Shvitra and its Ayurvedic Management

Introduction

Vitiligo is a long term dermatological disorder characterized by patches of the skin losing their pigment. The patches of affected skin become white. This result in the destruction or hypofunction of melanocyte. Melanocyte cell of the skin contains melanin which is very important factor in respect of pigmentation. The cause of vitiligo is unknown till date. It is multifactorial disease. Genetic susceptibility is important factor in this case. Risk factors are positive family history, sufferings from inflammatory diseases or autoimmune diseases [1, 2]. Worldwide Incidence of vitiligo is 1% and 3-4% population of India is affected by it. In Indian states of Gujarat and Rajasthan, the prevalence of vitiligo is very high being described by some as of epidemic proportions. Confirm diagnosis is possible by skin biopsy or tissue biopsy [3]. Cardinal symptoms of Shvitra are white coloured patches. So it is a cosmetic disfigurement, it affects human’s life psychologically. Treatment for vitiligo in conventional medicine includes topical steroids, systemic steroids, topical PUVA, systemic PUVA, sometimes surgically grafting is also done. PUVA therapy is having side effects like photo toxicity, hyperpigmentation, solar elastosis, cataract and squamous cell carcinoma in white skin individuals. UVB phototherapy is a safer alternative to PUVA therapy but is relatively expensive. In Ayurveda all the skin diseases are considered under the umbrella of Kustha. All the Acharya of Brihattrayi have given individually definition and description of Shvitra. Difference between shvitra and kushta is based on non- secretory and non-infectious nature of disease, involvement of twacha only, peculiarity of Nidana, Asadhya lakshana and chronicity.

Etymology and Definition

The word Shvitra has its root in Sanskrit word ‘shweta’ means white. The term Shvitra is defined as white colored object in Shabdkalpdrum. Ayurveda Shabdokosha mentions it as a color changes towards whiteness. The condition which has white colour vitiated in skin is called shvitra. Acharya kashyapa in kustha Rogadhikara, mentions that any changes of skin colour towards white, is called as Shvitra. In Harita Samhita the word Pandura Varna is used for disease Shvitra. Vachaspatyam defines it as the type of kustha and used the term Dhavala to indicate the colour in Shvitra.

Classification

According to Charak samhita, three sub types of kilasa are due to vitiated doshas and dhatu [13, 14, 15]. • Red patches are due to vitiation of doshas reaching at the level of rakta dhatu. Coppery patches are due to vitiation of doshas reaching at a level maamsa dhatu. 3 white patches are due to vitiation of doshas reaching at a level of meda dhatu.

According to Sushrut Samhita, Three Sub Types of Kilasa Ie Vataj,Pittaja, Kaphaj. 1 Vataj Kilasa – Rough And Coppery Colour, Round Patches.

• Pittaja kilasa: Patches resemble as that of the colour of the lotus petal with bur3a-smooth, white patches in large size with itching. According to Asthang Hridaya a kilasa originates from three doshas and three dhatus [rakta,mamsa, meda].
• Vataj kilasa: Dry and light red patches due to vata dosha predominence in rakta dhatu.
• Pittaja kilasa: Characterised by itching and loss of hair on tamra patches [copper/lotus petal like skin lesions ] due to pitta dosha predominance in mamsa dhatu.
• kaphaj kilaasa: Itching present in white patches due to aggravated kapha dosha localized in mamsa dhatu. Three types of kilasa described in Madhav Nidan aresame as Asthang Hridaya. Samprapti Acharya harit has mentioned that pitta along with vata and rakta causes shvitra. Hence, vata becomes an important factor in the pathogenesis of shvitra symptoms like aruna and krishna varna. Prognosis The patches of shvitra if are matted together and numerous in number and hair over thepatchesareredincolordiseaseis supposedtobe incurable.As per Acharya Sushrut the type of shvitra in which eruptions or patchesextendandbecome confluentandinvadethesole ,palms and anal region and the local hair becomes red in color seems to be incurable.

Management of Shvitra

All the Acharyas have similar view that shvitra or kushta should be initially treated by shodhan karma followed by samshaman karma. Shodhan karma Snehan and swedan: Due to snehan and shodhana aggravated doshas are liquefied and mobilized to enter into kostha. Vamana karma: Any 52 yoga of kritavedhan, madanphala, leaves of patola with nimba juice administered for vamana karma. Virechana karma: juice of kaakodumbarika along with jaggery is the drug of choice for shvitra. Aggravated doshas located in the kostha is expelled out from the body through vamana and virechana process. Raktmokshan: Repeated bloodletting. After the Shodhan karma sansran karma should be done. For sanrsran karma the patient should be subjected to virechan karma by malapee rasa along with guda (jiggery). He should then anointed with oil. (snehkriya) and exposed to sunrays according to his/her tolerance. by this time when he feel appetite or thirst, peya should be given for three consecutive days. Kwath of malapee twak and aksha (baheda) twak with bakuchi kalka may be given to drink followed by exposure to sunlight and when blisters form, takra without salt may be allowed to take with meal [16]. Samshaman karma Most of the drugs used in treatment of kilasa are tikta (pungent), katu (bitter) rasa dominant and ushna (hot) in virya (potency). Tikta rasa itself is kusthaghna (able to cure dermatological afflictions), vishaghna (antidote to endogenous toxins), kandughna (anti-pruritic) and twak- mamsasthirakar (stabilizer of skin and muscles). Ushna virya is helpful in generation of ushna property of the pitta. This property is useful in reproducing melanin pigments. These melanin pigments are responsible for skin colour (Table 1).

Discussion

Shvitra is the chronic disfiguring disease involved with systemic autoimmune process .It is characterized by constrained, idiopathic progressive white patches of skin. The chronic nature of disease requires the patience of patient and physician to get treated. In modern science mainstay treatment of disease is PUVA (psoralen +ultraviolet A exposure ) therapy and corticosteroids which have many harmful side effects like skin cancer ,photoagieng, ultraviolet light burn and nausea. vitiligo is treated with Ayurveda therapy along with diet restriction and psychological counseling. The various modalities and management of shvitra are discussed with various aspects, the severity of disease related with the penetration of dhatus by doshas. The most effective treatment of shvitra is sramsana karma (light purgative method) by malapya juice (Ficus hispida) and jiggery after oleation therapy. The bhedana of pustular eruption is also indicated. Decoctions like khadira (Acacia catechu), plashakshara (Butea monosperma) etc. are mostly used to treat the severe condition of disease. The method of exposure to sunlight is also mentioned prior to purgative procedure as to regain the melanin pigmentation to cure the diseases. PUVA therapy mentioned in conventional medicine is to cure diseases like vitiligo and psoriasis is a similar to treat the shvitra mentioned in traditional texts. External

treatment reflects the utility of effective and efficient drug like kakodumbra (Ficus hispida), avalguja (Psoralea corylifolia) and chitraka (Plumbago zeylanica) along with gomutra. The modalities like raktamokshana (bloodletting), virukshana (dry therapy) and administration of sattu (rice water) are the fully effective in shvitra (vitiligo). The local application of Lepas (cold ointment) and pradeha (hot and thick ointment) is most effective method to treat this obstinate skin disease like shvitra.

Conclusion

The incidence of vitiligo is increasing, so identificationand elimination of multidimensional aetiology associated with the disease based on Ayurvedic principles is essential. Ayurvedic management give a blissful life by improving the immune system of the individual by doing repeated application of Shodhana karma and Samshaman aushadhi.