Ayurvedic management of Vipadika - A Case Report

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CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 247 Ayurvedic management of Vipadika - A Case Report Sinsha A.S 1 , Rashmita Tiga 2 , Pragya Priyadarsini Mallik 3 , Sonalika Jena 4 1,2 Final Year Post Graduate Scholar, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India. 3 Professor, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India. 4 Associate Professor, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India. I NTRODUCTION Vipadika , categorized as a type of Kshudra Kustha in Ayurveda , manifests as a chronic skin disorder primarily affecting the palms and soles, characterized by symptoms such as Pani - Pada Sphutana (fissures in palm and sole), Teevra Vedana (severe pain), Manda Kandu (itching) and Saraga Pidika (red patches) [1] Acharya Sushruta also explained this under Kshudra Kustha in the name of Padadari [2] In Ayurveda, skin disorders like Vipadika are attributed Address for correspondence: Dr. Sinsha A.S. Final Year Post Graduate Scholar, Department of Kayachikitsa, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India. E-mail: sinshasalam 9419@gmail.com Submission Date: 08/07/2024 Accepted Date: 13/08/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.8.37 to various factors including Viruddha Ahara, Ati-Drava, Ati-Snigdha, Guru Ahara, Vega Dharana, Asatmya Vihara, Papa Karma, Manasika Bhavas, and exposure to adverse environmental conditions. These Nidanas aggravate the Doshas, causing Agnimandya and inducing Dhatu Shaitilyata . Among the three Doshas, Vata and Kapha, are particularly susceptible to disturbance, infiltrating the Rasa-Raktadi Dhatus , disrupting circulation in the Tiryakgata Siras and settling in the Twak, thereby resulting in Vipadika. [3] According to Acharya Charaka , all types of Kustha are Tridoshaja which vitiate the Twak, Rakta, Mamsa, Ambu collectively causing Kustha [4] with Vipadika correlating with Palmoplantar Psoriasis Psoriasis is a common, chronic inflammatory skin disorder that is characterized by the formation of sharply demarcated, scaly, erythematous plaques [5] Palmoplantar psoriasis is a variant of psoriasis affecting the skin of the palms and soles presenting with hyperkeratotic, pustular, or mixed presentations. These chronic conditions cause significant functional disability and are associated with marked quality-oflife issues [6] The prevalence of psoriasis in India ranges A B S T R A C T Vipadika , categorized as a type of Kshudra Kustha in Ayurveda , presents as a chronic dermatological condition primarily affecting the palms and soles, characterized by symptoms such as Pani-Pada Sphutana (fissures), Teevra Vedana (severe pain), Manda Kandu (itching), and Saraga Pidika (red patches). Vipadika can be correlated to Palmoplantar psoriasis, which is a prevalent chronic inflammatory skin disorder characterized by erythematous plaques affecting the palms and soles significantly impairing daily function and quality of life. Ayurvedic management of Vipadika emphasizes Shamana Oushadhis aimed at pacifying aggravated Doshas , alleviating manifestations of Vipadika . Integral to this approach are Nidana Parivarjana and Pathya Ahara-Vihara Sevana to prevent recurrence. In the present case, a male patient with complaints of dryness, itching, cracking, scaling, and hyperpigmentation of skin of bilateral feet and bleeding from cracks for the last 6 months came to Kayachikitsa OPD and was diagnosed and treated as Vipadika with the Shamana Oushadhis. The patient's condition demonstrated a substantial improvement, with a marked reduction in symptoms evident within 21 days, suggesting effective management of Vipadika through Ayurveda . Key words: Vipadika, Kshudra Kustha, Palmoplantar Psoriasis, Shamana Oushadhi.

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Sinsha A.S. et al. Ayurvedic management of Vipadika ISSN: 2456-3110 CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 248 from 0.44 -2.8% and is commonly affecting individuals in their third or fourth decade, with males being affected twice as frequently as females [7] The palmoplantar variant of psoriasis constitutes 3 -4% of all psoriasis cases, affecting 2 -5% of the population [8] In contemporary medicine, Palmoplantar Psoriasis is typically managed with corticosteroids, topical therapies, vitamins, and immunomodulators, but recurrence remains a persistent issue. Ayurvedic management of Vipadika , involves Shamana Oushadhis aimed at calming aggravated Doshas, alleviating symptoms like itching, pain, and inflammation, promoting skin health, preventing recurrence, and emphasizing strategies such as Nidana Parivarjana (avoidance of causative factors) and Pathya Ahara-Vihara Sevana (appropriate diet and lifestyle practices) to avoid relapse. Patient Information A 42-year-old male patient came to Kayachikitsa Outpatient Department (OPD) of Gopabandhu Ayurveda Mahavidyalaya & Hospital, Puri in February 2024 with complaints of dryness, itching, cracking, scaling, and hyperpigmentation of skin of bilateral feet and bleeding from cracks for the last 6 months. There was itching and pain which was continuous throughout the day. The patient had developed watery discharge in cracks along with bleeding. The lesions were bilaterally symmetrical. History of the patient Past History - No specific history was found. Family history - No family history found. On general examination the patient is moderately nourished having blood pressure: 110/80 mm/hg with normal temperature, pulse, and respiratory rate. Other parameters like pallor, icterus, central cyanosis, digital clubbing, edema, and local lymphadenopathy were absent on examination. On physical examination, the patient was found anxious, with a loss of appetite and a constipated bowel with a coated tongue. Micturition was normal and sleep was disturbed. The patient has a height - of 173 cm & weight - of 74 kg. Habits: Spicy, oily food, Tea (2 times/day) Clinical Findings Ayurvedic Examination Table 1: Nidana Panchaka Nidana Purva Rupa Rupa Samprapti Upashaya Katu, Snigdha, Guru, Abhishyand i Ahara, Vatavardh aka Ahara, Divaswapn a, Kandu Pada sphutan a, Teevra Vedana, Kandu, Daha Nidana Sevana (Aharaja, Viharaja, Manasika ) ↓ Causes Agnimandya ↓ Tridosha Prakopa along with Rasa, Rakta, Mamsa, Lasika Dushti ↓ Sanga and Vimargaga mana of Dosha ↓ Sthanasams hraya in Pada Symptoms subsided after taking Shamana Oushadhis Kushta Samprapti Ghataka ▪ Dosha: Vatakaphaja (Vata Pradhana Tridoshaja) ▪ Dushya: Rasa, Rakta, Mamsa, Ambu, Twak ▪ Srotas: Rasavaha, Raktavaha, Swedavaha ▪ Srotas Dusti: Sanga, Vimarga Gamana ▪ Adhisthana: Ama Pakwashaya ▪ Vyaktasthana: Twak, Dwipadatala ▪ Sanchara Sthana: Raktavaha Srotas

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Sinsha A.S. et al. Ayurvedic management of Vipadika ISSN: 2456-3110 CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 249 ▪ Rogamarga: Bahya Table 2: Dashavidha Pareeksha Table 3. Ashtavidha Pareeksha Nadi Vata Pitta Mala Badha Mutra Prakrita Jihwa Lipta Shabda Prakrita Sparsha Ushna Drik Prakrita Akruti Madhyama Modern Examination of Skin A. Inspection Color: Erythema and Hyperpigmentation Texture: Rough, Dry, Scaly Lesions Erythmatous Plaques Distribution: symmetric and localized to dorsal and plantar regions of both feet Other: Fissures and erosions on the soles of both feet B. Palpation: Moisture: Dry Temperature: Warmth to touch Tenderness: Present especially on Pressure Texture: Rough Induration: Present Diagnosis and Assessment Based on clinical history and examination the condition was diagnosed. Table 4: Assessment of Subjective Criteria Padasphutana No cracks Cracks on heels only Cracks on heels and plantar aspect Cracks on complete foot 0 1 2 3 Vedana No pain Pain after pressing Pain on touch Pain without touching 0 1 2 3 Kandu No itching 1-2 times a day Frequent itching Itching disturbs the sleep 0 1 2 3 Daha (burning sensation No burning sensation Burning during itching Continuous Burning 0 1 2 Therapeutic Intervention Table 5. Therapeutic administration SN Medicine Dose/ mode of administration Anupana Schedule 1. Mahamanjisthad i Kwatha 15 ml Oral 30 ml Lukewarm water Twice a day before food Prakruti Vata Pittaanubandhi Vikruti Rasa, Rakta, Mamsa, Twak, Ambu Sara Avara Samhanana Madhyama Pramana Madhyama Satva Avara Satmya Sarva Rasa, Katu Pradhana Aharashakti Madhyama Vyayamashakti Avara Vaya Madhyama

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Sinsha A.S. et al. Ayurvedic management of Vipadika ISSN: 2456-3110 CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 250 2. Panchatiktaka Ghrita Guggulu 500 mg 2 tab Oral Lukewarm water Twice a day after food 3. Arogyavardhini Vati 500 mg 2 tab Oral Lukewarm water Twice a day before food 4. Gandhaka Rasayana 125 mg 1 tab Oral Luke warm water Twice a day after food 5. Jeevanthyadi Yamaka Sufficient quantity/Externa l - - 6. Sidharthaka Yoga Sufficient Quantity/Externa l washing Parisheka - Follow-up and outcomes Table 6. Follow up and outcome according to Subjective Criteria Features Before treatment After followup (1 week) After 2 nd followup (2 weeks) After 3 rd followup (3 weeks) Padasphutana 3 3 2 1 Vedana 3 2 1 0 Kandu 3 2 1 0 Daha (burning sensation 2 1 0 0 Figures 1: Before Treatment Figures 2: After 1 week of treatment Figures 3: After 2 weeks of treatment Figures 4: After 3 weeks of treatment DISCUSSION Vipadika is a Vata Kaphaja predominant, Kustha Roga characterised by symptoms like Sphutana (cracks or fissures in the skin), Vedana (pain), Kandu (itching,), etc. typically affecting Pani or Pada [9] In this condition, there is the involvement of mild Pitta Dosha , along

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Sinsha A.S. et al. Ayurvedic management of Vipadika ISSN: 2456-3110 CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 251 with specific Vata and Kapha Dosha . The predominant Lakshanas of Sphutana and Vedana are due to Vata Dushti, Kandu is linked to Kapha Dushti and mild Daha is associated with Pitta Dushti . Acharya Charaka highlights that the treatment of Kustha should be aligned with specific Lakshanas according to the Doshas [10] In the conventional medicine, the management of palmoplantar psoriasis is often limited. Research highlights the role of the immune system, inflammatory cascade, cytokines, and keratinocytes in its pathogenesis, with cytokines playing a crucial role in disease progression, resulting in a cytokine storm [11] Therefore, a multifaceted Ayurvedic approach is essential to effectively target the complex pathways involved and manage the disease's chronic and relapsing nature . Manjisthadi Kashayam consists of drugs predominantly possessing Laghu , and Ruksha Gunas , promoting Kledashosha (reduction of excess moisture) due to its Tikta and Kashaya Rasa . The formulation balances Pitta and Kapha Doshas , facilitating Ama Pachana, Agnidipana , and Rakthasodhaka , thereby supporting Rakta Prasadana and acts primarily on the Rasa, Rakta , and Mamsa Dhatus [12] Panchatikta Ghrita Guggulu contains ingredients with Tikta Rasa , Laghu , and Ruksha Guna , making it effective in Kandu, Kledameda Upashoshana , and Vranashodhaka properties. Guggulu , characterized by its Katu, Tikta, Kashaya, Madhura Rasa, Ushna Veerya, and Katu Vipaka properties, effectively targets Vikruta Kleda, Meda, and Mamsa Dhatu . According to Rasaratnasamucchaya, Arogyavardhini Vati acts as a Rasayana and Kusthanashaka , while also serving as a Pathya, Dipana, Pachana, Medanasaka, Malashuddhikara and Sarvarogaprasamani Arogyavardhini acts as Srotoshodhahara and helps in the healing of Vipadika by reducing the dryness and pain [13] Gandhaka Rasayana, through its properties as Agnideepaka, Amapachaka, Amanashaka , Vishahara, Soshaka , and Kriminashaka , plays a crucial role in addressing Kustha Nidana and Samprapti alleviating Dushita Kapha and Visha . Gandhaka Rasayana acts as a Dahanashak , Raktaprasadak , enhances Dhatvagni, Rasayana and reduces Kleda with its Ruksha and Laghu properties [14] Jivantyadi Yamaka with the Snigdha Guna of Jeevanti, Goghrita , Tila Taila , and Madhucchista balances Vata and prevent Rukshata in Vipadika . Its Vrana Shodhana and Vrana Ropana properties from Daruharidra, Kampillaka, Tilataila, Sarjarasa , and Manjistha reduce Padasphutana , while Go-Dugdha act as Rasayana . Tuttha and Daruharidra alleviate Kandu , and Kampillaka, Tilataila, and Sarjarasa reduce Vedana and Daha through their Pittaghna properties [15] Parisheka with Siddharthaka Yoga Kashaya [16] is effective as the procedure is suitable for Tridosha e specially in Vata Kapha predominant condition and is having Ushna Veerya, Laghu Ruksha Guna, Kusthaghna and Kandughna property which reduces Vipadika. Pathya Ahara Laghu Anna, Tikta Shaka, Purana Dhanya, Jangala Mamsa, Mudga, Patola, Purana Shali, Shashtika Shali, Yava, Godhuma , food and ghee prepared by Triphala, Nimba, Khadira Jala Pana and Aushadha Samskruta Takra. Pathya Vihara Abhyanga with Karanja Taila, Parisheka, Avagaha with Khadira Kashaya, Brahmacharya. Apathya Ahara & Vihara Guru Anna, Amla Rasa, Dugdha, Dadhi, Matsya, Guda, Tila, Mamsa, Taila, Adhyasana, Ajirnasana, Vidahi - Abhishyandi Ahara, Divasvapna, Maithuna , Vegadharana, Paapa Karma, Tapa Sevana Svedana , Walking bare foot, excessive walking, exposure to mud, dust, water, winter season. CONCLUSION In Ayurveda, Vipadika is categorized under Kshudra Kustha, characterized by Panipada Sphutana / Teevra Vedana, Kandu, Saraga Pidaka and Daha . The pathogenesis involves the disturbance of Vata and Kapha Doshas , leading to the Khavaigunya associated with Twak (skin), Rakta (blood), Mamsa (muscles), Ambu (plasma). Kustha , a disease of Bahudosha, Bhuridosha and ‘ Saptakodravyasangraha’ is to be treated by adopting repeated Shamana Chikitsa i.e.,

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Sinsha A.S. et al. Ayurvedic management of Vipadika ISSN: 2456-3110 CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 252 Bahirparimarjana and Antahparimarjana Chikitsa . The case report highlights the effectiveness of Ayurvedic therapies in reducing the severity of symptoms and improving the patient's quality of life with Shamana Chikitsa. Patient Consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has consented to report his images and other clinical information in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. REFERENCES 1 Vagbhata. Astanga Hridayam of Srimadvagbhata, Nidanasthana Adhaya 14/23. Edited by Tripathi BB. Varanasi: Chaukhamba Sanskrit Pratishthan; 2013. 2 Yadavji Trikamji, editor. Sushruta Samhita of Sushruta, Nidanasthana; Kshudraroga Nidana Adhyaya: Chapter 13, Verse 29. 6 th ed. Varanasi: Chowkambha Orientalia; 1997. p. 321. 3 Shrivastav P, Dasar D, Parwe S, Nisargandha M. Management of Vipadika (Palmoplantar Psoriasis) through Nitya Virechana and Shaman Chikitsa: A case report. J Indian Sys Med. 2023;18:563-76. 4 Basotra S. Evaluate the efficacy of Virechana Karma and Lepa in Vicharchika. Rajiv Gandhi University of Health Sciences; 2014. 5 Kimmel GW, Lebwohl M. Psoriasis: Overview and diagnosis. Evidence-Based Psoriasis. 2018 Jul;1 – 16. 6 Miceli A, Schmieder GJ. Palmoplantar psoriasis. Treasure Island (FL): StatPearls Publishing; 2022. 7 Dogra S, Yadav S. Psoriasis in India: Prevalence and pattern. Indian J Dermatol Venereol Leprol. 2010;76:595 – 601. 8 Khandpur S, Singhal V, Sharma VK. Palmoplantar involvement in psoriasis: A clinical study. Indian J Dermatol Venereol Leprol. 2011;77:625. 9 Charaka. Charaka Samhita (Chakrapani Hindi Vidyotini Commentary). Edited by Narayan Shastry. Varanasi: Chaukhamba Sanskrit Sansthan; 2012. p. 253. 10 Baliwag J, Barnes DH, Johnston A. Cytokines in psoriasis. Cytokine. 2015;73:342 – 50. 11 Kundra L, Verma P, Dharmarajan P, Bhatted SK. A case study on Ayurveda interventions in lipodermatosclerosis. J Indian Sys Med. 2020 Jul;8(3):217. 12 Deva S. A case study on the management of Kitibha Kushta (Psoriasis) with Virechana, Dhanyamla Dhara, and Takra Dhara. IJAM. 2023;13(1):185-90. 13 Lokhande S, Patil S, Parshurami S. Efficacy of Panchatikta Ghrit Guggul in the management of Mandal Kushtha with special reference to psoriasis. Int J Res Ayurveda Pharm. 2016;7:94-96. 14 Madduru MH, Jadar PG. A review on the probable mode of action of Gandhaka Rasayana - An Ayurvedic herbomineral formulation with multifaceted action. Int J Ayurveda Pharma Res. 2024;12(2):173-79. 15 Raghuwanshi B, Ade VN. Comparative study of Jeevantyadiyamaka Lepa and Vipadikahar Lepa in the management of Vipadika. Int J Ayurvedic Med. 2020;11(4):650-5. 16 Roy B. Clinical efficacy of Sarvanga Parisheka in Eka- Kushta w.s.r. to Psoriasis. Int Ayurvedic Med J [online]. 2023 [cited July 2023]. ******************************* How to cite this article: Sinsha A.S, Rashmita Tiga, Pragya Priyadarsini Mallik, Sonalika Jena. Ayurvedic management of Vipadika - A Case Report. J Ayurveda Integr Med Sci 2024;8:247-252. http://dx.doi.org/10.21760/jaims.9.8.37 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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