Scopes of skin disease management through Ayurveda.

Abstract

Human skin, the outer covering of the body, is the largest organ in the body. It also constitutes the first line of defense. According to Ayurveda, the skin is one of the essential sense organs. Ayurveda has its own unique principles of diagnosis and treatment of various skin diseases under the heading of Ku??ha. When we consider the prevalence of various diseases, every year, worldwide near about 20% of the total number of patients seeking medical advice suffer from skin diseases including cosmetic problems. Skin disease is a common ailment and it affects all ages from the neonate to the elderly and causes harm in a number of ways. Beside this, people suffering from skin disease suffer from social stigma.

Skin has been given due importance since time immemorial owing to the aesthetic value conferred upon skin, complexion and beauty by the society. Ayurveda has given prime importance to ahara (diet) and vihara (lifestyle) in the maintenance of health and prevention of diseases. In the recent past,  the relation between diet and skin ailments is well established in contemporary medicine. Ayurvedic literature has described skin diseases mainly under the spectrum of Kushta, the literary meaning of which is that which causes disfiguration. The Ayurvedic system of medicine describes a wide range of etiological factors for dermatological disorders. The etiological factors include physical, physiological, hereditary, psychological, psychosocial, and Papakarma (sinful activities/ Psycho-social stress and the related psychological factors are major culprits in the manifestation and or exacerbation of many dermatological disorders) etc.

The incidence of skin Diseases increasing due to the following factors-

• Faulty diet and daily regime; taking of incompatible and unwholesome foods; taking of meals before the previous meal has been digested; taking milk along with meats, fish (aquatic animals); bathing immediately after exposure to the sun or after physical exertion) etc.
• Excessive and improper use of chemicals, cosmetics, soap, shampoo, deodorants etc.
• Unhygienic practices
• Unnecessary and Overuse of antibiotics and Steroids

Principles of treatment of skin diseases 

• • Punaha-Punaha Shodhana in Bahudoshajanya Tvak roga (dermatological disorders)
  • After Shodhana and Raktamokshana, Ghritapana is essential to prevent Vata Prakopa.

• Lepa Prayoga- after Shodhana and Raktamokshana

Good Clinical Practice (GCP) guidelines

• Accurate diagnosis is must for quick and complete results.
• Nidana Parivarjana (avoidance of causative factors).
• For all chronic skin diseases, Shodhana (Bio-purification) is essential. 
• Then disease specific Rasayana (anti-oxidant & immune-modulator) and Shamana Aushadhi (palliative medicines).
• Psychogenic stresses and emotional conflicts act as causative factors of a few skin diseases. In the management of such conditions, patients' minds should be set at rest by using some Yogic Practice and also by prescribing some Medhya Rasayana (Nootropic) drugs.
• Medhya Rasayana (Ashwagandha, Bramhi, Guduchi etc.) should be given to patients having chronic skin disease.
• Rasa Aushadhi (mineral preparations) especially Malla (Arsenic), Naga (Lead) etc. should not be given for a longer period (more than 45 days). Give hepato-protective and nephro-protective drugs then again may restart after 15 days, if needed. 
• Prescribe Asava-Arishta (Herbal fermented preparation) in elderly patients having poor digestion.
• While prescribing Guggulu kalpana (Commiphora mukul preparations), it is wise to advise the patient to crush the pill.
• Topical therapy is delivered by various vehicles, most frequently soaks, lotions, solutions, creams and ointments, progressing in that order from least to most hydrating.
• Animal oils penetrate the skin best, vegetable oils less and mineral oils the least.
• Irritant drugs must be tested in a small area before applying them to a generalized lesion, otherwise severe allergic reaction may occur in Pitta Prakriti Person. For e.g., Bakuchi Lepa in Switra (vitiligo).
• Avoid the use of irritant drug applications in pregnant women, children, old aged persons, as the skin is very soft & sensitive.
• Avoid irritant drugs application to sensitive area scrotum, genital area, eyelid, lips etc. Oils and oil-based medications should be avoided in the acute stage.
• Before using the lepa yoga (external application), rubbing with rough leaves such as Gojihv? and Gomaya, Samudraphena should be used. This helps in increasing the local blood supply & thus absorption.
• Intake of adequate quantities of water/ liquid must be done daily.
• Green vegetables and seasonal fruits should be taken sufficiently.  
• Non-vegetarian, oily diet, fast/ junk food should be avoided.

Patients with Kushta (dermatological disorders) approach various health care systems with a hope to get a cure. Diseases of the skin account for a great deal of miseries, suffering, incapacity and economic loss. Patients with certain skin diseases, who do not get a cure from the Western Medicine, come to Ayurveda treatment with a great hope of curing their disease. By the time they approach an Ayurvedic physician for treatment, disease seems to have attained chronic state, thus making the treatment further difficult. 

All Acharyas have emphasized on Shodhana therapy for the management of Kushta. The therapy which expels out the morbid doshas from the body is known as Shodhana. By nature, Kushta is difficult to cure, but by the application of Shodhana therapy, cure of the diseases becomes easier due to removal of the root cause, hence Shodhana has great importance in Bahudosha avastha (multifactorial condition). 

According to Acharya Sushruta, Vamana (medicated emesis) should be administered once in every fortnight; Virechana (medicated purgation) once in a month; Raktamokshna (blood-letting) should done twice in a year and Nasya (Nasal installation) once in three days in a chronic case of Kustha considering the involvement and strength of dosha-dushya avastha. 1

According to Acharya Charaka, the patient suffering from Kustha dominated by Vata should first be administered Ghrita internally. The patient suffering from Kustha dominated by Kapha should first be administered Vamana therapy. The patient suffering from Kustha dominated by Pitta should first be administered Virechana therapy for optimum result. 2

Drugs of tikta varga (bitter taste herbs) such as Aragvadhadi Kwath, Manjisthadi Kwath, Patoladi Kwath, Nimbadi Kwath, Panchanimba Churna, Guducyadi Lauha/ Kasaya, Lavan Bhaskar Churna, Haridra Khanda, Giloy Satwa, Rasamanikya, Khadirarista, Saribadyarista, Arogyavardhini, Gandhak Rasayan, Panchatikta Ghrita Guggulu, Triphala Guggulu, Kaishore Guggulu, Chandan, Neem, Khadir, Sariba, Ghrita kumari, Haridra, Strikutaja, Bakuchi etc. are found very useful in the management of skin diseases. Externally Tuvaraka Taila, Mahamarichyadi Taila, Satadhauta Ghrita, Suddha Gandhak with Coconut Oil, Kumkumadi Taila, Somraji Taila, Nimba Taila, Yasad Bhasma etc. are also found effective in the management of certain skin diseases. 

Virechana is the best measure for Kushta (dermatological disorders)

Most of the Kushta come under the heading of Raktapradoshaja vyadhi. Pitta is the mala of Rakta. So, there is avinabhava sambandha between Rakta and Pitta. When an excessive amount of pitta is expelled out from the body it helps to purify the Rakta also, and cures the Raktapradoshaja vikaras like Kushta. Virechana karma has got specific action on sapta-dravyas (Rasa, Rakta, Lasika, Udaka, Vata, Pitta & Kapha), which are the prime factors in causation of skin disorders. Hence, Virechana is the best Shodhana karma in Pitta pradhana kushta and to prevent re-occurrences. Similarly, in Raktadushti conditions malaroopa pitta gets increased in the body, which is located in the liver and gallbladder. To eliminate such malaroopa pitta, Virechana karma is the only line of treatment.3