemic effects [9]. High concentrations are attained at the desired site without exposing the rest of the body. Drug is applied as ointment, cream, lotion, paste, powder, dressing etc highly lipid soluble drugs can be applied over the skin for slow and prolonged absorption [10].
Discussion
Even after the greater advancement in Dermatology, the disease continues to be a challenge in Ayurveda general line of treatment of Kushtha includes Shodhana and Shaman therapy. But to give earlier relief for the localized symptoms / discomfort, Sthanika Chikitsa such as Lepa is very beneficial.
All types of Kushtha are Tridoshaja in origin. Vicharchika has Kapha predominance attributed by Acharya Charaka with the symptoms of Kandu, Pidika,Shyava Varna and Bahusrava. This indicates initial or acute stage of Eczema. Acharya Sushruta stated Vicharchika as dominance of Pitta Dosha with the symptoms like Raji, Atikandu, Arati, Rukshata that indicates chronic or later stage. This explanation suggests different stage of Vicharchika. Acharya Vagbhata mention specific type of discharge like Lasikadhya .Indu explained it with Jalapraya i.e. watery discharge [11]. Acharya Kashyapa has mentioned Vrana, Vedana and Paka as a specific feature of Vicharchika [12]. Acharya Bhela has mentioned Shyavava Rakta Varna as variety, Praklinna Srava and through Mamsenopachitata as characterstic feature of Vicharchika [13]. Twaka, Rakta, Mamsa , Lasika are Dushya of Vicharchika.Rasavaha , Raktvaha, Mamsavaha and Swedvaha Srotasa vitiated and Kha Vaigunya occurs in them [14].
When Lepa is applied over the surface of skin opposite to the direction of hairs on it, through a proper base, the active principles of the ingredients of Lepa are released into that base. After that this combination enters the Romkupa and further gets absorbed through the Swedvahi Srotas and Siramukha it does the cutaneous biotransformation and which will pacify the Doshas and leads to breaking of Samprapti [15, 16].
Conclusion
Skin being the outermost covering of the body serves as an important component in terms of protective as well as cosmetic purpose. Lepa Kalpana is an excellent scientific method of introducing the active principles of drugs to the target cells for a quick and effective healing process. These drugs are herbal drugs which is very simple, safe, economic, no side effect and good efficacy drugs in medium dose. Hence
it can be employed in the case of Vicharchika. Ayurveda can definitely prove to be a boon in the proper and effective management of this kind of skin ailments in today’s time.
References
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Agnivesha Charaka Samhita (2009) Yasyashyavanimittiya Indriyam, Reprint Ed. Chaukhamba Surbharati Prakashan, Varanasi. Indriya Sthana. 9(8): pp-368.
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