International Journal of Advances in Medicine

Singh S et al. Int J Adv Med. 2022 Feb;9(2):179-183

http://www.ijmedicine.com

pISSN 2349-3925 | eISSN 2349-3933

Case Report

DOI: https://dx.doi.org/10.18203/2349-3933.ijam20220132

Management of Twak vikruti: a case report

Swati Singh*, Vaishali R. Chaudhari, Mamata Nakade

Department of Panchakarma, Dr. D. Y. Patil College of Ayurveda and Research Centre, Pune, Maharashtra, India

Received: 06 December 2021

Revised: 31 December 2021

Accepted: 06 January 2022

*Correspondence:

Dr. Swati Singh,

E-mail: drswatis20@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

In today’s era skin disease is very commonly found. As there is no specific and permanent treatment available in modern science therefore people are attracting towards Ayurvedic treatments for skin related issues and diseases. Twak (skin) is the largest organ of human body which protects and covers whole body. It is one of five gyanendriya that is Sparsh gyanendriya (sense organ). Nowadays people use so many chemical products internally as well as externally for looking good which causes the imbalance of dosh, dhatu and mala (fecal product). These are the fundaments of human body and skin is the outer most protective organ. So, whenever anything uncommon happened with body, skin start showing some symptoms like redness, swelling, due to dushti of doshas (imbalance/toxicity of dosha). A male patient of 36 years old came in our hospital with the complains of Twak kandu (skin itching), Krushna varnata (hyper pigmentation), Krushna varni pitikotpatti (rashes), Vali (wrinkles) and Rukshta (dryness) which was diagnosed as Twak vikruti (skin disease) and treated with complete ayurvedic treatment Shaman chikitsa (internal medicine) along with Shodhan chikitsa (body purification treatment).

Keywords: Twak vikruti, Shaman chikitsa (internal medicine), Shodhan chikitsa (body purification treatment).

INTRODUCTION

Nowadays lifestyle of People has drastically changed. It includes their routines, dietary habits, sleeping patterns even the atmosphere changes too. For good personality, people use so much cosmetic products too, which cause Dosh dushti (imbalance of doshas).

In Ayurveda skin disease commonly comes under Kushtha which could be Mahakushtha or Kshudra kushtha but here the condition of patient was not corelated with any of given Kushtha. So as stated in Charak samhita that naming of disease is not important, so we considered it in Twak vikruti only.1 The fundament of Ayurveda is three doshas (vata, pitta, kapha) seven dhatus (rasa, rakta, mamsa, asthi, majja, shukra) and two mala (mutra and purisha). They make major role in diagnosis of any disease and treatment also. According to Ayurveda, examination of patient can be done by Chaturvidha pariksha (four steps of examination) where symptoms analysed by Pratyaksha praman (direct examination), Anuman praman (indirect examination), Aptopadesh praman (written in ancient text books) and Yukti (ideology). So, the treatment planned using these Pramans.

Ayurvedic chikitsa is a complete treatment in which so many types of chikitsa are describes according to disease and patients’ condition.

Here in this study 2 types of treatment were used, that is, Shaman chikitsa and Shodhan chikitsa. Shodhan means detoxification, it cleanses the body as well as nourishes the dhatus too. Shaman chikitsa means internal medicines which was given according to dosh dushti.

CASE REPORT

A 36 years old middle age male worked in IT sector came to outpatient department number 9 (Panchakarma OPD) with chief complaints of Krushna varni twak vaivarnya (hyper pigmentation), pitikotpatti (rashes), vali (wrinkles), kandu (itching), rukshta (dryness).

On both the hands, wrist with thumb and fingers in the last 6 months. Before 6-month patient was completely fine but it started slowly. As patient worked in IT sector and night shifts, heavy working hours, uncertain timings of food intake were very common.

On examination, nadi: vata pradhan pitta; prakruti: pittanubandha vata; jivha: alpa sama; satva: madhyam; kshudha: prachiti; nidra: sound sleep; mala: samyak; mutra: samyak; udar: laghavta; sparsh: ushna and ruksha; blood pressure: 120/80 mm Hg.

So, after examining all the lakshanas (symptoms) of patient and knowing the lifestyle of patient the case was diagnosed as vata pradhan pitta twak vikruti.

Table 1: Shaman chikitsa (started from 1 October 2021 to 30 October 2021).
Table reproduced from source PDF page 2
Table 2: Basti treatment.2
Table reproduced from source PDF page 2

Total days of treatment were 30 days (from 1 January 2021 to 30 October 2021).

After diagnosis the patient treatment was planned under shodhan and shaman chikitsa.

As the agni of patient was madhyam so the shaman chikitsa started with day one as shodhan chikitsa needed some deepan pachan.

In shodhan chikitsa we chose yoga basti for 7 days with dashmool tail 80 ml for anuvasan basti and for niruha basti: panchtikta kwath 480 ml+Bala tail 60 ml+tila tail 30 ml and sarwanga snehan with dashmool tail and swedan with dashmool kwath.2,3

Preparation of Niruh basti

The Niruh basti was prepared using the folling ingredients: Nimba (A. indica); Vasa (Adhatoda vasica); Kirattikta (Swertia chirayita); Guduchi (Tinospora cordifolia); Patol (Trichosanthes dioica); Panchtikta kshaya dravyas taken as above.8-13 Each drug quantity in kshaya was 24 gms.

In Niruha basti prepration: Madhu 30 ml, Saindhav 10 gm, Sarshap kalka 10 gm, Sneha (Bala tail) 60 ml+(Tila tail) 30 ml and Panchtikta kshaya 480 ml was taken.

Shaman chikitsa continued till 30 October 2021.

Probable mode of action

Internal medicines helped in the maintenance of Agni and Dosha awastha.

Snehan, Swedan did shithilikaran of dosha and brought them into Koshtha from Shakha to Koshtha.

As here the dominance of Vata dosha was presented so Snehan and Swedan did Shaman of Vata dosha along with other Doshas.

Basti was described as Ardha chikitsa, so here Yoga basti was given.2 It detoxified the body as well as provided nourishment of body too.

Dashmool, Bala, Panchtikta (guduchi+nimb+patol+ vasa+kirattikta), all these ingredients were Vata, Pitta and Kapha shamak.

Figure 1: Before treatment.
Figure 1: Before treatment.
Figure 2: After treatment.
Figure 2: After treatment.

DISCUSSION

As stated in Charak Samhita, sutrasthan tridoshiya adhyaya naming of any vikar/yikruti was not mandatory. Treatment can be given by assessing the factors such as Prakopita dosha, Adhishthan and Lakshana.

Patient had a habit of irregular food intakes, ratri jagaran, (late night sleep) work in AC, work in shifts (morning, evening, night) and Adhik chinta (stress) which led to Utapatti of Twak vikar. Keeping in mind all the above Hetus shaman (causes) and Shodhan chikitsa planned, which worked very well.

Shodhan chikitsa

In Shodhan chikitsa Yoga basti was planned for seven days, in which 4 Anuvasan basti and 3 Niruh basti was given. In Niruh we had used Panchtikta niruha basti and Dashmool tail Anuvasan basti. All the contents used in this basti were Kushthaghan, Vatashamak, Swedjanak and Tridoshashamak. As the given symptoms can be correlated with Dushti of all three doshas that was Vata, Pitta, Kapha and Twak vikruti also was disease of Twak so here all the treatment and references taken from the Kushtha chikitsa or related with that.

Panchtikta kshaya was a combination of 5 Tiktas rasatmak dravyas, nimba+vasa+kiratikkta+guduchi+patol.

Nimba

Nimba used in the wide range of diseases. Such usages were attributed to its purification effect on blood. It had properties of antibacterial, antiviral and more importantly immunomodulatory agent.

Vasa

It was Jwarghana, Kushthaghana, Swedajanana. It was used to treat Raktavikar, Charmaroga And Kushtha.

Kirattikta

It was Tridoshashamak, Raktashodhak, Pittasrak, Shothahara, Swedjanana, Kushthaghana. It was used in Agnimandya, Vibandha, Krimiriga, Kushtha and Charma roga.

Guduchi

It was also known as Amruta as it was Tridoshashamak as well as Rasayan too. It had a property of Kushthaghana, Raktashodhak and Raktavardhaka, Krimighana and Anulomak.

Patol

It was Dushta kaphnashakdravya and useful in Agnimandya. It also used in the treatment of several skin disease/infections, wound, fever and constipation.

Dashmool tail

It was used in Vatavyadhi.

Bala tail

It was used in Vatavyadhi. As Bala was main content in this oil and it had a property of Vatashamak which gave good Snigdhata to Twak and worked on valli.14

Tila tail

It was considered to be the best oil in Ayurveda as it was Tridoshashamak in nature and nourished tissues and increased Agni for good digestion.

Yoga basti was continued for 7 days and after Yoga basti the symptoms like kandu, rukshta and pittikotpatti was completely gone.

Shaman chikitsa

In this study Shodhan chikitsa was given with Shaman chikitsa and in Shaman chikitsa we used very common drugs like Nimba churna, Manjishtha churna, Jatamasi churna, Laghumalini vasant, Arogyavardhini vati and Pittashamak vati. This Shaman chikitsa was given for 30 days. All these medicines were Tridoshashamak, Kushthaghana, Krimighana, Deepak-pachak and worked on Rakta dhatu.

Table 3: Variation of Lakshanas with treatment.
Table reproduced from source PDF page 4

During this study we have studied so many previous works done but we have seen so much variations in those studies. As Twak vikruti was a vyadhi of twak and in Ayurveda Twak vyadhis described in Kushtha adhyaya so, we have studied work done in various kind of Kushtha management with ayurvedic treatment like in one study Panchtikta ghrita matra basti was given for 3 weeks (21 days) along with internal medicines in the management of psoriasis, in which the symptoms like Kandu, Twak vaivarnay and Matsya shakalopama were started to reduce over course of time.15

In second study panchtikta panchprasutic basti was given for 16 days with internal medicine. The duration of whole study was 3 months in Kitibh kushtha (psoriasis). In this study after 16 days of Basti treatment symptoms reduced which was measured on the scale of PASI, so the PASI score was reduced from 14.4 to 0.8 after Basti and after 3 months it was reduced to 0.416.

In my study we have given yoga basti for 7 days along with internal medicines for 30 days and got satisfactory results as can be seen in Table 3.

CONCLUSION

Vikaras can be treated by assessing the Dosha prakop, Vikruti and Lakshanas. Drugs in Panchtikta act as Krumighana, Kandughana and Kushthaghana, so here Panchtikta niruha basti acts on Dusht doshas in this Vikruti. As here the Pradhan dosha was Vata and Basti is the best treatment for Vata dosha, so it worked well. Along with Basti, Shaman chikitsa and following proper Pathya will give faster and long-lasting results. After discussing all the points above given in discussion, we found out that treatment have given in my study is taking minimum time with good results in comparison to other previous studies.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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