“Ayurvedic Assessment and
Management of Skin Diseases”
Part-1
Prof. Muralidhara Sharma
based on the lecture available at
Ayurvedic Assessment and Management of Skin Diseases
The diagnosis and assessment of skin diseases often lead to confusion, particularly in terms of reliance on investigations versus clinical examination in dermatology. Although investigations, such as histopathology, are useful, they predominantly rely on clinical examination, visual appeal, and subtle differences in clinical presentation. The contemporary approach tends to complicate matters by overemphasizing dependence on investigations. Our perspective is to simplify the entire process by fostering coordination between clinical examination and investigations, targeting the complexity of the issues.
In contemporary science, the classification of skin diseases is based on pathology, categorizing them as allergic, infective, connective tissue pathologies, etc. Conversely, from an Ayurvedic standpoint, most skin diseases fall under the chapters of Kushtha roga or Kshudra Roga. Additionally, skin symptoms can manifest as secondary presentations of primary systemic diseases, a concept shared with contemporary medicine. Our approach is grounded in these Ayurvedic principles, focusing on skin disorders like Kushtha and Kshudra roga, as well as systemic disorders.
Dermatological assessments in contemporary practice involve detailed discussions on clinical classes, emphasizing the site, number, distribution, arrangement, and consistency of lesions. While this may seem modern, Ayurvedic texts delve into these aspects with even greater detail, offering a comprehensive understanding for more effective diagnoses. An essential diagnostic parameter, according to Ayurveda, is the type of lesion.
Medical students commonly learn about different lesion types, such as macules, during their courses. Depending on the appearance, raised lesions are called macules, and the pattern of distribution, like centrifugal spread, is considered. The final diagnosis hinges on these assessments. From the contemporary viewpoint, macules are seen as conditions involving discoloration, possibly accompanied by other symptoms. However, for Ayurvedic clinicians, a macule marks the beginning of clinical assessment. Based on the color and accompanying symptoms, macules can be categorized as Vataja, Pittaja, or Kaphaja. For instance, a macule with a darker color is of the Vataja variety, a reddish one is Pittaja, and a pale-colored macule is Kaphaja. Similarly, if accompanied by pain, it is Vataja; signs of inflammation make it Pittaja, and if associated with itching, it is Kaphaja.
Papules
Papules, with a slightly raised surface and irregular distribution, can be classified as Vataja, Pittaja, or Kaphaja based on color and accompanying symptoms. Features such as “twak sankoch” and “swap” indicate Vataja, signs of suppuration and inflammation suggest Pittaja, and itching or a pale color signify Kaphaja. Ayurvedic texts describe similar assessments, and once these Dosha lakshanas are identified, the management becomes relatively simpler.
For Vataja, the prescription includes Kaishor Guggulu, Rasamanikya, Sarivadyasav, and Basti with options like Manjishthadi or Dashamuladi. Pittaja management involves Arogya vardhini, Kamdugha, Manjishtadi kwath, and Virechana. In Kaphaja cases, Laghusootshekhar, Gandhak Rasayan, Khadirarishta, and Vaman are recommended. Local treatments include Triphala Kwath cleaning, Jatyadi taila, Gandhak Karpoor malahara, and Raktamokshana by Jaluka.
In my practice, I primarily prescribe these drugs for various skin conditions. However, predicting the outcome remains a challenging aspect. Understanding the finer clinical presentation is crucial for prognosis, as attempts at similar-looking treatments can yield varying outcomes.
One notable difference in my dermatological prescriptions compared to others is my infrequent use of local applications. While I don’t completely avoid them, I prefer washing with Kwathas instead. Malahar preparations, commonly expected for skin disorders, often contain bases like bee wax or oil, which can either dry up or increase moisture content. Regular application may affect overall hygiene conditions. Maintaining good hygiene habits reduces the chances of skin disorders. I have observed complications in patients with good hygiene when administering Malahar, hence my preference for Kwathas. Raktamokshan with Jaluka is another option, though it may not be as frequent in some conditions
Papules
Papules with a slightly raised surface and irregular distribution can be classified as Vataja, Pittaja, or Kaphaja based on color and accompanying symptoms. Features like twak sankoch, swap as Vataja lakshana, signs of suppuration, inflammation as Pittaja lakshna, itching, or pale color sign of Kaphaja guide the classification. Once this assessment is made, the management becomes relatively simpler. The information I’ve provided is not from my perspective; Ayurvedic texts describe similar issues. After assessing Dosha lakshanas, the management becomes straightforward. In my approach to all types of skin disorders, I use a limited set of prescriptions.
For Vataja: Kaishor Guggulu, Rasamanikya, Sarivadyasav, Basti (Manjishthadi or Dashamuladi). For Pittaja: Arogya vardhini Kamdugha, Manjishtadi kwath, Virechana. For Kaphaja: Laghusootshekhar, Gandhak Rasayan, Khadirarishta, Vaman. Local treatment includes Triphala Kwath cleaning, Jatyadi taila, Gandhak Karpoor malahara, and Raktamokshana by Jaluka. I prescribe only these drugs based on the conditions I’ve described.
In the management of disorders, predicting the outcome is a challenging task. Awareness of the finer aspects of clinical presentation is crucial. Without this awareness, it may not be possible to discern the prognosis, and attempts using similar-looking approaches may yield varying outcomes. This is an important consideration.
Compared to others, one of the differences in my prescriptions for dermatological conditions is that I rarely use local applications. Although I don’t completely avoid them, I use them very rarely. The restrictions arise when dealing with skin disorders. There is a general expectation for local applications, but Malahar preparations, often made with bee wax or oil, can impact hygiene due to their drying or high moisture content. Maintaining good hygiene habits reduces the chances of skin disorders. In such cases, Malahar administration can lead to complications. Therefore, I prefer washing with Kwathas, deviating slightly from the usual trend of prescription. Raktomokshan with Jaluka is another option, though not so frequent in some conditions.
Vataja Kushtha’s first lakshana is Ruksha, Arun, Parushani, where the surface is dry, the color is red, and palpation reveals redness. These features are similar to erythema multiforme, an allergic disease. Common allergies may cause itching followed by a short-duration rash, which subsides—resembling Sheeta Pitta. Sheeta Pitta is not considered a skin disorder in Kushtha Roga or Kshudra Roga. It is a different entity but an extension of the same, persisting for a long duration due to continuous contact or certain variations in pathology, resulting in static erythema multiforme. Allergic reactions are complex, presenting with variations in clinical presentation. Erythema multiforme has two categories: minor and major. Minor lesions have clear borders, minimal raised surface, appearing as discoloration scattered in localized areas. They usually last 3 to 4 days with recurrence. In the long run, lesions may spread, but oral mucosa is not involved. Spontaneous healing occurs after a few months. If the condition becomes more chronic and not self-limiting, my prescription includes Kaishor Guggulu and Manjisthadi due to their predominant Vata-Kapha Lakshana.
Erythema multiforme major
Erythema multiforme major covers more than 10% of the body area, with mucosa involvement and raised, palpable lesions. Arogyavardhini, Kaishor Guggulu, and Manjishthadi kwath are chosen drugs for three months. Some patients may show resistance; in such cases, Virechana could be another choice.
Steven Johnson syndrome is an extension of erythema multiforme, where initially dry, red lesions spread haphazardly. The edges become rough, and the central area becomes moist. The cause is allergic, but the phenomenon is more rapid. It often results from internal consumption of specific foods or medicines, such as penicillin. Incidence is high during the rainy season, especially among those consuming shellfish.The characteristic features include a rapid onset, fever, vomiting, and erythema progressing to broken skin lesions with slough, blisters, and necrosis. Managing the acute phase is challenging with ayurvedic drugs alone; glucocorticoids are often required initially. After stabilizing the acute phase, Kaishor Guggulu and Manjishthadi Kwath can be prescribed.
Toxic epidermal necrolysis
Toxic epidermal necrolysis involves skin necrosis, filling up blisters rapidly, and can be fatal. It should be avoided. The course of a simple allergic phenomenon can vary widely, from erythema multiforme minor to toxic epidermal necrolysis, even with the same causative factor. The cause could be the same drug, producing different reactions in three different patients, ranging from erythema to necrolysis—a highly unpredictable issue.
