A case study on management of Sheetapitta with special reference to Chronic...

[Full title: A case study on management of Sheetapitta with special reference to Chronic Urticaria]

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[Find the meaning and references behind the names: Kalpana, Madhav, Rasa]

CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 307 A case study on management of Sheetapitta with special reference to Chronic Urticaria Diksha P. Nandurkar 1 , Kalpana R. Chavhan 2 1 Post Graduate Scholar, Department of Agadtantra, Government Ayurved College, Nagpur, Maharashtra, India. 2 Associate Professor, Department of Agadtantra, Government Ayurved College, Nagpur, Maharashtra, India. I NTRODUCTION In Ayurveda , Sheetapitta is mentioned as one of the Twak Vikara . Sheetapitta is composed of two words, Sheeta and Pitta which are contrary to each other by meaning. The word Sheeta indicates Vata and Kapha Dosha and their association with Pitta Dosha . According to Madhav Nidana , Sheetapitta caused due to exposure to cold breeze which results in vitiation of Vata and Kapha Dosha dominantly in association with Pitta Dosha, [1] Due to the impairment of Doshas , it leads Address for correspondence: Dr. Diksha P. Nandurkar Post Graduate Scholar, Department of Agadtantra, Government Ayurved College, Nagpur, Maharashtra, India. E-mail: diksha 0569@gmail.com Submission Date: 14/03/2024 Accepted Date: 22/04/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.5.52 to Rasa and Rakta Dhatu Dushti , then spreads towards the extremities and manifests as maculopapular rash. Sheetapitta , Udarda and Kotha are three different terminologies mentioned in Samhita , having few different characteristics and different causative factors. The specific reference for Sheetapitta is not found in Brihtrayee but these terms are mentioned as Purvarupa , [2] Lakshana [3] and Vyadhi [4] Madhukosa explained that, though the features of Sheetapitta and Udarda are similar to each other, there is a predominance of Vata Dosha in Sheetapitta while Udarda is dominated by Kapha Dosha [5] The etiological factors responsible for Sheetapitta appears due to the consumption of Asatmya Ahar or various kinds of allergens. In todays advanced lifestyle, improper and unhealthy food habits leads to lower nutritional value in diet resulting in Dhatu Daurbalya and impaired immune responses. This causes sensitization towards allergens and produce allergic reactions. Sheetapitta can be correlated with urticaria due to the resemblance of etiological factors and symptomatology. Urticaria affects about 20% of A B S T R A C T Background: Sheetapitta is one of the Twak Vikara mentioned in ancient Ayurvedic Samhita . Sheetapitta is Tridoshaj Vyadhi occurs after exposure to cold breeze. This dominantly leads to the vitiation of Kapha and Vata Dosha associated with Pitta Dosha and circulate all over the body manifesting as maculopapular rash. The symptoms include Varti Damshavat Shotha and Kandu due to dominance of Kapha , Shula due to Vata and Daha caused by vitiation of Pitta Dosha . Sheetapitta can be correlated with urticaria due to resemblance of etiological factors and symptomatology. Aim & Objectives: The aim of the study is to access the efficacy of Ayurvedic management ( Shaman Chikitsa ) in Sheetapitta . Materials & Methods: It is a single case study. A 44 year old female patient presented with complaints of elevated reddish irregular lesions associated with gradual onset of itching and burning sensation all over the body since 4 months. Itching starts immediately after the consumption of food items like non-veg, spices, citrus fruits, oily food, dry fruits and nuts. The symptoms aggravated more in the night time and gradually subside in the morning. The diagnosis was done as Sheetapitta . Result: Ayurvedic management was done by using Shaman Chikitsa can effectively manage Sheetapitta (urticaria) and improved the quality of life of patient. Conclusion: This case report shows that the classical Sheetapitta treatment was significantly effective in treating urticaria. Key words: Sheetapitta, Urticaria, Shamana Chikitsa, Ayurveda

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[Find the meaning and references behind the names: Rupa, Ritu]

Diksha P. Nandurkar et al. A case study on management of Sheetapitta ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 308 population at some point in lifetime [6] Though it is not life threatening disease, but it makes patient irritable and affects the quality of life. Urticaria is derived from the Latin word ‘ Urtica’ means stinging nettle. Urticaria is commonly occurring dermatological disease characterized by erythematous and itchy lesions involving the dermis and mucous membrane and caused by dilatation and increased permeability of capillaries [7] Urticaria has a variety of etiological factors including IgE antibodies mediated foods, drugs, physical stimuli, infection, autoimmune diseases [8] Acute and chronic urticaria can occur at any point in the lifespan of third to fifth decade. Acute urticaria is widespread and lasts for less than 6 weeks and may be a manifestation of type 1 allergic reaction [9] If it continues for more than 6 weeks then it is said to be chronic urticaria. Upto 45% of the patients with chronic urticaria have an autoimmune cause for their disease [10] The present study aimed to evaluate the efficacy of Shaman Chikitsa in Sheetapitta . A IM AND O BJECTIVES To study about Sheetapitta Vyadhi (Urticaria) and to assess the competency of Shaman Chikitsa in Sheetapitta Vyadhi . C ASE R EPORT A 44 year old female patient with medium built reported to OPD and presented with chief complaints of elevated reddish irregular lesions with swelling. The above complaints associated with gradual onset of itching and burning sensation all over the body since 4 months. Itching starts immediately after the consumption of food items like non-veg, spices, citrus fruits, oily food, dry fruits and nuts. The symptoms aggravated more in the night and gradually subside in the morning. The diagnosis was done as Sheetapitta on the basis of etiological factors and clinical presentation. History of present illness The patient was completely healthy before 4 months and gradually developed reddish irregular lesions all over the body. Initially patient neglected the symptoms but when the symptoms got aggravated, she approached to an allopathic hospital and was on antihistamine medication for 4 months. Patient got symptomatic relief but after withdrawal of medication, recurrence of disease occurs. As a result, she decided to take Ayurvedic treatment. Past history Patient had no history of any systemic disease, no medical or surgical history. Personal history Occupation - Housewife Nidana [11] Due to Sheeta Marutadi Sevan (exposure to cold wind and cold weather), Kapha and Vata Dosha gets vitiated and mixed with Pitta Dosha . All the three vitiated Doshas spreads all over the body and manifests as Sheetapitta . 1. Aharaj Hetu - Atiamla Sevan, Atilavan, Atikatu Sevan, Kshara Sevan, Viruddha Ahar Sevan, Dadhi Sevan. 2 . Viharaj Hetu - Sheet Maruta Sevan, Bahya Krumi, Keeta Damsga, Chardi Nigrahan, Shishir Ritu, Vastra, Abhushan. 3 . Nidanaarthakara Roga - Pittaja and Kaphaja Jwara, Sannipatika Roga, Unmarda, Adhoga Amlapitta Poorvarup (Premonitory signs) [12] Pipasa (Thirst), Aruchi (loss of appetite), Hrillasa (Nausea), Dehasaad (Feeling of tiredness), Anga Gaurava (Feeling of heaviness), Rakta Lochanata (Redness of eyes). Rupa (Signs and Symptoms) [13] Varti Damshta Samsthana Shotha (Inflammation like an insect bite), Kandu Bahula (Sever itching), Toda Bahula (Excessive pain like pricking), Chardi (Vomiting), Jvara (Fever), Vidaha (Burning Sensation), Ksanikotpatti Vinasha. Samprapti Ghataka ▪ Dosha: Tridosha ▪ Agni: Mandagni ▪ Vyadhimarga: Bahya ▪ Dushya: Rasa, Rakta ▪ Srotas: Rasavaha, Raktavaha

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

Diksha P. Nandurkar et al. A case study on management of Sheetapitta ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 309 ▪ Srotodushtiprakara: VimargaGamana ▪ UdbhavaSthana: Aamashaya ▪ VyaktiSthana: Tvak ▪ Svabhava: Ashukari General Examination ▪ Pulse : 82/min ▪ B. P. : 110/80 mmHg ▪ RR : 20/min ▪ Temp : 98.2°F ▪ Weight : 67 Kg ▪ Height : 5.3” ▪ Appetite : anorexia ▪ Sleep : disturbed Table 1: Ashtavidha Pariksha of patient SN Name Lakshana 1. Nadi (Pulse) Pitta-Kapha predominant 2. Mala (Stool) Malavrodh 3. Mutra (Urine) Samyak 4. Jivha (Tongue) Alpasama 5. Shabda (Speech) Spashta 6. Sparsha (Touch) Anushnasheeta 7. Druk (Eyes) Samyak 8. Aakruti (Appearance) Madhyam Assessment Criteria Assessment of patient was done on the basis of improvement in subjective parameters like Kotha (inflammation), Kandu (itching), Daha (burning sensation). Table 2: Objective Criteria [14] Urticaria Activity Score (UAS) as per Indian Journal of Dermatology Score Wheals/24 hrs Pruritus 0 None None 1 Mild: < 20 wheals over 24 hrs Mild present but not troublesome 2 Moderate: 20-50 wheals over 24 hrs Moderate: Troublesome but doesn’t interfere with daily routine or sleep 3 Severe: > 50 wheals over 24 hrs or large area of wheals Severe pruritus which is sufficiently troublesome to interfere with daily activity or sleep Table 3: Subjective Criteria Symptoms Mild Moderate Severe Kotha (Raised oedamatous wheals of pink red colour) 1 2 3 Kandu (itching) 1 2 3 Toda (pricking sensation) 1 2 3 Daha (burning sensation) 1 2 3 Table 4: Treatment Protocol SN Medications Dosage Anupana Duration 1. Haridra Khanda 1 tsf BD Milk 3 months 2. Dushivishari Agad 2 Tab BD Lukewarm water 1 month 3. Bilwadi Gutika 2 Tab BD Lukewarm water 1 month 4. Avipattikar Churna 1 tsf HS Lukewarm water 15 days 5. Maricha Churna 1 tsf BD Ghrit 1 month

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[Find the meaning and references behind the names: Guru, Madhu]

Diksha P. Nandurkar et al. A case study on management of Sheetapitta ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 310 O BSERVATIONS AND R ESULTS Following the treatment, improvement in the patient’s signs and symptoms started to visible within 15 days following the treatment. Significant relief was found in Kandu (itching), Daha (burning sensation), Shoth (inflammation) upto second visit. Satisfactory improvement in Kandu were seen. Image 1: Erythematous wheals on the skin Image 2: Erythematous wheals on the skin Table 5: Observation SN Symptoms Observed Score Before Treatment After Treatment 1. Kotha (Raised edematous wheals of pink red colour) 3 1 2. Kandu (itching) 3 1 3. Toda (pricking sensation) 2 0 4. Daha (burning sensation) 3 0 Table 6: Pathya-Apathya [21] Pathya Ahara Apathya Ahara 1. Jererna Shali 2. Jangala Mamsa 3. Triphala 4. Madhu 5. Mudga Yusha 6. Kulattha Yusha 7. Ushnodaka 8. Karkotaka Shaka 9. Karavellaka Shaka 10. Moolak Yusha 11. Dadima Phala 12. Shigru Shaka 13. Moolaka Shaka 14. Vetragra Phala 15. Potika Shaka 16. Lava Rasa Tittira Rasa 1. Ksheera Vikarani 2. Chhardi Nigraha 3. Ikshu Vikarani 4. Divaswapna 5. Matsya 6. Poorva and Daksheena Disha Pavana 7. Anupa-Audak Mamsa 8. Snana 9. Naveena Madhya 10. Atapa Sevana 11. Virudhahara 12. Vyavaya 13. Snigdha, Amla, Madhura 14. Dravya, Guru Annapana DISCUSSION Sheetapitta is commonly encounter Twak Vikara in clinical practices. A variety of etiological factors are responsible for triggering the disease. So, for the treatment of Sheetapitta (urticaria), drugs acting on different causative factors is the key line of treatment. Ayurveda has a vast concept of Pathya and Apathya and it also believes that prevention is always better than cure so the first line of treatment is Nidana Parivarjan as food plays a major role in aggravating the symptoms of urticaria. In modern medicine, there is widespread treatment modalities available but persistent usage of steroids and antihistamines can cause hazardous consequences to the human health.

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[Find the meaning and references behind the names: Wali, Arya, Prakashan]

Diksha P. Nandurkar et al. A case study on management of Sheetapitta ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 311 There are higher chances of recurrence rate thus it is essential to find out the effective treatment which will eliminate the disease from its root cause. Haridra Khanda [15],[16] - Haridra Khanda is the drug of choice for Sheetapitta mentioned by Bhaishajya Ratnavali . It is a potent anti-allergic drug, it has antibacterial and anti-microbial properties. Dushivishari Agada [17] - Most of the ingredients are Katu, Tikta Rasatmaka and Katu Rasa possess Krumihar, Kushthar and Vishaghna properties, it clears Kapha and Kleda from Strotas . Bilwadi Gutika [18] - Majority of the drugs of Bilwadi Agad are Tikta, Katu Rasa Pradhan and are Ushna Veerya (hot potency) and Katu Vipaki thus, can act as Vishaghna and Keetaghna . Avipattikar Churna [19] - It causes Raktaprasadana by eliminating Dushta Kapha , Pitta Dosha and Kleda from Rasa and Rakta Dhatu. Maricha [20] - Maricha contains active principle called piperine because of which it performs antiinflammatory effect. Ayurveda has a considerable amount of potential in treatment aspect of allergic skin diseases by using various formulations followed by Pathya-Apathya . CONCLUSION Before treatment, assessment and examination of patient was done on the basis of Urticaria Activity Score (UAS). The diagnosis was done that the patient was suffering from grade 3 urticarial phase. After a month of taking continues treatment, the grading of Urticaria Activity Score (UAS) and clinical features of a patient were reduced significantly. Remarkable changes were evident after 2 months of treatment with above mentioned medicine. This single case report concludes that Ayurvedic management with Shaman Chikitsa offers excellent result in the treatment of Sheetapitta . REFERENCES 1 Upadhyaya A, Madhavnidanam, Sheetpittodardkotha nidanam adhyaya 50/1, edited by Chaukhamba Prakashana, Varanasi, p-200. 2 Tripathi R, Charak samhita, Volume 2, Chikitsa Sthana, Kushthachikitsa adhyaya, 7/12, edited by chaukhamba sanskrit pratishthan, delhi 2017; p-182. 3 Tripathi R, Charak samhita, Volume 2, Chikitsa Sthana, Jwarachikitsa adhyaya, 3/108, edited by chaukhamba sanskrit pratishthan, delhi, 2017; p-85. 4 Tripathi R, Charak samhita, volume 2, Sutra Sthana, Maharog adhyaya, 20/17, edited by chaukhamba sanskrit pratishthan, Delhi, 2017; p-296. 5 Shastri S, Madhav Nidana Madhukosh Vyakhya, Uttarardha, Chaukhamba Sanskrit Sansthana. 6 Wali D, Ranjitha. Conceptual study on Sheetapitta, Udard and Kotha with special reference to Urticaria. Journal of Ayurveda and integrated Medical Sciences, 2019;4 (6):82-87. 7 Penman I. D, Ralson S. H., Strachan M. W. J., Hobson R., Davidson’s principles and practice of medicine 24 th edition, Elsevier Health Sciences, London, England, 2022, p- 1103. 8 Lohe P, Chalakh S. Clinical Study of in with reference to Urticaria Dushivishari Agad Kotha. Joinsysmed, 2018: 6 (2) : 49-55. 9 Chugh S N, textbook of medicine, 4 th edition, vol - 2, Arya publications, 2019. 10 Harrison’s principles of internal medicine, 20 th edition, 2 nd volume, New York: McGrow-Hill, Health Professions Division. 11 Shastri S, Yogratnakar Sheetapittaudardakotha nidanam, edited by chaukhamba prakashan Varanasi; p- 234. 12 Upadhyaya A, Madhavnidanam, Sheetpittodardkotha nidanam adhyaya 50/2, edited by Chaukhamba Prakashana, Varanasi, p-201. 13 Upadhyaya A, Madhavnidanam, Sheetpittodardkotha nidanam adhyaya 50/3-4, edited by Chaukhamba Prakashana, Varanasi, p-201. 14 https://compass.clinic/wpcontent/uploads/2020/05/U AS 7-1.pdf 15 Murthy K. R., Ashtanga Samgraha of Vagbhata, volume 3, uttarsthana, Vish Pratishedh Adhyaya, /91, Chaukhamba Orientella, Varanasi, p- 363. 16 Shastri A, Bhaishjyaratnavali, /21, edited by Chukhamba Prakashan, Varanasi, p- 917.

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

Diksha P. Nandurkar et al. A case study on management of Sheetapitta ISSN: 2456-3110 CASE REPORT May 2024 Journal of Ayurveda and Integrated Medical Sciences | May 2024 | Vol. 9 | Issue 5 312 17 Tripathi R, Ashtang hridaya, Vishpratishedha adhyay 35/39, edited by p-1148. 18 Tripathi R, Ashtang hridaya, Uttarsthana, Sarpavishpratishedh adhyay 36/84-85, edited by p- 1163. 19 Ayurvedasar samgraha 20 Sharma PV, Dravyaguna Vigyana vol - 2, edited by Chaukhamba Bharti Academy, Varanasi, 2018; p – 362. 21 Lakshmipatishastri, Yogaratnakar Hindi Translation, Uttarardha, Sheetapittaudardakothanidinam, verse 14, Chaukhambha Prakashana, Varanasi, p -236. ******************************* How to cite this article: Diksha P. Nandurkar, Kalpana R. Chavhan. A case study on management of Sheetapitta with special reference to Chronic Urticaria. J Ayurveda Integr Med Sci 2024;5:307-312. http://dx.doi.org/10.21760/jaims.9.5.52 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 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 (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Lakshana, Rupa, Samhita, Rasa, Ayurveda, Tridosha, Rakta, Pathya, Tvak, Mandagni, Purvarupa, Bahya, Apathya, Maricha, Vyadhin, Pathyapathya, Marichachurna, Bhaishajyaratnavali, Rasavaha, Vatadosha, Pittadosha, Kaphadosha, Stinging nettle, Shishir-ritu, Present illness, Personal history, Urticaria, Past history, Etiological factor, Ayurvedic Management, Clinical presentation, Avipattikar churna, Objective Criteria, General examination, Aharaj Hetu, Viharaj Hetu, Rasa and Rakta, Subjective parameter, Ashtavidha Pariksha, Twak Vikara, IgE antibodies, Shaman Chikitsa, Chief complaint, Rasa dhatu dushti, ALLERGIC REACTION, Vimargagamana, Nidana Parivarjan, Bilwadi Gutika, Aamashaya, Tridoshaj Vyadhi, Madhav Nidana, Dushivishari Agad, Sheetapitta, Chronic urticaria, Acute urticaria, Haridra Khanda, Maculopapular rash, Urticaria activity score, Dushivishari Agada, Raktavaha, Rakta dhatu dushti.