Ayurvedic Management Of Vicharchika – A Case Report

Vicharchika, is a common type of skin disorder described under Kshudra kushta in Ayurveda¹. According to Charaka, it is a srava roga with symptoms like kandu (itching), pidaka (eruptions), syava (blackish discoloration) and bahu srava (excessive oozing)². It is usually associated with increased kapha dosha³ along with the dushyas (pathogenic substances), which are twak, rakta, mamsa and ambu. Clinically, certain chronic skin conditions present with similar complaints which are relapsing in nature and affect the patient’s quality of life significantly. Conventional treatment usually includes topical steroids, oral antibiotics, immunosuppressants and procedures like laser therapy⁴. Long term dependence on these medications can cause adverse effects and even recurrence of the symptoms. In Ayurveda, Acharyas have mentioned specific treatment for Kushta roga including shodhana procedures followed by shamana aushadis along with proper diet and lifestyle modifications⁵. In the present case study, patient presented with symptoms of Vicharchika and underwent sodhana and shamana therapy. The symptoms reduced and overall condition of the patient improved showing effectiveness of Ayurveda treatment in the management of Vicharchika.

CASE REPORT

Details of the case

An 18-year-old male approached the Outpatient department of Visha Chikitsa at Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan with complaints of multiple dark, raised skin lesions over neck, cheeks, both shoulders and arms since the past one and half years. The lesions were associated with severe itching, burning sensation, occasional pus discharge and intermittent powdery discharge. He also mentioned feeling of stretching of skin over the cheeks. Patient was anxious regarding prognosis of this disease which was precipitated by depression due to demise of his father before 2 years.

History of the present illness

The patient was apparently healthy one and a half years back. Gradually, he started developing itching over the neck and bilateral shoulders, along with pus-filled eruptions. Around the same time, he was diagnosed with Hepatitis A and underwent allopathic treatment for the same.

During these months, itching increased and spread to his cheeks, shoulders and bilateral arms. The skin lesions were associated with burning sensation, pus formation, and a powdery type of discharge. He took allopathic treatment for these without any significant improvement. As the symptoms persisted, he approached our hospital for further management.

History of past illness:

History of Hepatitis A, one and half years back for which he underwent allopathic treatment. He also took extract of the leaves of bhoomyamalaki (Phyllanthus niruri) for 2 months following this.

Family history: Nothing significant

Personal history

Diet – Mixed

Appetite- Good

Bowel- Regular

Micturition- Regular

Sleep- Disturbed due to itching

General Examination

On general physical examination, there was no evidence of pallor, edema, clubbing, cyanosis, icterus or lymphadenopathy.

Vital Signs

Pulse: 74/min

Blood Pressure: 120/70mmHg

Respiratory Rate: 16/min

Temperature: 97 F

Weight: 59kg

Height: 174cm

Systemic examination

No abnormality on examination of central nervous system, cardiovascular system, respiratory system and gastrointestinal system

Integumentary system- examination of lesions

Distribution- Generalized

Number of lesions – Multiple

Type of lesion- Papulopustular

Pattern – Discrete to confluent

Areas involved – bilateral shoulder, arms, cheek, neck

Local examination (Representative lesion)

Site- Left shoulder

Size- Varying sizes (1-2mm)

Shape- Round to irregular

Surface- Rough

Margins- ill-defined

Color- Reddish black hyperpigmentation

Asta-Vidha Pareeksha:

Nadi: Vata pitta

Mala: Prakruta

Mutra: Prakruta 

Jihwa: Alipta

Shabda: Spashta

Sparsha: Anushna-Sheeta

Drik: Prakruta

Akriti: Madhyama

Dashavidha pareeksha

Prakruti: Vata Pitta

Vikruti: Kapha Pitta

Saara: Madhyama

Samhanana: Madhyama

Pramana: Madhyama

Satva: Madhyama

Satmya: Madhura Katu

Ahara shakti: Madhyama

Vyayama shakti: Madhyama

Vaya: Madhyama

Investigations

In serology examination, IgE was elevated with a value of 700.1 IU/ml

Diagnosis – Vicharchika

Therapeutic Intervention

Medicines given in OPD before admission (for 1 week)

1. HARIDRA KHANDA -5gm morning A/F with warm water
2. BRINGARAJASAVA - 15ml BD A/F with warm water
3. AVIPATHIKARA CHURNA – 3gm at night A/F with warm water
4. GUDUCHI CAPSULE 1-1-1 A/F
5. L.S VATI - 1BD B/F
6. TRIPHALA KWATHA CHURNA – for external wash
7. CHITRAKADI VATI- I BD B/F

Apart from this, patient was educated regarding chronicity of the case and importance of timely shodana therapy. Whole procedure of virechana was explained and informed consent was obtained.

BEFORE	AFTER
( Figure 1)	(Figure 2)
(Figure 3)	(Figure 4)
(Figure 5)	(Figure 6)

DISCUSSION

About the disease

Vicharchika is one among the kshudra kushta and is a kapha predominant tridoshaja vyadhi involving Twak, Rakta, Mamsa and Ambu as dushyas. In the present case, severe itching (kandu), papulopustular eruptions (pidaka), blackish discoloration (syava) and profuse discharge (bahu srava) are the main symptoms which are similar to the classical features of Vicharchika mentioned by Charaka. In contemporary medicine, due to the chronic nature and similarity in clinical features it can be considered as eczema.

History of Hepatitis A could have altered the immune status of the patient triggering chronic skin conditions⁶. Additionally, stress and anxiety of the patient could have aggravated the condition⁷.

About the Interventions

Considering the pathogenesis, treatment approach was focused on the Kapha Pitta dosha, kleda vridhi and rakta dushti. As the condition was chronic, addressing the root cause by shodhana was essential rather than mere shamana aushadis. Along with this counselling and relaxation therapy was provided which assured the patient, and helped gaining his confidence in treatment.

Due to non-willingness for admission on the first day, the symptoms were addressed by prescribing Bringarajasava, Guduchi capsule, Laghusutashekara vati and Haridrakhanda⁸; Avipathikara churna⁹ to decrease the toxin-load and Triphala for external wash considering its kushtagna property. Chitrakadi vati was advised for preparing the body for snehapana.

After proper ama pachana, patient underwent shodhananga snehapana for 5 days with dosages 30ml, 50ml, 100ml, 100ml and 120ml respectively. Considering the indication of Mahatiktaka grita in kushta, kandu, daha, kamala and manasika vikaras, it was the best drug of choice for snehapana¹⁰.

After attaining samyak snigda lakshana, sarvanga abhyanga followed by Bashpa sweda was done aiming at channelizing the dosha from sakha to koshta. Eladi taila was preferred for abhyanga because of its vatakaphahara, varnaprasadana and kandu pidaka nasana property¹¹.

Trivrit lehya being the best drug of choice, it was preferred as virechana aushadi¹² along with Draksha panaka resulting in 28 vegas indicating proper elimination of aggravated doshas.

Strict samsarjanakrama (peyadi krama) and pathya was advised after the shodhana.

During discharge, Nimbadi kashaya and Guduchi¹³ capsules were prescribed considering its kushtahara property, along with Bhunimbadi kadha to address liver function and balancing Pitta dosha. For Bahya shodhana, nitya abhyanga with Eladi taila, and Pure soap (main ingredient - Sidharthaka churna¹⁴) was adviced.

As the dermatological symptoms reduced significantly during follow up, medicines further prescribed included Patolakaturohinyadi kashaya¹⁵, Avipathikara churna to address Pitta and liver function along with Laghusutashekara vati and Nimbadi guggulu to address skin complaints.

CONCLUSION

In this case there was a significant reduction in itching and burning sensation, along with complete stoppage of discharge, leaving the lesions dry. Shodhana and Shamana therapies helped in managing both the systemic and local aspects of the condition. Maintaining a healthy internal environment by pathya sevana supported the treatment. A psychosomatic approach contributed to the overall health of the patient. Since this is a single case study, the results cannot be generalized. Further research with larger sample sizes and longer follow-up is needed to validate the same.

REFERENCES

1. Agnivesha, Charaka Samhita, revised by Charaka & Dridhabala with Ayurveda deepika commentary of Chakrapanidatta, edited by Vd. Yadavaji Trikamji Acharya, Chaukhambha Prakashan, Varanasi, reprint Chikitsa Sthana, 2007; 7/26.: 450.
2. Agnivesha, Charaka Samhita, revised by Charaka & Dridhabala with Ayurveda deepika commentary of Chakrapanidatta, edited by Vd. Yadavaji Trikamji Acharya, Chaukhambha Prakashan, Varanasi, reprint Chikitsa Sthana, 2007; 7/26, p450
3. Acharya   Agnivesa   Charaka   Samhitha   edited   by Vaidya Jadavji Trikamji commentary with Ayurveda    Deepika    published    by    Choukhamba Orientalia, Varanasi reprint 2021, Chikitsasthana 7thchapter, sloka no.30 pages no 451.
4. Calabrese G, Licata G, Gambardella A, De Rosa A, Alfano R, Argenziano G. Topical and Conventional Systemic Treatments in Atopic Dermatitis: Have They Gone Out of Fashion? Dermatol Pract Concept. 2022 Jan 1;12(1):e2022155. doi: 10.5826/dpc.1201a155. PMID: 35223191; PMCID: PMC8824598.
5. Agnivesha, Charaka Samhita, revised by Charaka & Dridhabala with Ayurveda deepika commentary of Chakrapanidatta, edited by Vd. Yadavaji Trikamji Acharya, Chaukhambha Prakashan, Varanasi, reprint Chikitsa Sthana, 2007; 7/39.
6. Griffin PM, Kevat DA, McCarthy JS, Woods ML. Chronic urticaria following acute hepatitis A. BMJ Case Rep. 2012 Sep 18;2012:bcr2012006479. doi: 10.1136/bcr-2012-006479. PMID: 22989421; PMCID: PMC4544675.
7. Shchaslyvyi AY, Antonenko SV, Telegeev GD. Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. Int J Environ Res Public Health. 2024;21(8):1077. doi:10.3390/ijerph21081077.
8. Shreelakshmi   S, Raju   C   M   M.   A   Clinical   Study   to   Evaluate   the   Efficacy   of Haridrakhanda in the Management of Allergic Rhinitis in Paediatric Age Group. International Journal of Ayurveda and Pharma Research. 2022;10(8):14-20.
9. Govind Das, Bhaishajya Ratnavali, Edition Reprint 3rd, Chaukambha Prakashan,Varanasi 2013, chapter 56 verse 25-29 Pg. no. 922.
10. Agnivesha, Charaka Samhita of Acharya Charaka, Dridhabala krit, edited by Vaidya Yadavaji Trikamaji Acharya. Chikitsasthana, Ch.7, Ver.144-150. 2nd edition. Varanasi: Chaukhambha Surbharati Prakashan; 2020.p.457.
11. Tripathy Brahmananda, Ashtanga Hridya Chaukhamba Sanskrit Pratishthan, Delhi Edition Reprinted 2012 Su. S. Chapter 15, Shloka 43.
12. Atrideva Gupta (2005). Vidyotini Hindi Commentary, Astanga Hridayam, Kalpasthana 2/9–10, Chaukhambha Samskrita Samsthana, Varanasi.p.509
13. Neethu M., Chaitra H., Ananya Latha Bhat, Madhusudhana V., Ayurvedic Approach in the Management of Urticaria-A Case Study, Int. J. Sci. R. Tech., 2025, 2 (10), 102-107. https://doi.org/10.5281/zenodo.17294703
14. Phartale R, Upadhyay R, Phartale V. A review of Patolakaturohinyadi Kashaya as a polyherbal hepatoprotective formulation. Int J Ayurveda360. 2025;2:933–943. doi:10.63247/3048-7390. vol.2. issue 3.13.
15. Tripathi B editor, Charaksamhita   by   Acharya Agnivesh, Chikitsasthana, Chapter 7, Verse   91,92, Varanasi     Choukhamba     Surbharati     Prakashan, edition 2012.p311