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2 RESEARCH ARTICLE Impact Factor (2014) by International Scientific Indexing (ISI) UAE A CLINICAL STUDY ON THE MANAGEMENT OF VICHARCHIKA (ECZEMA) BY PANCHATIKTA GHRITA GUGGLU AND LEPA OF GAIRIKA Gaikwad Madhavi Dattatray 1*, Deshmukh Avinash Madhav 2 1. Assistant Professor, Dept. of Rognidan and Vikrutivigyan, C.S.M.S.S. Ayurved College, Aurangabad, Maharashtra, Contact No , madhavigaikwad17@gmail.com 2. Associate Professor, Dept. of Rognidan and Vikrutivigyan, C.S.M.S.S. Ayurved College, Aurangabad, Maharashtra, Contact No , avimdeshmukh@gmail.com Article Received on - 9 th Jan 2015 Article Revised on - 12 th Jan 2015 Article Revised on - 29 th Jan 2015 Article Accepted on - 18 th Feb 2015 All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non commercial purpose (see copyright notice below). (Full Text Page IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3 RESEARCH ARTICLE A CLINICAL STUDY ON THE MANAGEMENT OF VICHARCHIKA (ECZEMA) BY PANCHATIKTA GHRITA GUGGLU AND LEPA OF GAIRIKA *Corresponding Author Gaikwad Madhavi Dattatray Assistant Professor, Dept. of Rognidan & Vikrutivigyan, C.S.M.S.S. Ayurved College, Aurangabad, Maharashtra, Contact No , madhavigaikwad17@gmail.com QR Code IJAAM ABSTRACT: All skin diseases can be included under the umbrella of kustha roga. Vicharchika is a variety of kshudra kustha. The features of eczema are somewhat similar with that of vicharchika mentioned in ayurveda. Symptoms of vicharchika mentioned by Charaka correlate with wet eczema & symptoms mentioned by Susruta correlate with dry eczema. Due to its chronic and recurrent nature, it has a great impact on the quality of life of the patients. The present study was aimed to compare the effect of Panchatikta Ghrita Gugglu tablets along with local application of lepa containing Gairika mixed with Karanja Tailam in patients of dry and wet eczema (vicharchika). For this study, selected patients were divided into two groups-dry group & wet group. 17 patients were registered under dry group and 20 patients were registered under wet group. The duration of the study was 1 month with follow up for 15 days. Dry group showed highly significant results in all signs and symptoms. Insignificant results were recorded in wet group for shrava, vaivarnya and raji, so it was concluded that trial formulation is quite effective in management of dry eczema (vicharchika). Key Words: Kustha, Vicharchika, Dry Eczema, Wet Eczema, Panchatikta Ghrita Gugglu, Gairika, Karanja Tail. INTRODUCTION Skin is the largest protective organ of the body. A healthy skin is the mirror image of a good health. The colour of the skin is important biologically, cosmetically and socially. The unbroken skin is the nature s dressing over the body. It acts as an effective barrier against the entry of diseases. Skin diseases though afflicts bodily but gives lot of psychological conflicts and can harm affected individual in a number of ways like discomfort, disfigurement, disability and death. Though the disease, vicharchika is not a life threatening, it makes the patient worried due to its appearance, severe itching, disturbing routine and its chronic nature. Almost all the scholars of Ayurveda of modern era consider vicharchika as eczema in modern parlance. Vicharchika is described under kshudra kustha in ayurvedic textual also mentioned as a curable disease, yet the relapsing nature of this disease makes it much harassment for patient and troubles some for physician too. Vicharchika as considered by Charaka, the ancient medical authority, is characterized by kandu (itching), shyavapidika (skin eruption with dark discolouration), bahusrava (profuse discharge) involving the domination of kapha which correlates wet eczema. [1] Whereas Sushruta, the father of surgery has mentioned the symptoms as rajyo (thickening of skin), atikandu, ruja (pain) and rukshata (dryness of skin) involving the domination of pitta which correlates dry eczema. [2] A similar clinical presentation in modern dermatology is seen eczema which is defined as a non-contagious inflammation of the skin characterized by erythema, scaling, oedema, vesiculation and oozing. Eczema, or dermatitis, is a reaction pattern that presents with variable clinical and histological findings and is the final common expression for a number of disorders, including atopic dermatitis, allergic contact and irritant contact dermatitis, dyshidrotic eczema, nummular eczema, lichen simplex chronicus, asteatotic eczema, and seborrheic dermatitis. Primary lesions may include papules, erythematous macules and vesicles, which can coalesce to form patches and plaques. In severe eczema, secondary lesions from infection or excoriation, marked by weeping and crusting, may predominate. Long-standing dermatitis is often dry and is characterized by thickened, scaling skin (lichenification). Eczema is a specific type of an antigen-specific immune response and results due to an antigen-antibody reaction. It is resultant of delayed type hypersensitivity mediated by memory T lymphocytes in the skin and the clinical lesions may be acute (wet and oedematous) or chronic (dry, thickened and scaly) depending on the persistence of the insult. [3] The modern treatments given for eczema have their own limitations and side effects. The trial formulation Panchtikta Ghrita Gugglu used for internal therapy is taken from the reference found in Bhaijyaratnavali [4] and the fine powder of Gairika [5] mixed with Karanja Tail [6] used for local Page22

4 application is anubhuta yoga (non-classical formulation). The same trial drugs used in both dry and wet group. Considering all these points, the present study was planned with the aim to evaluate the role of above trial drug in the management of wet and dry eczema. Aim and Objectives 1. To find out an easily available and considerably low cost, safe and effective remedy for the treatment of vicharchika. 2.To evaluate the clinical efficiency of Panchatikta Ghrita Gugglu orally and the fine powder of Gairika mixed with Karanja tail used for local application in the management of dry and wet eczema. 3. To compare the effects of above mentioned therapy on dry and wet eczema. 4. To ascertain different clinical aspect of vicharchika described in Ayurveda as well as modern medical science. Inclusion Criteria 1. Age yrs, irrespective of sex, religion, socioeconomic status. 2. The patients having the classical signs and symptoms of Vicharchika (both dry and wet) described in Ayurvedic classics. 3. Duration of lesion less than 1 year. Exclusion Criteria- 1. Age less than 16 years and more than 70 years. 2. The lesion which is infected and having p collection or secondary infection. 3.Known cases of systemic disease like Diabetes Mellitus, Cancer, AIDS,TB etc and other skin diseases like scabies, psoriasis, lichen simplex chronicus etc. Materials and Methods- For the present study, after institutional ethical committee clearance, the patients having the symptoms of vicharchika were randomly selected from OPD of Rog nidan dept. R.A. Podar Ayurved College, worli, mumbai. A special proforma was made for assessing all the patients. Grouping Diagnosed patients were divided into two groups. 1. Dry Group patients with dry lesion (dry eczema) 17 patients registered under this group. among them 6 patients discontinued the treatment. No. of. patients 17 Completed patients 11 Drop out patients 6 2. Wet Group patients with wet lesion (wet eczema) 20 patients registered under this group. among them 7 patients discontinued the treatment. 20 Completed patients 13 Drop out patients 7 The patients of both groups were administered internally Panchatikta Ghrut Gugglu tablets in a dose 2 tablets of 500 mg twice a day after meal with lukewarm water and fine powder of Gairika mixed with Karanja Tail used externally for local application. Required quantity as per the area of distribution of the lesion, the lepa was used. Duration of the study One month. Follow up was done for 15 days after the completion of the treatment. Criteria for assessment The following criteria or variables were assessed before and after the drug administration- 1) Kandu (itching) 2) Pidika (skin eruption) 3) Shrava (profuse discharge) 4) Vaivarnya (depigmentation) 5) Raji (lichenification) 6) Rukshata (dryness) Laboratory Investigations- 1. Routine hematological investigations- Hb%, TLC, DC, RBC, ESR. 2. Urine Routine and Microscopic examination 3. Random blood sugar. Above examinations were carried out before and after treatment to rule out the other associated pathology as well as to assess and evaluate the effect of therapy. Dietary Restrictions The Patients were advised to follow the pathyapathya available in Ayurvedic literature for kustharog. [7] The Patient suffering from Vicharchika were advised to take following types of diet: Light and wholesome food, leafy vegetables having bitter taste, old (not freshly harvested) cereals, food preparations and medicated ghee prepared by boiling with bhallataka, triphala and nimba, meat of animals inhabiting arid land and preparations of mudga mixed with patola. Intake of heavy and sour food, milk, curd, excess salt, meat of animals inhabiting marshy land, fish, guda (jaggery) and tila (sesame) is prohibited for patients of vicharchika. Follow up A follow up study was carried out for fifteen days after completion of treatment. For this purpose, cardinal signs and symptoms were given scores Page23

5 according to their severity before and after the treatment. Statistical Analysis The information gathered on the basis of above observations was subjected to statistical analysis in terms of mean (X), standard deviation (S.D), standard error (S.E), paired T test were carried out at p<0.05,p<0.01 and p< The obtained results were measured according to the grades given below: Complete Remission -100% relief Marked Improvement -75%-99% relief Moderate Improvement -51%-74% relief Mild Improvement -25%-50% relief Unchanged -<25% or no relief OBSERVATIONS Table 1: Distribution of 37 registered patients Patients Total Completed patients Dropouts patients Total Table 2: Age wise distribution of 37 patients Age Group (years) Table 3: Sex wise distribution of 37 patients Sex Male Female Table 4: Habitat wise distribution of 37 patients Habitat Urban Rural Table 5: Desha wise distribution of 37 patients Desha Aanup Jagnal Sadharan Table 6: Ahara wise distribution of 37 patients Ahara Vegetarian Mixed Page24 Table 7: Recurrence of disease wise distribution of 37 patients Recurrence of disease Recurrence Present Recurrence Absent

6 Table 8: Dosha Lakshana wise distribution of 37 patients Dosha Lakshan Vata-Pitta Pitta-Kapha Kapha-Vata Tridosha Table 9: Rupa (signs and symptoms) wise distribution of 37 patients Desha Kandu Pidika Shrava Vaivarnya Raji Rukshata Table 10: Distribution of 37 patients according to Part involve Part involved Upper extremities Lower extremities Head, Neck, Face Abdomen(middle) Table No.11: Overall effect of Treatment in Dry Group Sr.No Symptoms BT AT X SD SE T P 1 Kandu (n=11) < Pidika (n=8) < Vaivarnya(n=11) < Raji(n=9) < Rukshata(n=11) <0.001 Table No.12 : Overall effect of Treatment in Wet Group Sr.No Symptoms BT AT X SD SE T P 1 Kandu (n=13) < Pidika (n=11) < Vaivarnya(n=13) > Raji(n=10) > Shrava(n=13) >0.001 Table No.13 % Relief in Dry Group Sr.No Symptoms % Relief 1 Kandu Pidika Vaivarnya Raji Rukshata Table No.14 % Relief in Wet Group Sr.No Symptoms % Relief 1 Kandu Pidika Vaivarnya Raji Shrava Overall effect in Dry Group % Overall effect in Wet Group % RESULTS The details of patients registered in dry group and wet group are given in table 1. Out of 37 patients registered, 11 patients in dry group and 13 patients in wet group completed the study. Maximum number of patients i.e, 56.76% were from the age group years, 56.76% were male, 78.37% patients were from the urban area, 75.68% patients were from the aanup desha, 64.87% patients were taking mixed diet. Recurrences of disease (vicharchika) were present in 70.27% patient. Page25

7 48.64% patients were of pitta-kapha dosha lakshana, 35.13% patients were of kapha-vata dosha lakshana % patients reported the lower extremities as the commonest site of involvement. Chief complaints reported were kandu, pidika, vaivarnya, raji in all patients. Shrava was found in wet group only and rukshta was found in dry group only. Kandu and vaivarnya were reported in100% patient (all patients), pidika was reported in 70.27% patients, raji was reported in 51.35% patients, shrava was reported in 54.05%, rukshata was reported in 45.95% patients. Highly significant results were found in all signs and symptoms of dry group. Whereas significant results were found in kandu and pidika of wet group and insignificant results were found in shrava, vaivarnya, raji of wet group. Insignificant results were found in laboratory parameter in both the group. In follow-up study, no recurrence was found in 90% patients of dry group and recurrence was noted in 10% patients at the end of 15 days. Paired t-test was applied on the cardinal symptoms. Significant difference was found between effects of therapies on both the groups which suggested that dry group showed equally good effect on all cardinal symptoms. Therapy was effective in kandu, pidika of wet group. Effect of Therapy - Overall effect of therapy in dry group was found 74.43% and in wet group was found 17.73%. Table No.15 Effect of therapy in symptoms of vicharchika in dry group and wet group of the patients selected for the study in percentage of patients showing improvement (Paired t test) Symptoms effect in dry group effect in wet group (in %) (in %) Kandu Pidika Vaivarnya Raji Rukshata Shrava Table No.16 Overall effect of therapy on patients enrolled in the study and divided into dry & wet group, in number of patients and corresponding percentage of patients showing varying degrees of improvement Effects dry group Number of Patients wet group Number of % Patients Complete Remission Marked Improvement Moderate Improvement Mild Improvement Unchanged % DISCUSSION Out of both groups, dry group showed improvement in all signs and symptoms. Insignificant results were found in wet group. Most of the patients had reported in the chronic stage of vicharchika. Negligence in the early stage of eczema is observed in patients. Relapsing nature of vicharchika is most common which suggest that long term intensive therapy is necessary for eradication of the disease. Panchatikkta ghrut gugglu orally and fine powder of gairika mixed with karanja tail used for local application is low cost, safe and effective remedy for the dry vicharchika. On the basis of history, maximum number of patients were having progressive tendency of disease and which is due to continuous irritation to the skin and may precipitate the disease in further progress. Maximum number of patients i.e, 75% felt more itching in lesion in winter and in 50% it aggravated due to food taken. Humid, cool atmosphere and spicy food is much responsible for skin disorders. Thus above data suggests that winter served excess dryness in the skin, which may have aggravated the eczematous condition. (Dry Vicharchika) In classics, many kusthahara single and compound preparations have been mentioned, but none of them has been specifically mentioned for oral use of vicharchika, therefore depending upon its Page26

8 symptoms and samprati a compound preparation named as Panchatikkta Ghrut Gugglu was selected for oral use. It contains number of drugs which have properties like kanduhara, kusthahara, vishahara, twakgami. The manifestation of eczema occurs in skin, where in the sensitivity of the local cells is disturbed. Further, ayurveda emphasizes on managing the sthana (place of the lesion), therefore Gairika mixed with karanja tail was selected for external use as lepa (local application on the lesion). It was anubhuta yoga (non-classical formulation). Gairika is well known rasadravya. Gairika and karanja tail have properties like kanduhara, varnaropak, raktaprasadan, vishahara, vicharchikanashak. CONCLUSION From above study it was concluded that Panchatikkta ghrut gugglu orally and gairika mixed with karanja tail for external application is choice of therapy for dry eczema (vicharchika) REFERENCES 1. Charaka, Charaka Samhita of Agnivesa Vidyotini hindi commentary by Kasinatha Sastri edited by Gangasahaya Pandeya, 4 th ed. Chaukhambha Sanskrit Sansthan Varanasi, India p Susruta, Susruta Samhita of Maharshi Susruta Ayurved- Tattva-Sandipika hindi commentary edited by Kaviraja Ambikadutta Shastri, 10 th ed. Chaukhambha Sanskrit Sansthan Varanasi,India p Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser S, Jameson JL, editors. Harrison s Principles of Internal Medicine. 16 th ed. New York, Chicago, New Delhi: McGrow-Hill; p Bhaisajyaratnavali Vidyotini hindi commentary by Kaviraja Ambikadutta Shastri, 12 th ed. Chaukhambha Sanskrit Sansthan Varanasi, India p Rasatargini by shrisadanandasharma Rasavigyan hindi commentary by Pandit Kashinathshartri Chaukhambha Sanskrit Sansthan Varanasi p Bhaisajyaratnavali Vidyotini hindi commentary by Kaviraja Ambikadutta Shastri, 12 th ed. Chaukhambha Sanskrit Sansthan Varanasi, India p Charaka, Charaka Samhita of Agnivesa Text with English translation and critical exposition based on Cakrapani Datta s Ayurved Dipika by Dr. Ram Karan Sharma and vaidya Bhagwan Dash (Volume III) Chaukhambha Sanskrit Series Office Varanasi, India p CITE THIS ARTICLE AS Gaikwad M. D. et.al., A Clinical Study on the Management of Vicharchika (Eczema) by Panchatikta Ghrita Gugglu and Lepa of Gairika, Source of Support Nil Conflict of Interest None Declared Page27

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