www.aamj.in ANVESHANA Review Article AYURVEDA MEDICAL JOURNAL ISSN: 2395-4159 ROLE OF JALAUKAVACHARANA (LEECH THERAPY) IN THE MANAGEMENT OF VICHARCHIKA (ECZEMA) Chhabra Shailly 1, Kaur Rimpaljeet 1, Singh Amitabh 2 1 PG Scholars, 2 HOD, Dept. of Kayachikitsa, PG School of Ayurveda & Research, Desh Bhagat University, Mandigobindgarh, Punjab, India Corresponding Author: drshallychhabra@yahoo.in ABSTRACT Skin is one of the five Gyanindriyas (sensory organs) as described in Ayurvedic texts. It is a highly complex organ which plays a vital role in the body s general working. About 30% of all the skin diseases are eczematous. It is a second commonest cause of loss of function. Vicharchika may be defined as a clinical entity; in which the lesion is covered with Shyava coloured pidika (skin eruption with dark discolouration), kandu (profuse itching) and ruja (pain), which may develop anywhere in the body and it may be either wet or dry. In comparison with modern disease, Vicharchika can be easily correlated with Eczema. The first appearance is erythema or reddening of the skin. These vesicles or papules break down then and oozing from the affected area of the skin starts. If the condition persists, the skin tends to become thickened and scales may develop. Despite of great advance in dermatology and the advent of powerful antibiotics and antifungal as well as steroids, Eczema continues to challenge the best effort of dermatologists. Shodhana therapy is the speciality of Ayurveda and plays a key role as a preparatory procedure for further progressive treatment. In this process morbid Dosha, the root cause of diseases are eliminated from main site of lesion and thus the main cause of disease is eradicated. Jalaukaavcharan (bloodletting by leech) as a Shodhana karma is found to be very effective in Vicharchika. It is cost effective and has less adverse effects. Key words: Vicharchika, Jalaukaavcharan, Kandu, Ruja, Pidika, Shodhana INTRODUCTION Vicharchika (Eczema) is very old disease mentioned in ancient science among the Kushtha (Skin Disease). Though the disease, Vicharchika is not a life threatening, it makes worried the patient due to its appearance, severe itching, disturbing routine and its nature susceptible to be chronic. Vicharchika is described under Kshudra Kushtha in Ayurvedic texts 1 and also mentioned as a curable disease yet there lapsing nature of this disease makes it much harassment for patient and troublesome for physician too. Vicharchika as explained by Charaka, is characterized by pidika, kandu and srava (profuse discharge). 2 Sushruta, the Father of Surgery has mentioned the symptoms as rukshata (dryness of the skin) with kandu (intense itching) and raji (marked linings). 3 A similar clinical presentation in modern dermatology is seen in Eczema, which is defined as a non-contagious inflammation of the skin characterized by erythema, scaling, oedema, vesiculation and
oozing. 4 Particularly at the site of lesion, there is blockage of sweat glands which creates Aswedanam (loss of sweating) or hyperactivity of sweat glands which creates Atiswedanam (excessive sweating). Modern medical science treats eczema with corticosteroids, antifungal /antiseptics but the therapy gives symptomatic relief only and also the therapy has some side effects like liver and kidney failure, bone marrow depletion etc. With long term use of topical steroids, the skin may develop permanent stretch marks (striae); bruising and it can also change the skin colour. This change is more noticeable if the patient has dark skin. 5 The Ayurvedic texts consider Raktadushti as one of the primary cause of skin disease and patient get relief after letting out the vitiated blood. 6 Among various methods for bloodletting, Jalaukaavcharan (bloodletting by leech) is considered as the ideal method to expel out the vitiated blood safely, quickly and effectively. 7 In general all the Kushtha are said to possess a Tridoshaja origin, 8 in Vicharchika, kandu is caused due to Kapha, srava is due to Pitta and shyavata (blackish discolouration) is caused due to Vata. Despite of its Tridoshaja nature Acharya Sushruta categorised Vicharchika as Pittapradhan Kshudra kushtha 9 and Jalaukaavcharan as its ideal treatment. Lakshana (Symptoms) Samprapti (Etiopathogenesis) Disease Vicharchika is caused due to the following of improper and unwholesome dietary practices (viruddha ahaar-vihaar). Viruddha ahaar like intake of fish with milk, mulak and lasuna with ksheera, excessive use of alcohol with milk, Gramya, audaka and anupamamsa with milk, intake of articles having sour taste with milk and viruddha vihaar like sudden diving into cold water or drinking cold water after fear, exhaustion and coming from sunlight, 10 doing physical exercise and sun bath after heavy meal, suppression of urges of emesis. All these factors lead to vitiation of three doshas moving in the blood. Nidanasevana Tridosha Prakopa Reaches to Twaka, Rakta, Mamsa, Ambu and produce Shaithilya Further vitiation of Doshas occurs These Doshas gets enlodged at the place of Dhatushaithilya Produce Kushtha 11 Table 1: Correlation of symptoms of Vicharchika and Eczema Sr. No. Lakshanain Vicharchika In Eczema 1. Kandu Itching 2. Atiruja Pain 3. Daah Burning sensation 4. Shyava pidika Skin eruption with dark discolouration 5. Bahusrava Profuse discharge 6. Raji Marked linings 7. Rukshata Dryness 8. Sparshhani or suptata Loss of sensation According to Acharya Sushruta, the lesion of Vicharchika is Ruksha, so it becomes Ruksha Vicharchika (dry Eczema) while others have mentioned either Srava 12 or Lasika in lesions called ardra Vicharchika (wet type of Eczema). Vicharchika is a Sadhya type of Kushtha. According to modern science, eczema is curable condition but cure of this disease is affected in tropical countries by AAMJ / Vol. 1 / Issue 3 / May June 2015 143
heat, humidity and prevalent unhygienic condition. Management Ayurveda has given prime important on two types of treatment i.e., Shodhana and Shaman especially for chronic and recurrent diseases. Shodhana therapy is most important measure for Bahudoshjavyadhi. If doshas are depleted with shaman therapy, there is a chance to provoke that doshas again, but if they are removed by Shodhana therapy, there is no chance to provoke again. 13 Raktamokshana As per Ayurveda, Jalaukavacharana is one of the procedures of Raktamokshana. Raktamokshana is a technical term employed to denote a para surgical procedure to expel out the vitiated blood from selected areas of the body by specific methods. 14 Jalaukavacharana is claimed to be the Supreme therapy because of its safety and high efficacy in the disorders involving the vitiation of blood. Raktamokshana not only purifies the channels but also let the other parts become free from disease and action is faster than other remedies. Instructions for Raktmokshana 1. It should be done according to Aturabala, Rogabala and Ashaya (site of diseases) 15 2. The bloodletting should be done once in a week or performed even 3 4 times. For achieving more effect, it should be done after 15 days with Snehana and Swedana. 3. Season should be neither hot nor cold nor can cloudy/windy atmosphere. 16 But in case of emergency Raktamokshana can be done at any time. It should be done in SharadaKala. 4. Matra (Quantity of expellation): According to Charaka, it depends upon the roga-rogibala, but it should be performed till the Rakta become Shuddha (purified). According to Sushruta and Vagbhata it should be 1 Prastha = 64 tolas = 768g. 1 tola = 12 g. Uttama Matra 1 Prastha = 768 g. Madhyama Matra ½ Prashta = 384 g. Adhama Matra ¼ Prastha = 192 g. Jalauka (leech) is defined as a creature with distended abdomen living either in water or mud. These are antiphlogistic, blood suckers and are also having anticoagulants in saliva. Leech should be stored in well labelled container having multiple pores on the top for proper aeration. Temperature should be maintained around 5-27 0 C. 16 The water of container should be declorinated and should be replaced after 5-6 days. 17 Leech Application Leech should be kept in fresh water, cool, shady and calm place in a large glass and refill daily by low mineral water. Actually the application of leeches demands passion, place and silence. The patient should be placed on a rubber towel. Wash the part with natural odourless soap, rinse it cleanly, don t use any perfume in skin area. 18 If needed, shave the eventually marked bite area and slit it a bit with a haemo lancet. Take leech out of the jar with the help of a blunt tweezers and put it with its hand onto the small wound. After fall of put into a fixed lockable containers and set them free in a clear water or at a damp place in the forest. Eventually kill them with the help of concentrated acetic acid. Leeches may only be used once and have to be disposed after doing so. Morning is the best time for application, without emergency it should not be put at evening. Before starting Leech therapy, patient should be given snehana and swedana. Secondary haemorrhage may occur after removing leech. On excessive loss of blood various haemostatics are used such as burnt cotton, desiccated alum, copper sulphate, tannin, turmeric etc. Pressure with the finger over the bite may be useful. Even a very fine point of caustic nitrate of silver is inserted into the wound with benefit. Apply a AAMJ / Vol. 1 / Issue 3 / May June 2015 144
bandage with lot of absorbent cotton wool after approximately seven hours mostly in the evening. Until then the patient must holds still while lying. Change the bandage after 24 hours and remove it three days later. Chemical Constituents of Leech Saliva During the process of feeding, leeches secrete a complex mixture of different biologically and pharmacologically active substances into the wound. Hirudin is the best known component of leech saliva. Hirudin is sometimes used to describe all active substance in leech saliva. In reality, components of medicinal leech saliva that exert its effect in the hosts body are Heparin like substance Hirudin-A 65-prevents the clotting of blood by inhibiting the cleavage by thrombin of fibrinogen and a synthetic tripeptide substance. Hirudin (mainly from leech) having approximately three times more anti-thrombin activity than pseudohirudin (mainly from leech whole body). Calin has also anti-coagulant effect which inhibits blood coagulation by blocking the binding of von-wille brand factor to collagen. It inhibits collagen-mediated platelet aggregation. Destabiliase has thrombolytic effect which dissolve the clots of blood as well as it also breakup the fibrins that have formed. An enzyme called hyaluronidase, which breaks down hyaluronic acid, the bonding material of connective tissue, thus fostering the flow of blood and fluids from affected areas. It is spreading factors that ensures that the other active substances which are active at the bitten areas can be spread. Eglin restrains digestive proteasis. Bdellin is a plasma hindrance. They both have effects on the coagulation hindrance having different effective mechanisms together with Apyrase and Collagenase. Piavit contains leech prostanoids and highly purified destabilase fraction. It has protective antithrombotic effects. 19 Pathya apathya: After Raktamokshana, patients should be given Laghu and Deepaniya Ahara and neither too hot nor too cool. 20 Acharya Vagbhatta added with Snigdha and Shonita (Rakta) Vardhaka Ahara. 21 While Mamsa Rasa of deer and goat, milk, Sali rice was advised. Patient should avoid Vyayama (exercise), Maithuna (coitus), Krodha (anger), Sheeta Snana (cold water bath) Vayu (breeze), Shoka, Diwaswapna (day sleep), Kshara (alkalis), Amla (sour), Lavana (salt), Katu Ahara (pungent diet). CONCLUSION Vicharchika is a type of Kushtha, Rakta pradoshaj and Tridosha prakopaj and chirkari (chronic) vyadhi. Leeches gives best effect in Vicharchika by expelling the morbid, vitiated Dosha and Dhatu. But the effect of therapy is not only by expelling the vitiated blood but leech also emits some enzymes in the wound. So Jalaukavacharana has also provided normalization and improvement of capillary as well as collateral blood circulation, expressed anti-inflammatory effect, Immuno-stimulation and Immuno-modulating effect and early wound healing effect. This action may be effect of such salivary enzymes like Hirudin anticoagulant effect with diuretics, antibiotic action, Calin prevent blood coagulation, eglin, hyaluronidase, antithrombin, antitrypsin and antichymotrypsin etc. Leeches are the perfect solution for many skin diseases. Demand of leeches is increased day by day from physicians all over the world. The clinician who knows all about the leeches, habitat, and their method of collection, varieties, storage and method of application is successful in treating the disease. AAMJ / Vol. 1 / Issue 3 / May June 2015 145
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