Role of Rasayanas in the management of Urticaria or Hives (Shittapitta)

This Research has been conducted by Dr. Gurdip singh is the professor & Head, Department of P.G.studies in Kayachikitsa & Dean, I.P.G.T. & R. A., Gujarat Ayurved University, Jamnagar.

In experimental studies carried out on rabbits in the early eighties I found that rasayana drugs such as Mandukaparni, Shatavari and vacha potentiates hum oral antibodies. Studies carried out later on in my unit also showed that Rasayana drugs increased serum immunoglobulin such as IgA, IgG and IgM in human volunteers and patients. During these studies, particularly while assessing the role of Ashvagandha in the   prevention of seasonal diseases of upper respiratory tract, we observed that the drug significantly increases IgA, IgG and, IgM and at the same time provides cure to many patients suffering from allergic diseases such as allergic rhinitis and allergic pharyngitis (Chudasame and singh, 1987).

Shattapitta

These observations puzzled us as to how a drug increasing the serum immunoglobulin’s cured allergy. In other studies we found that katuki increased the level of stercobilinogen in patients in which it was decreased and decreased its level in patients in which was increased. (singh 1976)

On the basis of the above observations, some of which were contradictory, I evolved a hypothesis that most of the Ayurvedic herbal drugs are concerned with correction of dysfunctions of the bodily tissues. This hypothesis is also supported by the definition of shamana (palliative) therapy, which corrects the dysfunction of the tissues without disturbing the function of normal tissues is shaman therapy.

It was further observed that a rasayana drug e.g. ashvagandha, which cures the allergic disorders of upper respiratory tract has very little effect on the allergic conditions of the skin such as urticaria. Hence the theory of specific tissue Rasayana was also evolved. For instance Guduchi and Bhringaraja for the skin, Gokshura for urinary tract and so on.

Further it was also observed that only Rasayana drug may not provide complete cure and we have to prescribe drugs mentioned for the treatment of that particular condition along with Rasayana drug to get the cure and prevent recurrence. Charaka, in the context of the treatment of Apasmara  has also mentioned that in all the chronic diseases, Rasayana drug should be prescribed for better cure.

Talking all these points into consideration we carried out several studies to evaluate the role of Rasayana drug in the management of allergic disorder of various systems. The observations of some significant studies are being reviewed here.

Material and Methods

The patients attending the kayachikitsa OPD of the institute having typical signs and symptoms of the diseases were selected for the studies. To exclude other pathologies, routine hematological, urine and stool examinations were carried out. The criterion of diagnosis was mainly based on the typical signs and symptoms and presentation of the disease. Only such patients of urticaria who were having no other disease were included in the studies.

Assessment of the effects of the therapy

To assess the effect of the therapy, signs and symptoms were assigned to the suitable score so that some objectivity may be given to the results for comparison purposes. The overall effect of the treatment was assessed as follows:

Cured

100% relief in the signs and symptoms was taken as cured.

Marked improvement

The patient’s relief between 50% and 100% in the signs and symptoms were considered as markedly improved.

Improvement

The patients showing 20% to 50% relief in the signs and symptoms were taken as improved.

Unchanged

Less than 20% relief in the signs and symptoms.

Follow up study

After completion of the course of the drug, the patients were advised to attend the OPD fortnightly for follows up study to note whether the recurrence of the disease occurred after stopping the drug.

Effect of Saptaparni on patients of Urticaria

10 patients of urticaria (Shitapitta) were administered decoction of Saptaparni prepared from coarse powder of its bark in the dose of 40 ml twice a day for sixty days.

The drug provided significant relief in itching (58.8%), size of lesions (59.6%) and body involvement (41.5%) by the circular lesions and other general symptoms (50% to 100%). It also significantly reduced the vitiation of Dosha of Kapha (75.1%), Vata (67.7%), Pitta (57.7%) and Rasa.

In this group 10% patients were cured, 20% patients were markedly improved and remaining 70% patients were found improved.

Role of Rasayana Drugs in the cure and prevention of shitapitta (urticaria)

One group of the patients of urticaria (Shitapitta) was given only Udarda Prashamana powder while the second group of the patients was administered Bhringraja-Guduchi  Rasayana along with powder of Udarda Prashamana drugs.

Effect of Udarda Prashamana dravyas on urticaria

11 patients of urticaria were treated with powder of Udarda Prashamana drugs administered in the dose of 4 gm, four times a day with water for sixty days.

Ingredients of Udarda Prashamana are Saptaparni, Tinduka, Priyala, Arjuna, Khadira, Kadara, Irimeda, Asana, Badara and Ashvakarna.

The drugs provided significantly relief in itching (79.9%), size of lesion (87.4%), the percentage of body involvement (72.6%) and other general symptoms (71% to 100%). It significantly relieved the vitiation of Vata (86.1%),Pitta(83.3%), Kapha (71.9%), and Rasa(79.6%).

In this group 27.3% patients were found cured, 45.4% patients were markedly improved and remaining 27.3% patients got mild improvement.

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Effect of Udarda Prashamana dravyas along with Rasayana on urticaria

7 patients of urticaria were administered Udarda Prashamana powder in a dose of 4 gms, 4 times a day and simultaneously they were given decoction prepared from two Rasayana drugs.

Guduchi Bhringraja  Rasayana comprises of equal parts of Guduchi and  Bhringraja. The decoction was prepared by taking its coarse powder and was administered in the dose of 40ml twice a day. Duration of the treatment was 60 days.

The therapy provided on average significantly relief in itching (92.5%), size of lesion (90.8%), percentage of body involvement (93.8%) and other general symptoms (87.7% to 100%). It significantly relieved the vitiation of Pitta(81.2%), Vata (78.9%), Kapha (60.6%), and Rasa(89.9%).in this group the cure rate was highest i.e. 71.4% and the remaining 28.6% patients were also markedly improved. In this group the recurrence of the disease was also negligible.

On the basis of the result of this study, it has been concluded that if Guduchi and Bhringraja  Rasayana are added to the treatment of urticaria then the cure rate of the patients of  urticaria may be increased upto 71.4%.  So this combined therapy may be considered as ideal for the treatment of Shitapitta.

Role of Udarda Prashamana Ghanavati and Rasayana in the management of shitapitta

Ramajiyani and singh carried out a clinical study to evaluate the role of Udarda Prashamana powder when given in the form of ghanavati along with single Rasayana drug, either Bhringraja or Guduchi. Ghana vati was prepared from the contents of Udarda Prashamana powder. For the preparation of Ghana vati, the decoction was prepared from the coarse powder of the contents of the respective drug. Thereafter the decoction was concentrated on heating on the slow fire and solidified to make tablets (Ghana vati). For the comparison purpose, a control group was also maintained where the patients of urticaria were given only the powder of   Udarda Prashamana. The duration of treatment in all the 3 groups was two months.

Effect of Udarda Prashamana powder on urticaria patients

6 patients of urticaria were administered UdardaPrashamana powder in the dose of 6 gms twice a day with water in control group.

The drug provided significant relief in itching (78.3%), in surface area involved (79.5%), burning sensation (75.2%) and nausea (75.2%). It significantly corrected the vitiation of Pitta (76.7%), Kapha (73.2%), Vata (60.2%), Rasa (87.5%), and Rakta (80.2%). In this group 33.3% patients were recorded as cured, 50% as markedly improved and 16.7% patients were improved.

Effect of UdardaPrashamana Ghanavati and Guduchi on Urticaria

Ghana vati was prepared from the contents of Udarda Prashamana Mahakashaya described in Charak Samhita sutra sthana chepter 4. It was administered in the dose of 1.2 gm three times a day with water along with 6 gms of powder of Guduchi twice a day with ghee.

The combination provided significant relief in itching -70.9%, surface area involved -81.9%, pricking pen -74.6%, and burning sensation – 74.9%. It significantly relieved vitiation Kapha (74.3%), Pitta (74.9%), Vata (70.8%), Rasa (72.6%), and Rakta (71.5%). In this group of 42.9% patients were cured, 42.9% patients were markedly improved and 14.2% patients were improved.

Effect of Udarda Prashamana Ghanavati along with Bhringraja

12 patients of Urticaria were administered 1.2 gms of UdardaPrashamana Ghana vati three times a day with water along with Bhringraja powder 6 gms twice a day with ghee.

The combination provided significant relief in itching (75.7%), body area involved (81.3%), pricking pen (79.8%), burning sensation (81.3%), fever (89.3%) and nausea (100%). The therapy significantly corrected the vitiation of Vata (85.8%),Pitta(77.4%), Kapha (77.4%), Rasa(76%) and Rakta (79.1%). In this group 58.3% patients were cured, 25% were markedly improved and 16.7% patients were improved.

It was concluded that amongst the two Rasayana drug Bhringraja is better to augment the effect of UdardaPrashamana Ghana vati in comparison to Guduchi.

Effect of Vamana Karma on Urticaria (shitapitta)

Dhabaria and singh Gurdip (1997) carried out further studies to evaluate the role of Vamana Karma in the Management of urticaria. The results of the 3 groups were as follows:

8 patients of Urticaria were first prepared with internal snehana, Abhyanga and Svedana and then Samayak Vamana was produced with Vamana yoga mainly containing Madanaphala, Vacha and Saindhava. Thereafter, the patients were brought gradually to their routine diet as per schedule of Samarjana Karma. The improvement provided by Vamana Karma in the signs and symptoms of urticaria patients were as follows:

Vamana Karma provided significant relief in itching (71.4%), lesions (64.4%), pricking pain (80%), fever (53.3%) etc. consideration of overall improvement showed that 37.5%, patients showed complete remission, 37.5% patients were markedly improved, 12.5% were improved and 12.5% patients showed no response.

Effect of UdardaPrashamana with Rasayana Ghanavati after Vamana

After proper Vamana Karma and completion of Samarjana Karma the patients were administered Udarda Prashamana with Rasayana Ghana vati in the dose of 1.2 gms three times a day with water for 45 days. Udarda Prashamana with Rasayana Ghanavati was prepared by adding Guduchi and Bhringraja  to the contents of Udarda Prashamana as mentioned above.

The drug provided further improvement to 100% in itching, pricking pain and burning sensation and 87.2% in the lesion (Mandala). The cure rate reached to 62.5% and the remaining 37.5%patients showed marked improvement.

Effect of UdardaPrashamana with Rasayana Ghana vati on Urticaria

10 patients of Urticaria were treated only with UdardaPrashamana with Rasayana Ghana vati administered in the dose of 1.2 gms three times a day for 45 days.

The drug provided significant relief in itching (77.4%), lesion (Mandala)(88%), pricking pain (84.6%) burning sensation(50%), Vomiting (69.2%) and fever (50%) etc. it also provided significant relief in vitiation of Vata (60.1%),Pitta(63.6%), and Kapha (77.4%). UdardaPrashamana with Rasayana Vati provided complete remission to 60% patients, marked improvement to 20% patients and improvement to 20% patients.

It has been concluded that to provide better cure it is better to conduct Vamana Karma prior to the administered of UdardaPrashamana with Rasayana drugs.

Role of Ardraka Khanda along with Rasayana in the management of shitapitta (urticaria)

In this study Shridhara and singh (1989) evaluate the role of Virechana as well as Ardraka Khanda in the management of Urticaria (shitapitta). Ardraka Khanda described by Bhavaprakasha in the chapter of shitapitta was selecled for this study.

Ardraka Khanda 

Bhavaprakasha in the chapter of shitapitta has described Ardraka Khanda which comprises of Ardraka – 64 parts and 4 parts each of fruit and root of pippli, Maricha, Shunthi, Chitraka, Mustha, Nagakeshara, Tvak,Ela, Karchura, tamalapatra and Vidanga. All these drugs were added to 32 parts of ghee and 128 parts of milk and Ardraka Khanda was prepared as per lehya Kalpana.

Effect of Ardraka Khanda on patients of Urticaria

Ardraka Khanda was  administered in the dose of 5 gms twice a day with milk after meal for 4 weeks. The drug provided significant relief in itching 66.6%, percentage of body involvement (55%) and other symptoms (69 t0100%). It significant relieved the vitiation of Vata(100%), Kapha (72%), and Pitta (64.9%), Dosha and Rasa (100%) and Rakta dushya(69%).

The consideration of overall improvement showed that in this group 46.2% patients were cured , 15.4% were markedly improved,23.1% patients were improved and 15.4% patients remained unchanged.

Effect of Ardraka Khanda along with Rasayana on Urticaria

9 patients of Urticaria were given Ardraka Khanda as mentioned above and were simultaneously given Guduchi powder in the dose of 5 gms twice a day with milk for 4 weeks.

The drug provided significant relief in itching (73.3%), surface area involvement (82.7%), and other symptoms (from 80% to 100%). It significantly corrected the vitiation of Pitta(88.9%), Kapha(85.7%) and Rakta (72.2%).

In this group 33.3% patients were cured 22.2% were markedly improved, 33.3% were improved and 11.1% remained unchanged.

On the basis of this study it was concluded that Ardraka Khanda provided significant relief to the patients of shitapitta(urticaria) and this effect may be augmented to some extent by the addition of Rasayana drug Guduchi.

Effect of Ardraka Khanda after administered Virechana on Urticaria

7 patients of  urticaria were first given Virechana after proper Snehana and Svedana. After Samsarjana Karma, the patients were administered Ardraka Khanda and Guduchi powder in the manner mentioned above 4 weeks.

The therapy provided significant relief in itching (63.7%), surface area involved (76.2%), and other symptoms (79.8% to 100%). It also significantly corrected the vitiation (Dushti) of Vata(90%), Pitta (60%), Kapha (58.7%),Rasa (803.3%) and Rakta(66.7%).

On the basis of this study it was concluded that Ardraka Khanda provided significant relief to the patients of shitapitta (urticaria) and this effect may be augmented to some extent by the addition of Rasayana drug Guduchi.

Discussion and conclusion

It is obvious from the studies that ayurvedic drugs provide significant relief to the patients of urticaria and the rate of recurrence can be by adding suitable Rasayana drugs, particularly Guduchi and Bhringraja. Further the administration of these drugs after performing classical Vamana or Virechana may further enhance the chance of better cure.

References

 

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