A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in the...

[Full title: A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in the management of Vicharchika (eczema)]

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[Find the meaning and references behind the names: Shri, Guna, Deepa, Low, Long, Deep, Asta, Good]

ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 64 A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in the management of Vicharchika (eczema) Dr. Shivappa A. Gangal 1 , Dr. Deepa S. Gangal 2 1 Reader, Department of Shalya Tantra, Shri Veerpulikeshi Rural Ayurvedic Medical College Hospital & Research Center, Badami, 2 Lecturer, Department of Kayachikitsa, Shri Kalidas Ayurvedic Medical College and Hospital & Research Center, Badami, Karnataka, INDIA. I NTRODUCTION Skin is the most exposed part of body which remains continuously in direct touch into the outer atmosphere and foreign bodies, physical, chemical and biological environment agents also play role in producing the skin disease. Skin is the largest organ which protects and covers an area of approximately 2 m 2 of whole body [1] It is one of the Panchendriya which is called as Sparsnendriya [2] Healthy skin is the mirror image of good health. The color of the skin is important biologically, cosmetically and socially. Skin problems occur from all the ages’ neonate to the elderly and causes harm, they are disability, discomfort and Address for correspondence: Dr. Shivappa A. Gangal Reader, Department of Shalya Tantra, Shri Veerpulikeshi Rural Ayurvedic Medical College Hospital & Research Center, Badami, Karnataka, INDIA. E-mail: dr.deepa.v.hallikeri 11@gmail.com Submission Date: 15/11/2020 Accepted Date: 13/12/2020 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.5.6.8 disfigurements. Ayurveda is an ancient science which helps to maintain the health of the healthy person and also helps to cure the disease [3] Our Acharyas has consider the skin disease under the heading of Kustha . This is one of the Asta - mahagadha also [4,5] In our science skin disease have explained as Mahakustha and Kshudra Kustha. Skin disorders are having prevalence rate of about 15% of wor ld’s population. Because of vitiation of Tridosha it produces many groups of symptoms. Some of them has mentioned as kind of Kustha can be classified, According to the dominance of the Dosha as Mahakustha and Kshudrakustha. Vicharchika is one type of Kshudra Kustha having the dominance of Kapha , Pitta and Kapha Dosha . Vicharchika can be correlated with Eczema in modern parlances. It is commonly seen in clinical practice for long proportion of skin disease. As the Kustha Roga has different and complex type of pathology with different sign and symptoms. Many skin diseases have not any remedies. Some of them are relapsing out of them. Vicharchika is one which relapsing by its complex pathology. Though the various treatments are available in contemporary science they are still not effective in preventing its reoccurrence. Hence wide spectrum prevalence its chronicity, lack of effective drug attract the researcher to look the A B S T R A C T Beauty is either skin deep i.e. Superficial or the purity of soul itself the later which is implied to Satwa Guna is penultimate and is beyond physical afflictions. Complexion, color etc. attributed to the healthy status of Tawk (skin) and the humors and the former is mean of sensory perception and the Vata Dosha pervades in it. People who live in urban areas and in climates with low humidity seen to be at increased risk for developing atopic dermatitis. W.H.O reveals that more than 75 million people all over the world have this disease. Key words: Vicharchika, Siravyadha, Snuhu Kaanda Lepana.

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[Find the meaning and references behind the names: Fast, Main, Raji, Rasa]

Dr. Shivappa A. Gangal et al. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in Vicharchika ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 65 suitable remedy for the disease. The Modern medicine consist of Antihistamine pills, oral and topical Steroids, Topical immune modulators and phototherapy by UV rays. oral steroids are reserved for life saving cases and its prescription is for a limited period, Long term use of Topical steroids causes thinning of skin, stretch marks, unwanted hair growth, redness of skin, and rebound of disease on withdrawn, Topical immune modulators can cause skin cancer which has been proven on animal experimentation and even phototherapy may end in white skin and skin cancer. With these drawbacks, the prese nt study titled ‘To evaluate the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in the management of Vicharchika (eczema), is being taken in the direction of giving relief to the patient and prevent the relapse, this can save the patient from agony of persistent discomfort and restricted social life, thereby considerably improving the dermatology - specific quality of life. Here Siravyadha is Ardha Chikitsa in overcoming Rakta Pradoshaja Vyadhi and Lepa Karma is patient friendly (can be carried out by patient). Local therapeutic procedure which is found to be highly efficacious in skin disorders to abate the local discomfort which is by easy and fast absorption and will have local results and unwanted reactions. O BJECTIVE OF THE S TUDY The main objective of the study was to establish the authenticity of the reference stating that Dagdha Snuhi Kaanda is effective in the management of Vicharchika . M ATERIALS AND M ETHODS Source of data Patients suffering from features of Vicharchika , were selected from OPD and IPD of Tegginmath Ayurvedic Medical College, Hospate. Method of collection of data A total of 40 cases with clinical features of Vicharchika namely Kandu, Pidaka, Srava, Shyavata, Rukshata, Raji, were selected for the present study, adhering to inclusion and exclusion criteria. Informed consent was taken in all the cases. Inclusion Criteria 1 Patients with clinical features of Vicharchika namely Kandu, Pidaka, Srava, Shyavata, Rukshata, Raji, Ruja and Daha were included. 2 Lesions limited to upper or lower limbs. Exclusion Criteria 1 Vicharchika associated with other skin disorders. 2 Systemic disorders, that would come in the way of disease and treatment 3 Pregnancy and Lactation 4 Age below 16 and above 70 years Investigations CBC, RBS, Urine Routine Examination were done to rule out other systemic disorders. Sampling Design A total of 40 cases of Vicharchika , after considering the above mentioned criteria were included for the study. The 40 cases included were randomly allotted into two groups namely Group-A & Group-B, each consist of 20 patients. General instructions to the patients 1 Advised to take bath regularly with gram flour, lukewarm water and avoid using soap and shampoo. 2 Maintain good physical hygiene. 3 Avoid tight clothing. 4 Pathya Ahara - Bland diet, food products which are bitter in taste, light for digestion. 5 Apathya Ahara - Diet having excessive Katu, Amla & Lavana Rasa, fatty & fried food, curds & nonveg diet were strictly avoided during the course of the study. In addition alcohol, smoking & tobacco chewing were also avoided.

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[Find the meaning and references behind the names: Kala, Min]

Dr. Shivappa A. Gangal et al. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in Vicharchika ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 66 Materials required For Siravyadha ▪ Tila Taila - sufficient quantity purchased from Davanagere Ayurveda Pharmacy. ▪ Pressure cooker connected with rubber tube - 1 ▪ Water - sufficient quantity ▪ Sterile Cotton - sufficient quantity ▪ Tourniquet - 1 ▪ Sterile glove - No 6.5, sufficient number ▪ Surgical Spirit - sufficient quantity ▪ Disposable needle -18 No. gauze - 1 ▪ Measuring jar - 1 ▪ Cotton Pads - sufficient quantity ▪ Sterile roller bandage - 1 Materials for Lepa application ▪ Dagdha Snuhi Kanda Bhasma - Sufficient Quantity ▪ Sarshapa Taila - Sufficient Quantity ▪ Wooden Spatula - 1 ▪ Sterile Cotton Swabs - Sufficient Numbers. ▪ Surgical Gloves - No 6.5, Sufficient Numbers ▪ Sponge Holding Forceps - 1. ▪ Roller Bandage - Sufficient Quantity. Study Design - Comparative clinical study Group A Table 1: Showing the procedure in Group A Poorva Karma Pradhana Karma Paschat Karma 1 Tila Yavagu Pana , 1 Moohurth (48 min) before the procedure. 2. Sthanika Abhyanga by warm Tila Taila. 3 Nadi Sweda with Jala Siravyadha 2 Angula above Kshipra Marma on 1 st , 15 th & 30 th day Pressure bandage applied Group B Table 2: Showing the procedure in Group B Poorva Karma Pradhana Karma Paschat Karma 1 Tila Yavagu Pana , 1 Moohurth (48 mins) before the procedure of sufficient quantity 2 Sthanika Abhyanga by warm Tila Taila 3 Nadi Sweda with Jala 1 Siravyadha 2 Angula above Kshipra Marma , on 1 st , 15 th & 30 th day 2 Application of Dagdha Snuhi Kanda Bhasma in sufficient quantity with Sarshapa Taila , once daily for 30 days in the morning. 1 Pressure bandage applied 2 Allowed to dry up the Lepa and then wiped with swab. Procedure Group - A ( Siravyadha ) Poorvakarma ▪ Procedure was made known to patient in advance and written consent was obtained. ▪ Yavagupaana - Patients were advised to consume sufficient quantity of Tila Yavagu 1 Moohurth Kala (48 minutes), before undergoing Siravyadhana . ▪ Abhyanga and Sweda - The affected limb was anointed with Tila Tail , followed by Sthanika Nadi Sweda with water. Pradhana Karma The patient was made to sit comfortably over the examination table in the minor OT. Then the area (Prominent vein just 2 Angula above Kshipra Marma ) was thoroughly cleansed with surgical spirit. A tourniquet was tied 2 inch above the ankle joint/wrist joint to make the vein prominent and if essential, mild blow was given over the vein. A sterile needle of 18 No. gauze was used for Bloodletting, and blood was collected in the measuring jar, The procedure was completed when Blood flow stopped on its own, or upto 200 ml, which was earlier. Paschat Karma After letting out blood, the needle was taken out, and the area wiped with cotton swab, a sterile cotton pad

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Dr. Shivappa A. Gangal et al. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in Vicharchika ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 67 was applied and bandaged. The patient was asked to take rest for 10-15 minutes, and advised to consume Gudajala Pana of sufficient quantity, and was advised to remove the bandage in the evening. Group B: ( Siravyadha and Lepa ) Siravyadha Poorvakarma ▪ Procedure was made known to patient in advance and written consent was obtained. ▪ Yavagupaana - Patients were advised to consume sufficient quantity of Tila Yavagu ( Pana ) 1 Moohurth Kala (48 minutes), before undergoing Siravyadhana . ▪ Abhyanga and Sweda - The affected limb was annointed with Tila Taila, followed by Sthanika Nadi Sweda with water. Pradhana Karma The patient was made to sit comfortably over the examination table in the minor OT. Then the area (Prominent vein just 2 Angula above Kshipra Marma ) was thoroughly cleansed with surgical spirit. A tourniquet was tied 2 inch above the ankle joint to make the vein prominent and if essential, mild blow was given over the vein. The sterile needle of 18 No. gauze was used for Bloodletting, and collected in the measuring jar, the procedure was completed when Blood flow stops on its own, or upto 200 ml, which was earlier. Paschat Karma After letting out blood, the needle was taken out, and the area wiped with cotton swab, a sterile cotton pad was applied and bandaged. The patient was asked to take rest for 10-15 minutes, and was advised to remove the bandage in the evening. Lepa Dagdha Snuhi Kanda Lepa Quantity of this Lepa was prepared, as mentioned in the Review of preparation of Dagdha Snuhi Kanda Lepa and the same was stored in air tight glass jar, which was used whenever required with sufficient quantity. Based on the size of the lesion, the quantity of the Lepa was decided. The Dagdha Snuhi Kanda Lepa was applied to the lesion in the following manner ▪ The lesion was cleaned properly with sterile swabs dipped in clean warm water & the area was mopped with sterile gauze, and then allowed to dry up. ▪ The Dagdha Snuhi Kanda Lepa was applied over the lesion with the help of a spatula in the opposite direction of the hair root & care was taken not to extend the Lepa over the normal skin. The thickness of the Lepa was that of Ardra Mahisha Charma . ▪ The Lepa was allowed to dry up after which the area was moistened and cleaned with warm water & mopped up with dry sterile gauze. The area was then dressed with plain gauze to avoid exposure to dust etc. and also to see that it should not come in contact with the cloth of the patient which maybe soiled. ▪ The Lepa was applied once a day in the morning for a period of 30 days. Assessment Criteria The results were evaluated by subjective & objective parameters mainly based on clinical observations by grading method Grading of parameters Subjective criteria 1) Kandu - (Itching) ▪ Absent - [Score- 0] ▪ Mild - (Not disturbing daily activities) [Score -1] ▪ Moderate - (Disturbing daily activities) [Score -2] ▪ Severe - (Disturbing daily activities and sleep.) [Score -3] Objective criteria 1) Pidaka ▪ Absent - [Score 0] ▪ Present - [Score 1]

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[Find the meaning and references behind the names: Hindu, Muslim, Red]

Dr. Shivappa A. Gangal et al. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in Vicharchika ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 68 2) Srava : (Discharge) ▪ Absent - [ Score 0 ] ▪ Mild - [ Score 1 ] ▪ Moderate - [ Score 2 ] ▪ Profuse - [Score 3 ] 3) Shyava Varna ▪ Normal skin color - [Score 0] ▪ Brownish red discoloration - [Score 1] ▪ Blackish red discoloration - [Score 2] ▪ Blackish discoloration - [Score 3] 4) Rookshata ▪ Absent (Normal skin) - [Score 0] ▪ Mild (dry with rough skin) - [Score 1] ▪ Moderate (dry with scaling) - [Score 2 ] ▪ Severe (dry with cracking) - [Score 3 ] 5) Raji ▪ Absent - [Score 0] ▪ Present - [Score 1] 6) Ruja ▪ Absent - [ Score 0 ] ▪ Present - [ Score 1] 7) Daha ▪ Absent - [ Score 0 ] ▪ Present - [ Score 1 ] Total effect assessment of the study Unchanged O – 25 % Mild Response 26 – 50 % Moderate Response 51 – 75 % Marked Response 76 – 99 % Cured 100 % O BSERVATIONS AND R ESULTS In the present study 40 patients were studied in the following 2 groups, those were included based on inclusion criteria and fulfils the subjective and objective parameters Group A - Siravyadha 20 patients. Group B - Siravyadha and Dagdha Snuhi Kanda Lepa 20 patients. The data’s collected are presented below: Showing the distribution of patients by age Out of 40 patients, 7 patients of <30 yrs. (17.5 %),7 patients of between 31-40 years (17.5 %), 9 patients of between 41-50 years (40%), 9 patients of between 51-60 years (22.5%), and 1 patient was of >60 years (2.5%). Distribution of Patients by Sex Out of 40 patients majority of patients were male i.e. 25 patients (62.5%), and 15 (37.5%) patients were female. Showing the distribution of patients by religion Among 40 patients 32 patients (80%) were Hindu and 3 patients (8%) were Muslim. Showing the distribution of patients by Economical status Out of 40 patients; 20 (50%) were belonging to Lower class, 18 (45%) were of middle class, and 2 (10%) were belonging to upper class. Showing the distribution of patients by Food Habit Out of 40 patients; 32 (80%) are Vegetarian, 8 (20%) are taking mixed food. Showing the distribution of patients in terms of body parts affected Among 40 patients; 23 (57.5%) had lesion in legs, 4 (10%) had in soles, 2 (5%) had in Hand, 7 patients had on Arm, 01 (2.5%) had in palm and 3 (7.5%) had lesion in Back. Distribution of the patients according to their chronicity The maximum number of patients with chronicity of disease about 1-2 year with the incidence of 45 % in both the groups, Duration up to 1 year with the incidence of 30% in group A, and 15% in group B.

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Dr. Shivappa A. Gangal et al. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in Vicharchika ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 69 Duration of disease 2-3 year with the incidence of 20% in group A, and 15% in group B. Duration of disease 3-5 year with the incidence of 25% in group B and 5% in group A. Comparative evaluation of Kandu in two groups In group A, Maximum number of 18 (90%) were having Severe Kandu , two patients (10%) were having moderate Kandu before treatment, On 15 th day, 8 patients (40%) got complete relieved of Kandu , 11 ( 55%) patients got mild relief, and 1 patient got moderate relief. On 30 th day, 17 (85%) patients got complete relief, and 3 (15%) patients got mild relief. So in group A, Total 85% of patients got complete relief from Kandu , and 15% of patients got mild relief Comparative Evaluation of Pidaka in two groups In group A,- 17 patients (85%) presented with Pidaka and 3 patients (15%) were not presented with Pidakas , On 15 th day, 16 patients (80%) got complete relief. On 30 th day, 19 patients (95%) got complete relief. And 1 patient not relieved with Pidakas . Comparative evaluation of Srava in two groups In group B- Maximum of 5 ( 25%) patients presented with profuse Srava , 2 patients (10%) with moderate Srava , and 1 patient with mild Srava . On 15 th day, 3(15%) patients showed mild Srava , and 5 patients got complete relieve of Srava . On 30 th day, all 19 (95%) patients got complete relief of Srava . one patient still presented with Srava Comparative Evaluation of Shyavatha in two groups In group A- Maximum of 19(95%) patients presented with Blackish discoloration of lesion before treatment and one patient with Blackish red discoloration.. On 15 th day, 15 (40%) patients showed blackish red discoloration, and 5 (60%) patients showed brownish red discoloration. On 30 th day, 8 (40%) patients showed blackish red discoloration, and 12 (60%) patients showed brownish discoloration. In this study, no complete relief observed regarding the discoloration. Comparative evaluation of Rookshata in two groups In group A, Maximum of 6(30%) patients showed severe Rookshata , 5 (25%) patients showed moderate Rookshata . On 15 th day, one patient showed complete relief of Rookshata , and 10 (50%) patients showed mild Rookshata . On 30 th day, 6 (30%) patients showed mild Rookshata , and remaining all patients showed complete relief from Rookshata . Comparative evaluation of Raji in two groups On 15 th day, 6 patients relieved completely and 3 (15%) patients showed Raji On 30 th day, 7 patients showed complete relief and 2 (10%) patients were still with Raji over the lesion. In group A, Maximum of 11(55%) patients were presented with Raji before treatment, Comparative evaluation of Ruja in two groups In group A, Maximum of 11 (55%) patients presented with Ruja before treatment. On 15 th day, all 20 patients relieved with Ruja Comparative evaluation of Daha in two groups In group A, Maximum of 10(50%) patients presented with Daha at lesion. On 15 th day, all patients relived by Daha . Comparative evaluation of overall outcome in two groups studied . Overall outcome Group A Group B Excellent 10(50.0%) 17(85.0%) Good 9(45.0%) 3(15.0%)

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Dr. Shivappa A. Gangal et al. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in Vicharchika ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 70 Poor 1(5.0%) 0 Total 20(100.0%) 20(100.0%) Excellent outcome are significantly more in Group B with P=0.041* DISCUSSION Among 40 patients, In both the Groups 27 (67.5) Patients shown Excellent response, 12 (30%) Patients shown Good response, 1 (2.5%) patient shown poor response, Those who were shown mild, moderate and poor response in them: (i) Once Siravyadhana is not sufficient, (ii) Strong involvement of morbidity of Dosha and (iii) Patient didn’t follow the proper instructions during Siravyadhana Karma (iv) One patient unable to follow proper Ahara- Viharas and indulged in Nidana Sevana during the procedure. Probable mode of action of Siravyadha Siravyadha is a procedure of Raktamokshana . It is indicated to expel out the vitiated blood from all over the body. Acharya Sushruta advocates Siravyadha at the site of Kshipra Marma as a treatment of Vicharchika . The disease Kushta is a Rakta Pradoishaja Vyadhi and Vicharchika is one of the Kshudra Kushta , hence Raktamokshana helps in expelling out the Dushta Rakta from the body. The site selected is 2 Angula above the Kshipra Marma , here the site can be corelated to dorsal arch of the foot. So the peripheral point has been selected for Siravyadha because it is easy to perform Siravyadha as the veins are superficial in the extremities After a particular amount of blood letting (120 ml) the fluid and plasma components of the blood will be decreased. Normally the exchange of gases, nutrients and waste products between blood and tissue takes place at the capillary level. Hence the volume loss may affect this exchange mechanism and also decreases the plasma and its contents like immune globins, carbohydrates, lipids, salts, vitamins and clotting proteins. Here the low oxygen at the tissue stimulates the development of RBC’S by haemopoesis and even the volume loss will be replaced by the plasma proteins, Plasma proteins are essential in maintaining the blood volume. These plasma proteins are too large to leave the vasculature and remain in the capillaries exerting the osmotic pressure over the lesion that pulls the fluid back into the vascular system from the interstitial space. So whenever the blood is contaminated with any type of particular allergens that starts to circulate all over the body, finally it gets lodged in the tissue at capillary junction where the blood exchanges its contents with the tissue. Hence these particular allergens deposit there and produce the symptoms as in case of eczema. Hence in Siravyadha the Dushita Rakta Nirharana takes place, replacing with Shuddha Raktha , which nourishes the affected site with Oxygen and nutrients, hence the symptoms of Vicharchika subsides. Probable Mode of action of Lepa Application of Lepa in opposite direction of the hairs, help the active principles in Lepa infused to enter Romakupa and absorbed through Siramukha and Swedavaha Srothas , the opening of Dhamanis connected to Romakupas , the essence of these are absorbed and passed to the deeper layers, The Lepa mentioned in Astanga Hridaya meant for Vicharchika and said to have Kusthaghna property, Katu Rasa, Ushna Virya, and Katu Vipaka of the ingredients of Lepa helps in pacifying Kapha Dosha which is causative factor of Vicharchika . Snigdha Guna and Vata-Pittahara property of Sarshapa Taila helps in mitigating dryness of skin, which is main cause in the onset of Eczema. The chemical analysis of Lepa has come out to be having ph of 9.4, which is said to be alkaline in nature ( Kshara ), here Ksharana Karma of this helps in debriding the dead cells, allowing proper nutrition to

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[Find the meaning and references behind the names: Singh, Prakashan, Michael]

Dr. Shivappa A. Gangal et al. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in Vicharchika ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 71 local tissues and Sthambana property of Kshara helps in relieving the discharge,. Presence of high protein content of Lepa , acting as anti-oxidant and helps in nourishment of local tissues, which might help in resistance of skin allergen, thus probably reduces the relapsing nature of Eczema. CONCLUSION Vicharchika as a Kshudra Kustha has Kapha dominance & even involvement of Tridosha can be evident from its signs & symptoms. Vicharchika in modern view has similarity with Eczema. Vicharchika is a disease of agriculturists, housewives, industrial workers who are open to the assault of irritant substances. It is also chronic in nature so after remission, there are chances of recurrence. Reports of allergic contact dermatitis from shampoos are mainly case based. Shampoos can cause dermatitis of the scalp, face and neck. Most of the patients were reported in the chronic stage of Vicharchika . Negligence in early stage and recurrence of Vicharchika is common phenomenon. Vicharchika condition is more aggravated by dry and cold weather, and also when excessive sweating occurs. Sunlight and irritant material also precipitates the conditions. General emotional expression also interfere in skin condition i.e. anxiety, depression, tense mind activate the sympathetic nerve stimulation which produce indigestion, skin manifestation etc. There will be strong involvement of psychological factors in the causation of Vicharchika like Chittodwega , Krodha are found. Maximum number of patients had lesion in lower extremity especially feet followed by in hands is the 2 nd common site of affliction. The Lakshana Kandu is noticed in all the 40 patients of the present study. Lower extremities are more prone to be affected by Vicharchika . Siravyadha Karma provides better relief in the symptoms of Vicharhika , by Nirharana of Dusta Raktha and replacing it with Shuddha Raktha for nourishment to Twak . Lepa provides highly significant results as it has ph of 9.4, which acts like mild Kshara and hence Ksarana of Pidakas (dead cellular debridment) takes place. Lepa has the chemical constituents like ions in the Lepa helped for the easy diffusion of drugs, and proteins in the Lepa helped for the nourishment of skin. Statistical analysis of both the treatment plans yield results which were statistically significant. Clinically the features of Vicharchika namely Kandu, Pidaka, Srava, Rookshta, Raji, Rooja, and Daha showed signs of complete relief at the end of treatment. Complete relief of Shyavata was not achieved in both the treatments except (15%) in group B. REFERENCES 1 Hutchinsons clinical methods edited by Michael glynn,22 nd edition,reprinted 2007,Toronto,11 th chapter,Page no.251. 2 Agnivesha, Charaka samhita raised by charaka samhitha raised by charaka and dridabala with ayurveda dipika commentary of charakrapanidatta ,edited by harishchandra singh kushvane,Sutrasthana chapter 8/8,edition Reprint 2011 Pub:Chaukhambha orientalia,Varanasi and P-124. 3 Agnivesha, Charaka samhita raised by charaka samhitha raised by charaka and dridabala with ayurveda dipika commentary of charakrapanidatta ,edited by harishchandra singh kushvane,Sutrasthana chapter 30/26,edition reprint 2011 Pub:Chaukhambha orientalia,Varanasi and P-405. 4 Agnivesha, Charaka samhita raised by charaka samhitha raised by charaka and dridabala with ayurveda dipika commentary of charakrapanidatta ,edited by harishchandra singh kushvane,Indriyasthana, chapter 9/8,edition reprint 2011 Pub:Chaukhambha orientalia,Varanasi and P-913. 5 Sushruta, Sushruta samhita Nimbandhasangraha commentary of Dalhanacharya and Nyayachandrika panchika commentary of gayadasa,edited by Kaviraja ambika dutta shastri,sutrasthana chapter 33/4,reprint edition 2005 pub:chaukhambha Publication,Varanasi and P-127. 6 Amarsimha, Namalinganusasana or Amarkosha with the Ramashrami commentary of Bhanuji Dikshita and Maniprabha Hindi commentary Edited by Pandit Haragovinda Shastri, 3 rd Edition-1997, Choukhambha Sanskrit Sansthan,Varanasi, Pp-668. 7 Agnivesha, Charaka Samhita revised by Charaka and Dridabala with Ayurveda dipika commentary of chakrapanidatta, Edited by Yadavji Trikamji Acharya,Sutra sthana 8 th chapter, 7 thVaranasi, Pp-738, Page no.56. Edition- 2005, Choukhambha Surbharati Prakashan, 8 Sushruta, Sushruta Samhita, Nibandhasangraha commentary of Dalhanacharya and Nyayachandrika Panchika commentary of Gayadasa, Edited by Yadavji Trikamji Acharya,

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[Find the meaning and references behind the names: Nil, Med]

Dr. Shivappa A. Gangal et al. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in Vicharchika ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2020 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2020 | Vol. 5 | Issue 6 72 Shareerasthana 1 st Chapter, Reprint 2005, Choukhambha Orientalia, Varanasi, Pp-824, Page no.339. 9 Agnivesha, Charaka Samhita revised by Charaka and Dridabala with Ayurveda dipika commentary of Chakrapanidatta, Edited by Yadavji Trikamji Acharya, Chikitsa sthana 15 th chapter, 7 thPrakashan, Varanasi, Pp-738, Page no.514. Edition-2005, Choukhambha Surbharati 10 Agnivesha, Charaka Samhita revised by Charaka and Dridabala with Ayurveda dipika commentary of Chakrapanidatta, edited by Yadavji Trikamji Acharya, Shareera sthana 3 rd Prakashan, Varanasi, Choukhambha Surbharati, Pp-738, Page no.310. Chapter, 7 th Edition-2005, 11 Sushruta, Sushruta Samhita, Nibandhasangraha commentary of Dalhanacharya and Nyayachandrika Panchika commentary of Gayadasa, Edited by Yadavji Trikamji Acharya, Shareerasthana 4 th Chapter, Reprint 2005, Choukhambha Orientalia, Varanasi, Pp-824, Page no.355. 12 Vagbhata, Ashtanga hrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, edited by Bhishagacharya Harishastri Paradakara Vaidya, Shareera sthana, 3 rd Chapter, 9 th Edition- 2002, Choukhambha Orientalia, Varanasi, Pp-956, Page no.386. 13 Vagbhata, Ashtanga hrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, edited by Bhishagacharya Harishastri Paradakara Vaidya, Shareera sthana, 3 rd Chapter, 9 th Edition- 2002,Choukhambha Orientalia, Varanasi, Pp-956, Page no.386. 14 Agnivesha, Charaka Samhita revised by Charaka and Dridabala with Ayurveda dipika commentary of Chakrapanidatta, Edited by Yadavji Trikamji Acharya, Shareera sthana 7 th chapter, 7 thPrakashan, Varanasi, Choukhambha Surbharati, Edition-2005, Pp-738, Page no.337. 15 Vaidya Jadavaji Trikamji acharya edited Charaka samhita Shareerasthana chapter-7/4, edition reprint 2005, and pub: Chowkhamba Surabharati Prakashana, Varanasi, P-337. 16 Vaidya Jadavaji Trikamji Acharya edited Sushrutasamhita, Shareerasasthana, Chapter- 4/4, 7 th edition 2002, pub: Chaukhambha Orientalia, Varanasi, p-355. ******************************* How to cite this article: Dr. Shivappa A. Gangal, Dr. Deepa S. Gangal. A study on the efficacy of Siravyadha followed by Snuhi Kaanda Lepa in the management of Vicharchika (eczema). J Ayurveda Integr Med Sci 2020;6:64-72. http://dx.doi.org/10.21760/jaims.5.6.8 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2020 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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