Ayurvedic Management of chronic Vitiligo (Shvitra): A case study

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57 Journal of Ayurvedic and Herbal Medicine 2018; 4(2): 57-59 Case Report ISSN: 2454-5023 J. Ayu. Herb. Med. 2018; 4(2): 57-59 © 2018, All rights reserved www.ayurvedjournal.com Received: 18-04-2018 Accepted: 07-07-2018 *Corresponding author: Dr. Rahul K Shingadiya Assistant Professor, Department of Rasashastra and Bhaishajya Kalpana including Drug Research, Institute for Post Graduate Teaching & Research in Ayurveda (IPGT & RA), Gujarat Ayurved University (GAU), Jamnagar- 361008, Gujarat, India Email: shingadiyarahul[at]yahoo.in Ayurvedic Management of chronic Vitiligo ( Shvitra ): A case study Rahul K Shingadiya 1 , Jasmin K Gohel 2 , Suhas A Chaudhary 3 , Prashant Bedarkar 1 , BJ Patgiri 4 , PK Prajapati 5 1 Assistant Professor, Department of Rasashastra and Bhaishajya Kalpana including Drug Research, Institute for Post Graduate Teaching & Research in Ayurveda (IPGT & RA), Gujarat Ayurved University (GAU), Jamnagar-361008, Gujarat, India 2 Assistant Professor, Department of Shalya Tantra, Manjushree Research Institute and Ayurvedic Science, Pipalaj, Gandhinagar-382610, Gujarat, India 3 Research Officer (Scientist 1), Regional Ayurveda Research Institute for Infectious Diseases, CCRAS, Sadikpur, Patna- 800007, Bihar, India 4 Professor and Head, Department of Rasashastra and Bhaishajya Kalpana including Drug Research, Institute for Post Graduate Teaching & Research in Ayurveda (IPGT & RA), Gujarat Ayurved University (GAU), Jamnagar-361008, Gujarat, India 5 Dean and Professor, Department of Rasashastra and Bhaishajya Kalpana including Drug Research, Institute for Post Graduate Teaching & Research in Ayurveda (IPGT & RA), Gujarat Ayurved University (GAU), Jamnagar-361008, Gujarat, India ABSTRACT Vitiligo is a common autoimmune pigmentary disorder of great socio-medical importance. It is characterized by white spots appeared on the skin due to melanocytes deficiency. It can be correlated with Shvitra in Ayurveda. Due to side effects and limitation of the contemporary science, some harmless and effective medicines are expected from Alternative medical sciences. Ayurveda has great potential to treat such autoimmune skin diseases. Here a case of chronic vitiligo treated with Ayurvedic management is recorded. Keywords: Autoimmune, Kanakabindwarishta , Savarnakara Yoga , Skin diseases. INTRODUCTION Vitiligo is a chronic disfiguring disease involved with systemic autoimmune process. It is characterised by constrained, idiopathic, progressive, hypo-pigmented or white patches of skin [1] Prevalence of Vitiligo is 1% all over the world, while its incidence ranges from 0.1 to > 8.8% [2] It can be co-related with Shvitra disease in Ayurveda due to the identical signs and symptoms which are; non exudative white, red or coppery-red colored patches, roughness, dryness, itching, burning sensation of the patches, loss and discoloration of the hair. Generally it is found that Vitiligo develops with unknown causes. Several environmental factors affect the melanocytes of the patient and initiate the processes of malenocytosis. This leads to melanocytes deficiency and ultimately white coloured patches appears on the body [3] In modern science, mainstream treatment of disease is PUVA (Psoralen + Ultra Voilet A exposure) therapy and corticosteroids which have many harmful side effects like skin cancer, photo aging, ultraviolet light burns and nausea [4] Traditional medicines may be alternative of these unsatisfactory and harmful approaches and may provide some safe, easier, less complicating, cost effective and fruitful natural remedies for the disease. Ayurveda comprise so many potent formulations for the treatment of such autoimmune disease with chronic nature [5] Here a case of female patient suffering from chronic Vitligo was treated with Ayurvedic therapy along with Diet restriction and psychological counselling . CASE REPORT 50 years old married female was presented with history of white patches on hands, abdomen, back and chest, with mild itching over affected area and gradual increment since 10 years. The disease was in active stage and new spots were increasing gradually. Family history in first degree relation was negative. There was no personal history of autoimmune disorders (like Atopic dermatitis, psoriasis, Asthma, etc). There was no personal history of trauma or surgery, any major psychological disorder, endocrinal disorder (Diabetes), or any history of treatment from psychiatrist. She had menopausal history for last 3 years. She had allopathic medication history for last five year including corticosteroid, and multivitamins internal and PUVA and external applications. She had found some improvement in starting phase of the treatment, but then there was no progress in that condition for last three years. Hence, on the advice of her neighbor, she had come

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J Ayu Herb Med ǀ Vol 4 Issue 2 ǀ April- June 2018 58 for Ayurvedic medication. There were white patch measuring about 3 x 2 cm, 3 x 2 cm and 4 x 3 cm on left arm posterior region, left forearm posterior region and left carpus anterior region respectively. There were multiple small spots on hands, neck, abdomen and back. The spots and patches were asymmetric, well defined whitish and without scaling. Routine urine, haematological and biochemical parameters were also carried out. S. Triglyceride was 203 mg/dl. Rest of all parameters were found within the normal limit. (Table 1) The patient was clinically diagnosed as case of Shvitra (Vitiligo) and planned to enroll in clinical trial of Savarnkara yoga ointment [6] The patient was taking faulty diet in form of milk with meal containing salt at morning and at night regularly which was stopped during the study. She was taking excessive sweet, sour and food which was heavy to digest. It was advised to avoid these things. Patient was having the habits of day sleep (2 and ½ hrs after 30 minutes after meal) and night awakening. Mental affliction was found inform of anxiety and depression. Proper psychological counselling was carried out and advised for Yoga and Pranayam . The patient was prescribed Savarnakara Yoga [7] in ointment form once in a morning followed by sun exposure for 15 to 30 minutes. Internally, Kanakabindwarishta [8] was prescribed in dose of 10 ml twice a day after meal with equal quantity of water. On 14 th day of treatment (10 th day of local application), Patient had complaint of slight itching and burning after application of Savarnakara Yoga . Slight redness was observed over applied area. Sarjarasa Malahara was prescribed for local application followed by Savaranakara Yoga and found relief in itching and burning. After two months, skinny spots were found appeared between the white patches of hands, back and abdomen and small spots were become slight pink. Savaranakara Yoga and Kanakabindwarishta was stopped and Rasayana Churna (2 gm) was started for one month as follow up period. No recurrent patches were observed in this period and pink colour was persisting in the spots and patches. After completion of three month study period of clinical trial, it was planned to continue the medication for getting complete relief. Hence , Savaranakara Yoga was started again for local application and internally, combination of Arogyavardhini rasa [9] (250 mg), Rasayana Churna (2 gm) and Vindanga Churna ( Embelia ribes Burm. F ) [10] (1 gm) was prescribed with honey before meal twice a day. Manjishthadi Kwatha (20 ml) was prescribed twice a day. After six months, patches decreased to almost half of the initial and some of the spots found disappeared. After 10 months, patches of left arm and forearm decreased to 1 x 1 cm and on corpus, it was found decreased to 2 x 1 cm. After 12 months, small spots were found almost decreased, while after 16 month, patches of left arm and forearm disappeared and patches of left corpus remained 1 x 1 cm. (Figure 1) Patient was followed for next six months and found no any recurrence. Table 1: Haematological and Biochemical Parameters of the patient Haematological Parameters Before treatment After treatment Biochemical Parameters Before treatment After treatment TLC 9,500/Cumm 8,400/Cumm FBS 94 mg/dl 94 mg/dl Neutrophils 63% 65% S. Cholesterol 188 mg/dl 167 mg/dl Lymphocytes 33% 34% S. Triglyceride 203 mg/dl 145 mg/dl Eosinophils 02% 01% HDL Cholesterol 56 mg/dl 69 mg/dl Monocytes 02% 02% Blood Urea 24 mg/dl 20 mg/dl Basophils - - S. Creatinine 0.8 mg/dl 0.9 mg/dl Haemoglobin 12.9 gms% 13.1 gms% S.G.P.T. 14 IU/L 14 IU/L P.C.V. 37.8% 37.8% S.G.O.T. 22 IU/L 20 IU/L E.S.R. 42 mm/hr 32 mm/hr Total Protein 7.5 gm/dl 7.5 mg/dl Total RBC Count 4.78 mil/Cumm 4.87 mil/Cumm Albumin 3.8 gm/dl 3.5 mg/dl Platelet Count 356×10 3 /ul 340×10 3 /ul Globulin 4.0 gm/dl 3.7 mg/dl Table 2: Prescribed Medicines and their Pharmacological actions and therapeutic indications No Medicines Dose with Anupana Pharmacological actions Therapeutic indications 1 Savarnakara Yoga ( Bakuchi , Haratala and Gomutra ) Quantity sufficient for local application in morning followed by sun exposure for 30 minutes - Shvitra (Vitiligo) 2 Kanakabindwarishta 10 ml twice a day after meal Immunomodulatory , Anti-inflammatory Kushtha (Skin dissorders) , Shvitra 3 Rasayana Churna 2 gm twice a day before meal with honey Anti-depressant and anxiolytic activity Anxiety, Depression 4 Manjishthadi Kwatha 20 ml twice a day (early morning empty stomach, at night before meal) Rakta shodhaka (Blood purifier) Vartarakta (Gout), Pama (Eczema), Kapalika, Kushtha , Rakta mandala (Skin dissorders) 5 Arogyavardhini Rasa 125 mg twice a day before meal with honey Antioxidant, Antihyperlipidemic, hepatoprotective Jirna Jwara (Chronic fever), Medodosha (Disorder of adipose tissue), Kushtha , Yakrutvikara (Disorder of liver) 6 Vidanga Churna 1 g twice a day before meal with honey Antioxidant, Neuroprotective, Cosmetic agent, Wound healing, Antigenotoxicity, Antifungal, Antidepressant Krimi, Adhmana

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J Ayu Herb Med ǀ Vol 4 Issue 2 ǀ April- June 2018 59 Figure 1 : a,c,e shows before treatment and b,d,f shows after treatment DISCUSSION Among the main ingredients of Savarnakara Yoga , Bakuchi ( Psoralea corylifolia Linn.) is a renowned herb with many therapeutic properties [11] It contains psoralens, which on exposure to the sun bring out melanin in the depigmented lesions [12] Haratala (Orpiment), an arsenic compound, was used in the yoga along with Bakuchi . Haratala is best owed with immune modulating properties. Its formulations are widely used for some autoimmune disorders like psoriasis, allergic bronchial asthma, etc. in which the etiopathogenesis is deranged immunity [13] Arsenic is absorbed through skin in addition to other routes. In Shvitra , the deranged immune system destroys the pigment synthesizing melanocytes. Haratala breaks this pathogenesis and prevents the self ‑ destruction of melanocytes [12] Thus the effect of the formations may be due to increased immunostimulation, hepatic function and photo reaction. Kanakabindvarishta is a self generated alcoholic medicinal formulation. These typeof formulations have been reported to be effective in many diseases including Skin disorders [14] By their properties they help the drug to reach the site quickly and remove the obstruction of Srotasa [15] Manjisthadi kashaya is mainly blood purifier. It detoxifies blood and aids to eliminate toxins accumulated in the body. It increases skin glow. Combination of Arogyavardhini Rasa, Rasayana Churna and Vidanga causes Apatarpan , which helps in opening the blockage of strotasa. Guduchi and Amalaki are rasayana drugs which help in rejuvenation process. This combination is helpful in removal of excessive fat and reduces the amassed cholesterol in the body. It is also helpful to flush out various toxins from the body. It corrects digestive fire ( Agni ), unblocks 0 body channels for the nutrients to reach to the tissues ( Strotasa ), and balances three fundamental bodily bio-elements ( Tridosha ) Psychological involvement has been found in pathogenesis and aggravation of Shvitra [16] Hence, diet restriction and psychological counselling were also found helpful in the management of the disease. CONCLUSION The patient suffering from chronic active Vitiligo was treated with Ayurvedic management. Diet restriction and psychological counselling was also a necessary part of the treatment. This treatment protocol should be clinically evaluated on large number of patients to confirm their efficacy. REFERENCES 1 Vitiligo. Problems and Solutions Lotti T. & Hercogova J. , Editors, Marcel Dekker, Inc., New York (NY), 2004. 2 Srivastava G. Vitiligo- Introduction Asian Clinic. Dermatol 1994; 1:1-5. 3 Lotti T. Pigmentary Disorders, Dermatologic Clinics, 2007; Vol. 25(3). 4 Puva Therapy. Facts About Side Effects of Treatment [Last assessed on 2015 Nov 1] Available from http://www.medicinenet.com/ puva_therapy_photochemotherapy/article.htm. 5 Shingadiya RK, Sharma R, Bedarkar P, Prajapati PK. Autoimmune bullous skin disease managed with ayurvedic treatment: A case report. Ancient Sci Life 2017; 36:229-33. 6 Shingadiya RK, Chaudhary SA, Prajapati PK. Clinical Efficacy Of Savarnakara Yoga And Kanakabindvarishta In The Management Of Shvitra (Vitiligo). Journal of Research and Education in Indian Medicine. 2017; 23(2):91-99. 7 Shingadiya RK, Joshi K, Shukla VJ, Prajapati PK. Pharmaceutical and analytical profiles of Savarnakara Yoga. J Ayu Herb Med. 2016; 2(3):73-77. 8 Shingadiya RK, Dhruve K, Shukla VJ, Prajapati PK. Standard manufacturing procedure and quality parameters of Kanakbindvarishta. International Journal of Herbal Medicine. 2015; 3(1):33-36. 9 Anonymous. The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I, 2000; 20(4):664-5. 10 Anonymous. The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, part I, vol 1(77):209-11 11 Bhava Prakasha of Sri Bhavamishra by Brahmasankara Mishra and Rupalalji Vaisya. Part 1, 11 th ed. Varanasi, Chowkamba Sanskrit Series; Bakuchi, Haritakyadi Varga. 2002, p.123 ‑ 4. 12 Ajay Dhanik, Sujatha N, Rai NP. Clinical evaluation of the efficacy of Shvitrahara kashaya and lepa in vitiligo, AYU 2011; 32(1):66-9. 13 Sahara Shrestha, Shingadiya RK, Bedarkar PB, Patgiri BJ. Critical review of Bhaisajya ratnavali with special reference to Haratala. Int. J. Res. Ayurveda Pharm. 2017; 8(4):11-18 14 Shingadiya RK, Chaudhary SA, Bedarkar PB, Patgiri BJ, Prajapati PK. Clinical efficacy of fermentative medicinal formulations (Asavaarishta) - a review. European journal of pharmaceutical and medical research. 2015; 2(7):131- 138. 15 Susruta, Sushruta Samhita with commentary of Dalhana, by Vaidya Jadava JI Trikamji Acarya, Chaukhambha Orientalia; Varanasi. 7 th ed. Sutra Sthana 45/194, 2002, p. 211. 16 Shingadiya RK, Bedarkar PB, Patgiri BJ, Prajapati PK, Manani Y. Incidence of psychological stress as an etiological factor of skin disorders- A review through Ayurvedic clinical researches. International Journal of Pharma Sciences and Research (IJPSR). 2017; 8(10):188-194. HOW TO CITE THIS ARTICLE Shingadiya RK, Gohel JK, Chaudhary SA, Bedarkar P, Patgiri BJ, Prajapati PK. Ayurvedic Management of chronic Vitiligo ( Shvitra ): A case study. J Ayu Herb Med 2018;4(2):57-59.