Kilasamapi kusthavikalpa eva, tat trividham vaten, pitten, shleshman:, cheti | kusthakilasyorantaram twaggatamev kilasamparistravi ch || su ni 5/17
Shwitra the common depigmentation disorder described among the varieties of
Kustha in Ayurvedic classics Shwitra is a dermatological disorder having its references in the vedas. It is caused by the imbalance of all three doshas (vata, pitta, kapha) vitiating rakta, mamsa and meda dhatus. The disease involves the skin and does not cause pain, ulceration or any secretions. Shwitra can be corelated to leucoderma. Shwitra though not produces direct physical impairment it may considerably influence psychological wellbeing of the affected. Normal skin color depends on Haemoglobin (in both the oxygenated and reduced state), Carotenoides and Melanin pigment. Vitiligo is characterized by selective destruction of melanocytes of the basal layer of the epidermis and occasionally the hair follicles resulting in white patches on the skin. People with this disorder can experience emotional stress particularly if Vitiligo develops on visible areas of the body such as face, hands, arms and genitals. Worldwide prevalence is observed as 1% of the world population. Highest incidence has been recorded in India and Mexico. Shwitra emerges as a sequel to irregular dietary habits and life style changes. Ayurveda focuses on viruddha ahara (incompatible food) which causes the vitiation of all doshas. It is a cause of many skin diseases like shwitra etc because whatever we eat that effects on our body as well as mind also. So we should eat healthy food which will enhance our health. And avoid eating incompatible food as preventive measures of the diseases. Avoidance of intake of incompatible food play key role in the prevention of disease.
Shwitra is known by different names like:
- Kilasam (diseases where normal colour of skin is destroyed) Atharva Veda.
- Palitam (meant particularly for whiteness of the scalp hair) Atharva.
- Kilasi (meaning spotted dear) Max Muller’s commentary on Rig Veda
- Alasa (Atreya Bhraman).
- Daruna, Charuna, Switra – (Charaka Samhita).
- Darun Varun (Bhaluki Samhita)
- Padur Kustha.
- Pada Sphota, TwakPuspi, Kilasa, Sidhmali. These four terms have been used as synonym of Switra in Amarakosha.
Kusthaeksambhavam shwitram kilasam varunam bhavet |
Nirdishtamparistravi tridhatudbhavsankshayam ||
Ayurvedic descriptions of Switra and Kilasa are synonymous. However, some authors consider these two as subtypes. Acharya Sushruta explains that Kilasa is a variety that affects only the skin. Supporting his opinion, Madhava and Vagbhata view that Kilasa is stable (nirdista) as it remains at skin level (called the twakgata condition in Ayurveda). Charaka explains that Switra becomes firmly established when the basic energy principles (dosha) enter different levels of basic body tissues (dhatu), indicated by change in color of the lesions. When dosha enters dhatu, the disease shows poor prognosis (asadhya). Bhoja identified more subcategories on the basis of etiology (nidana); originating from the basic energy principles (doshaja) and from wounds (vranaja). Sub-classifications in the doshaja variety are Daruna, Aruna, and Kilasa.
There are three types of energy principles (Doshas) involved in the balance or imbalance of the physiology, according to Ayurvedic theory:
Vatadrukshaarunam pittatamram kamalpatravat |
Sadaaham romvidhvansi kaphatshwetam ghanam guru ||
Skanduram kramadraktamansmeda:su chadishet |
Varnenaidrugubhayam kruchram tacchottarottaram || madhav ni kushtha/ 37.38
Motion (Vata in Sanskrit — or ‘mobile natured energy’ indicating xerosis, light, cold, subtle, mobile aspects of physiology); metabolism, (Pitta in Sanskrit — or ‘combustion, heat production’ indicating oily, corrosive, heat, foul smell, liquid aspects of physiology), and structure (Kapha in Sanskrit — or water, indicating the slow, cooling, binding, stabile aspects of physiology). When predominant physiological disturbance is of ‘mobile natured energy’, it is called vataja Switra. Similarly, the pittaja and kaphaja varieties are recognized. When the vatajavariety is observed, the physiological disturbance is usually embedded at the blood tissue level (rakta dhatu). In the same way pittaja Switra spreads to the muscle tissue (mamsa dhatu) and kaphaja to the adipose tissue level (medo dhatu level).
The stage of the disease and selection of medicine are based on the above Ayurvedic principles. We have explained these principles on the basis of clinical features, using biomedical terminology.
Etiology (Nidana)
Vachamsyatthyani krutaghnbhavo ninda gurunam gurugharshanam cha |
Paapkriya purvakrutam cha karma hetu: kilasaya virodhi channam ||
Charak chi 7/172
The causative factors for skin diseases (kusta) and Vitiligo (Switra) are the same and affect the same basic body tissue (dhatu) levels. Switra differs from other skin disorders by the normal functioning of all but the ‘skin tissue’ (twak) resulting in discoloration of the skin (twak vaivarnyata), without discharge (aparisravi). The dietary factors are also discussed in the causation of vitiligo. Seventeen ways of dietary intake are labeled as incompatible (virudha) diet. Such incompatibility with the normal physiology of humans are determined on the basis of the habitat of the patient, food versus season, different combinations that are incompatible, and so on, which might trigger Vitiligo lesions. Excessive consumption of food that takes a longer time to digest (guru) and non-vegetarian and spicy foods are also an associated etiology.
Sinful actions (papa karma) done in the previous birth and current life and fighting with teacher (gurugharshana) are frequently reported by Indian patients as a possible cause. Customarily Hindu religion recommends several compensatory rituals for the same. Many patients undergo these rituals before reporting to or during the treatment course.
Prognosis (Sadhya-asadhyata)
Ashuklromaabahulasanshlishtamatho navam |
Anagnidagdhajam sadhyam shwitram varjyamatoanytha ||
Guhyapaanitalostheshu jaatamapyachirantanam |
Varjaniyaam visheshen kilasam sidhyimichta || ma ni/ kustha 40.41
Good prognosis (sadhya) patients have lesions of recent onset (nava), are not thickened (thanu), and show pigmented hairs (ashukla roma). However, patients who are likely to have poor prognosis exhibit lesions on the external genitalia, lips, and tips of fingers (Anthejatam), coalescing (samslista), and / or cover large areas of body (bahala) or those appeared following burns (agnidagdhaja).
Treatment (Chikitsa)
Shwitrini hrutdoshasya hrutraktasya va sakrut |
Khadirambuyavaannanaam truptasya malpurasa: || yogratnakar
Vitiligo (Switra) is chronic (deergha roga) and should be treated immediately. Classical textbooks of Ayurveda recommend four steps of treatment. The first step is purification therapies (Shodhana with or without suppressive therapies (shamanoushadha) using herbal decoction of Psoralia corylifolia (bakuci kwatha) and Eurphorbia nerifolia (snuhi). This medicine is expected to induce multiple bouts of purgation. Virechan Drugs having the property like Ushna, Tikshna, Sukshma, Vyavayi and Vikasi by virtue of their own potency it reaches the heart and circulates through the vessels. Due to their Ushna nature, they liquefy the compact doshas and because of their Tikshna guna, they separate the adhered doshas located in the gross and subtle channels of the entire body, from which doshas flows towards the gastro-intestinal tract, this morbid material reaches the stomach and gets propelled by Udana Vayu. Due to predominance of prithvi and jala mahabhutas in these purgative drugs it causes downwards movement of Doshas from the koshtha and leads to the expulsion of unwanted toxins from the body.
Virechana is the choice of therapy for the management of Shwitra. In addition to the acceptability and popularity it is considered as the best treatment for removal of morbid and increased pitta, and it is more useful in eradicating the disease originated from the vitiated pitta doshas from the body and purifies the blood, by removing the toxins from the body. Pitta is closely related with agni which is responsible for the digestive & metabolic process in the body. Thus refined pitta will aid in restoring the normal complexion.
Mechanism of action: Retention of Intraluminal fluid by hydrophilic or osmotic mechanism, Decrease in net absorption of fluid by affecting the small and large bowel fluid and electrolyte transport, effect on the motility of the intestine either by inhibiting the segmenting contraction or stimulating the propulsive contraction.
In the next step oil massage using oil selected on the basis of patient examination (rogi pariksa) and disease (roga). Step 3 is exposure of lesions to the sun rays as long as the patient can tolerate (Soorya pada santhapam in Ayurveda). Patient receives Gruel (peya) for the following three days. If bullae arise after a sun bath they must be punctured using a sterile needle. For the last three days, the patient receives decoction (kwatha) made of Ficus hispida (malayu), Pterocarpus marsupium (asana), Calllicarpa macrophylla (priyangu), Peusedanum graveolens (satapuspa), Coleus vettiveroides (ambhasa), and alkaline extract of Butea monosperma (palasa ksara), along with an alcoholic preparation of jaggery (the preparation is called phanitha in Ayurveda). On these three days the diet should be salt-free and should contain buttermilk.
Any or all of following purification therapies (shodhana) can also be initiated: Controllable induced emesis (Vamana), controllable induced purgation (Virechana), nasal instillation of drugs (Shiro virechana), and bloodletting (Rakta mokshana). These procedure-based therapies are used to expel the vitiated primary life forces (dushita dosha) through the nearest outlet. As part of the intervention, the patients may receive additional suppressive therapies (shamanoushadha) to restore the equilibrium of tridosha, and may be asked to follow diet restrictions.
Shamanousadha
Shamanoushadha is an oral administration of Ayurvedic medicines to keep the vitiated dosha in a normal state, to achieve equilibrium of the tridosha appropriately selected, without attempting to expel them as in the shodhana therapy. This should be documented as practiced if the treatment procedures are within the broad outline of Ayurvedic principles.