Copyright © 2023 The Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Comparative Study on the Efficacy of Vipadika Hara Ghrita and Taila Prepared with Go Ksheera and Arka Ksheera in the Management of Vipadika Kushta: A Case Study

1-Final year PG Scholar, Dept of Kayachikitsa, Dr. B.R.K.R. Govt Ayurvedic College, Hyderabad, Telangana, India

2- Professor & HOD, Dept of Kayachikitsa, Dr. B.R.K.R. Govt Ayurvedic College, Hyderabad, Telangana, India

3-Professor, Dept of Kayachikitsa, Dr. B.R.K.R. Govt Ayurvedic College, Hyderabad, Telangana, India

Article Info:

_____________________________________________

Article History:

Received 22 June 2023

Reviewed 18 July 2023

Accepted 03 August 2023

Published 15 August 2023

_____________________________________________

Cite this article as:

Surekha O, Srikanth Babu P, Swaroopa A,Comparative Study on the Efficacy of Vipadika Hara Ghrita and Taila Prepared with Go Ksheera and Arka Ksheera in the Management of Vipadika Kushta: A Case Study, Journal of Drug Delivery and Therapeutics. 2023; 13(8):5-10

DOI: http://dx.doi.org/10.22270/jddt.v13i8.5932 ____________________________________________

*Address for Correspondence:

Dr. O. Surekha, Final year PG scholar, Dept of Kayachikitsa, Dr. B.R.K.R. Govt Ayurvedic College, Hyderabad, Telangana-38.

Abstract

_____________________________________________________________________________________________________________________

Objective: In Ayurveda, majority of skin diseases are dealt under broader term Kushta. As per acharya Charaka, Vipadika kushta is classified under Kshudra kushta. This can be correlated with Palmo-plantar psoriasis, which mainly effects palms and soles of a person causing cracks associated with severe pain, itching, discolouration and burning sensation. In the present study, an effort is made to compare clinical efficacy of Vipadikahara ghrita and taila prepared using go ksheera and arka ksheera in two different batches for the treatment of Vipadika kushta. Intervention: Vipadikahara ghrita & taila is a yamaka preparation that is mentioned in both charaka samhitha and ashtanga hridaya kushta chikitsa adhyaya, in the context of vipadika kushta. In this formulation ksheera is one of the ingredients, where specific type of ksheera to be used is not specified in charaka samhitha. Whereas in ashtanga hridaya commentary by Kaviraj Athrideva Gupta, usage of arka ksheera is mentioned. As specific ksheera is not mentioned in Charaka samhitha, go ksheera is taken and its effect is compared with the arka ksheera. Vipadikahara Ghrita & taila is administered externally for 15 days and changes are noted. Results: Vipadikahara ghrita & taila prepared with go ksheera helped in reducing only pain, whereas that prepared with arka ksheera reduced pain, itching, discolouration and size of the lesion. Conclusion: Hence it can be said that arka ksheera is found to be more effective in the present case study.

Keywords: Vipadika kushta, Vipadika hara ghrita & taila, Go ksheera, Arka ksheera, Palmo-plantar Psoriasis.

Skin plays a vital role in a person’s overall well-being, serving as a protective barrier against external factors which in turn contributes to our physical, emotional comfort and attractive personality of a human being. Besides, healthy skin represents healthy gut and sound inner atmosphere of the body. However, for individuals with psoriasis, maintaining healthy skin becomes a constant challenge. Palmo-plantar Psoriasis, is a form of psoriasis, a chronic auto-immune disorder that primarily affects palms and soles of the person. The prevalence of skin diseases in the general population in different geographic regions of India varies from 7.9% to 60%. Among them Palmo-plantar Psoriasis varies in different studies, between 2.8% to 40.9%. The most prevalent type of Palmo-plantar psoriasis expresses morphologic patterns like thick hyperkeratotic plaques in palms and soles or both associated with pain, itching, and burning sensation. Even though the affected area is smaller, the quality-of-life impairment seems more in Palmo-plantar psoriasis patients, especially people with psoriasis on palms. People feel embarrassment in shaking hands at social gatherings, finds pain and difficulty while walking, causing social and functional disability. It significantly affects an individual’s self-esteem and mental well-being. In the contemporary science, treatment options for Palmo-plantar psoriasis include symptomatic management with topical cortico-steroids, vitamin-D analogues and in more severe cases, systematic medications like oral retinoids, Immune modulators like methotrexate, etc may be prescribed.

Based upon these symptoms, Palmo-plantar Psoriasis can be correlated with Vipadika kushta, a Vata-Kapha disorder¹, which has symptoms like pani pada sphutanam (cracks in palms and soles), teevra Vedana (severe pain)², kandu (itching) and daha (burning sensation)³. Vata-rakta is a disease condition mentioned by Charaka⁴ and Susrutha⁵, which is of two types, Uttana (superficial) and Gambhira (deep seated). According to Susrutha, just like Kushta, Vata rakta in the beginning remains superficial (uttana) and during the course of time it becomes deep seated (gambhira). Symptoms of Uttana Vata rakta resembles Kushta roga that includes kandu (itching), daha (burning sensation), ruk (pain) and discolouration of skin⁶. The differential diagnosis and management of Vipadika Kushta can also be done considering Uttana Vata rakta. Kushta is a broader term that encompasses most of the skin diseases under it. Kushta is defined as “Kushnati tad vapuhu” which means roga which causes discolouration and disfiguration, by the vitiation of seven dushyas like tridoshas and twak, rakta, mamsa and lasika. It is classified into 18 types based on severity like Maha kushta (7) and Kshudra kushta (11)⁷. Here the term Maha indicates “Major” and Kshudra indicates “Minor.” Though Vipadika kushta is mentioned one among the Kshudra kushta - a minor condition, now-a-days treating kshudra kushta became difficult due to its chronicity as patients’ approach ayurveda after many years of occurrence of the condition, taking various other contemporary medical treatments. In treatment of Kushta, sthanika chikitsa like lepa, udvartana, pariseka and abhyanga, etc are specifically mentioned, after sodhana and samana as it provides more significant effect locally⁸. Vipadika hara ghrita & taila is one such formulation cited in both Charaka Samhitha⁹ and Ashtanga hrdaya¹⁰ that consists of about ten ingredients like Jeevanthi, Manjista, Daruharidra, Kampillaka, Ksheera, Tuttha, Ghrita, Taila, Sarjarasa and Madhuchista. In Charaka samhitha, as particular Ksheera to be taken is not specified Go ksheera is taken and as per Kaviraj Athrideva Gupta commentary on Ashtanga Hridaya¹¹, Arka ksheera is taken to prepare Vipadika hara ghrita & taila in two different batches following Sneha kalpana vidhi and their clinical efficacy is compared in treating a patient of Vipadika kushta respectively.

Vipadika hara ghrita & taila is prepared following the classical reference mentioned in Sneha Kalpana Adhyaya of Sarangadhara Samhitha Madhyama khanda¹².

Jeevanthi, Manjistha, Daruharidra, Kampillaka, Tuttha, Sarjarasa, Madhuchistha, Ghrita (go ghrita), Taila (tila taila) and Ksheera (cow milk) were obtained from local market, Hyderabad. Arka ksheera is obtained from local vendor, Nellore district, Andhra Pradesh.

Entire preparation of Vipadikahara ghrita & taila was carried out in department of Rasa Shastra and Bhaishajya Kalpana, Dr. B.R.K.R. Govt Ayurvedic College, Hyderabad.

Preparation of fine powder (sukshma churna) of Jeevanthi, Manjistha, Daruharidra and Kampillaka.

Note: Hereby ksheera indicates both arka ksheera and go ksheera used in the preparation of vipadika hara ghrita & taila in two different methods.

Preparation of oil with ratio of 1:4:16 (kalka: taila: ksheera) till it attains kara paka consistency.

Madhuchista and Sarjarasa are added to the obtained oil, heated on mild flame till a homogenous consistency is obtained.

Finely powdered Tuttha is added to the oil and bhavana is continued till a homogenous mixture is obtained.

Churnas of Jeevanthi, Manjistha, Daruharidra and Kampillaka are mixed with required amount of ksheera and kalka is prepared. To this kalka dravya, oil and ghee are added as Sneha dravya and ksheera as Drava Dravya in prescribed quantities. This entire mixture is subjected to mild heat till it attains kara paka consistency. Sneha siddhi lakshanas are checked and confirmed, then the oil is filtered through a double layered cloth. This obtained oil is added with Madhuchistha and Sarjarasa, heated and stirred well, till they are completely melted and filtered again to remove any impurities present in them. This mixture is transferred to a khalwa yantra and bhavana is done by adding finely powdered tuttha till it attains homogenecity. Then it is kept for self-cooling, the resultant semisolid product obtained is Vipadikahara ghrita & taila.

A patient aged 55years/male, complains of cracks in soles associated with pain, itching, burning sensation, discoloration and difficulty while walking since 5 years. He used allopathy medication for 2 to 3 years and felt mild relief. Later the condition recurred on stoppage of medication. So, he visited Dr BRKR GAC, for the same complaint. After complete history taking, he is diagnosed to have Vipadika Kushta.

Vipadikahara ghrita & taila (Go ksheera) is administered externally for 15 days twice a day (morning after bath & evening during bed time) and follow up is done after 15 days. Patient found only mild relief in pain, but no significant change is found in symptoms like itching, burning sensation and discoloration.

For the next 15 days Vipadikahara ghrita & taila (Arka ksheera) is administered in the same way and advised for follow up. After 15 days, patient reported that significant changes are observed in itching, burning sensation, discoloration, and reduction in size of the lesion. So, the preparation of Arka ksheera is advised to continue till the condition is completely cured.

Before and after pictures of condition after using Vaipadikahara ghrita & taila (Go ksheera and Arka ksheera) are enclosed respectively.

Before treatment: After administration of Vipadikahara ghrita & taila (Go ksheera):

In Ayurveda, Kushta is considered as one among the Ashta Mahagadas in classics. Vipadika Kushta is mentioned as one among the eleven Kshudra kushta. It is called as Vipadika which means “Cracks on the skin.” Kushta is said to manifest in the body due to various nidanas like viruddhahara sevana, apathya ahara and vihara, manasika bhavas, santarpanottha vikara, as a sankramika roga and indulging in sinful acts etc^13.Due to indulgence in various nidanas, agni gets deranged which causes Mandagni (vitiated digestive fire) and leads to the formation of Ama and further causing imbalance in Tridoshas mainly with the predominance of Vata and Kapha and few other kushta contain Kapha and Pitta predominance. All types of Kushtas are Tridoshaja and none of them is produced by single dosha. Vipadika kushta is one such kushta with Vata-Kapha predominance. The vitiated doshas gets localised in Twak, Rakta, Mamsa of hasta (palms) and pada (soles) and produce’s lesions. Vata due to its khara and ruksha guna causes symptoms like Sphutana (cracks) and Teevra Vedana (severe pain). Kapha by its snigdha and guru guna causes Kandu (severe itching) and thickness of the skin. Because of sphutana, skin cracks open exposing to external environment causing daha (burning sensation). This involvement of Vata and rakta in kushta samprapti (pathogenesis) can be compared with Uttana Vata Rakta symptoms resembling Kushta. Vipadika kushta by its symptoms resembles with Palmo-plantar Psoriasis of modern science. Palmo-plantar Psoriasis is an auto-immune disorder and a genetic condition that runs in families. It can get triggered by any trauma or injury (Koebner’s phenomenon)¹⁴, psychological stress and gets aggravated during cold and dry seasons. In recent years there is an increased usage of hand sanitisers and hand washing liquids on regular basis that contains alcohol which makes the skin dry on surfaces of palmar areas, making the skin more prone to xerosis, and cracks leading to further onset of the disease Palmo-plantar psoriasis. In the management of Kushta and Vata rakta, agni plays an important role. If there is an involvement of Kapha and vata, underlying Kapha needs to be first taken care of, then Vata needs to be pacified. Hence Ama condition needs to ruled out and basing on which Vata hara or Kapha hara chikitsa is chosen accordingly, which in turn corrects the dushita twak, rakta, mamsa and lasika. While treating a patient with Kushta, physician should also focus on the patient’s psychological health as most of the skin condition comes under the umbrella of psycho-somatic diseases. “All diseases begin in the gut" - Hippocrates of Kos¹⁵, this statement was made by Greek physician Hippocrates, regarded as the father of modern medicine. The gut-brain axis is a bidirectional network between enteric and central nervous systems¹⁶. The impact of which extends to endocrine, humoral, metabolic, and immune routes of communication as well. As per ayurveda, the digestion, metabolism and assimilation of nutrients is controlled and regulated by Agni. Negative Psychological states like chinta, shoka, lobha, bhaya, krodha, dwesha, irsha¹⁷ etc., have bidirectional impact on the body and particularly with the agni which in turn causes the imbalance leading to the pathology. Hence in the current scenario, there is a need to study Palmo-plantar psoriasis that can be correlated with Vipadika Kushta to meet the patient needs. The treatment principle initially includes Ama pachana and langhana karma. Once the agni is restored, further managements will be Sodhana karmas like vamana and virechana according to the doshas involved along with Sneha pana to cleanse the aggravated doshas and balance them. This is followed by usage of various Samana oushadhis in association with proper pathya and apathya¹⁸ which plays a preventive role in further progression of a disease condition. Acharyas have also mentioned various Bahihparimajana chikitsa karmas like abhyanga, udvartana, pariseka and lepa in treating kushta, which will be effective if done after sodhana karmas. Generally, in skin conditions people tend to use topical applications initially as a primary care. Following that, one such yoga called Vipadikahara ghrita & taila indicated in the management of Vipadika kushta is selected as a simple way of treating it as sthanika chikitsa is undertaken in the present study. This yamaka is prepared according to Sneha kalpana vidhi upto kara paka. Kara paka is selected as the drug is employed for abhyanga procedure¹⁹. It consists a total of ten ingredients and each of their properties are mentioned in the below table.

Basing on the above properties of individual drugs, we can analyse and understand how Vipadikahara ghrita & taila might have helped in reducing the pain, healing the skin, reducing the itching, discolouration and promoting the formation of fresh skin. As both Vata & Kapha doshas plays a prominent role in causing the disease pathogenesis of Vipadika Kushta, there is a need to correct both the doshas simultaneously. By using Go ksheera, being vata-pitta hara and kapha kara Dravya, it might have worked solely on viatiated vata and pitta hence reducing the pain and dryness and no significant change is seen in kandu (itching) and sphutana (cracking) which are kapha dosha yukta rupas. Whereas Arka ksheera, which is a vata-kapha hara Dravya with gunas like Tikshna, ushna and laghu it might have simultaneously regulated the vitiated vata and kapha by its penetrating capacity. Hence symptoms like itching, cracks and size of the lesion might have reduced due to its effect, when Vipadika hara ghrita & taila prepared with Arka ksheera is used. Based on the above comparative study between the two yogas, it is understood that both the preparation has its own effects. Depending upon the condition, involvement of doshas like kapha, Vata, ama and patient’s symptoms the appropriate Dravya should be chosen accordingly. In the present case Vipadikahara ghrita & taila prepared with Arka ksheera proved to be more effective as there was more involvement of kapha in the pathology.

From the above study, it is observed that yoga prepared with Arka ksheera worked more efficiently when compared with Go ksheera based on its properties. As the study is done only in a single case, more relevant conclusions cannot be drawn from this. If studied on a greater number of cases better conclusions can be drawn accurately. The same Vipadikahara ghrita & taila is available as Jeevantyadhi Yamakam prepared by certain pharmaceutical companies in the market. Some pharmacies are using Go ksheera and some are using Arka ksheera in the preparation. A Practitioner should also be aware of these factors and must consider while prescribing the medication. Hence, this current study is conducted to throw light on to understand the impact of both the Yogas and their preparation methods.

S.N.	Name of the ingredient	Quantity
	Jeevanthi	16gm
	Manjishta	16gm
	Daruharidra	16gm
	Kampillaka	16gm
	Ghrita (go ghrita)	125 ml
	Taila (tila taila)	125ml
	Ksheera (go ksheera / arka ksheera)	1 litre
	Tuttha	16gm
	Sarjarasa	16gm
	Madhuchishta	16gm

VAIPADIKAHARA GHRITA & TAILA (Go ksheera)	VAIPADIKAHARA GHRITA & TAILA (Arka ksheera)
Dosage: BD, quantity sufficient on both affected areas of plantar region (soles)	Dosage: BD, quantity sufficient on both affected areas of plantar region (soles)
Duration: 15 days	Duration: 15 days
Follow up: 15 days	Follow up: 15 days

S.N.	INGREDIENTS	RASA	GUNA	VEERYA	VIPAKA	KARMA	RESEARCH WORKS
1.	Jeevanthi²⁰	Madhura	Laghu, snigdha	Sita	Madhura	Balya, rasayana, grahi, chaksusya, vatapitta hara	Anti-fungal Anti-oxidant
2.	Manjista²¹	Madhura, tikta	Guru, Ruksa	Usna	Katu	Kapha- Pitta hara, varnya, visaghna	Anti-inflammatory Anti-microbial
3.	Darvi²²	Tikta, kasaya	Laghu, ruksa	Usna	Katu	Kaphapitta hara, chedana	Analgesic Anti-inflammatory Anti-microbial
4.	Kampillaka²³	Katu	Laghu, Ruksa, Tiksna	Usna	Katu	Kaphavata hara, krimigh na, rechaka	Anti-fungal Anti-oxidant
5.	Sarja rasa²⁴	Kasaya, tikta	snigdha	Sita	Katu	Vatapitta hara, kandugna, kushtagna	Anti-tumour effect Healing property
6.	Tuttha²⁵ (CuSO4 5H2O)	Kasaya, madhura	Laghu			Kaphapitta hara, lekhana, bhedi, krimigna, chaksushya, balya, rasayana	Anti-inflammatory Anti-microbial
7.	Go ksheera²⁶	Madhura	Snigdhaguru	Sita	Madhura	Vata-pitta hara, dhatu vardanam, ojasya, vrsya, jeevaniya	Anti-oxidant Rejuvenative
8.	Arka ksheera²⁷	Tikta, katu	Tikshnalaghu, sara, snigdha	Ushna	Katu	Vata-kapha hara, kushta hara, kandugna	Analgesic Anti-tumour Anti-microbial Anti-helmintic Anti-oxidant
9.	Ghrita²⁸	Madhura	Snigdha, guru	Sita	Madhura	Vata-pitta hara, dhatu poshaka, balavardhaka, deepana, ayu vardhaka	Anti-bacterial Anti-fungal Anti-viral Anti-oxidant
10.	Tila taila²⁹	Madhura, Tikta	Guru, sara, vikasi, vishada, vyavayi, suksma, teekshna	Usna	Madhura	Vata-kapha hara, deepana, tvachya, balakara, vayasthapana, medhakara	Anti-microbial Anti-oxidant
11.	Madhuchista³⁰	Madhura		Sita	Madhura	Kushtagna	Anti-microbial