Patients attending the O.P.D. and I.P.D. of Panchakarma Department of I.P.G.T. and R.A., Gujarat Ayurved University Jamnagar, having classical signs and symptoms of Vicharchika (Eczema) were selected irrespective of religion, sex, occupation, etc. The study was approved by Institutional Ethics Committee.. A special Proforma including all the etiological factors of Kushtha with Dushti Lakshana of Dosha, Dushya, Srotas, etc., was prepared for proper assessment.
Patients having signs and symptoms of Vicharchika (Eczema) described in classical Ayurvedic texts as well as in Modern Medical literature; patients above 16 years and below 70 years of age; and chronicity not more than 5 years were included.
The patients less than 16 years and above 70 years of age were excluded. Patients suffering from diseases like anemia, hemorrhagic disorders, diabetes mellitus, cancer, tuberculosis, hemiplegia, convulsions, and other severe complicated systemic disorders were excluded. Wounded, timid, thin patients, pregnancy, and chronicity more than 5 years were also excluded.
Criteria of assessment
Total effect of therapy was assessed considering following criteria:
Cured: 100% relief in the signs and symptoms with plain skin surface. Significant changes in color of the affected skin lesion toward normal was considered as cured. Marked improvement 76 to 99% relief in the signs and symptoms were recorded as complete remission with marked improvement in pigmentation and thickening of the skin. Moderate improvement: 51 to 75% relief in signs and symptoms were considered as moderately improved with moderate improvement in pigmentation and thickening of the skin. Mild improvement: Patients showing improvement in between 26 and 50% in signs and symptoms with slight improvement of pigmentation and thickening of the skin was taken as mild improvement. Unchanged: Below 25% relief in signs and symptoms was considered as unchanged.
All the patients were examined weekly during the treatment. Assessment was done on the basis of relief in the signs and symptoms of the disease Vicharchika. For this purpose, cardinal signs and symptoms were given scores according to their severity before and after the treatment.
Routine hematological investigations like hemoglobin, total count, differential count, erythrocyte sedimentation rate (ESR), bleeding time (BT), clotting time (CT), and urine examination were done to rule out any other disease pathology as well as to evaluate safety and efficacy of the trial therapy.
Grouping and sampling
Total 29 patients of Vicharchika (eczema) were registered for the present study. They were randomly divided into the following two groups:
Jalaukavacharana (A) group
Jalaukavacharana Karma: In this group, four sittings of Jalaukavacharana Karma were carried out in consecutive four weeks. Number of Jalauka applied was decided on the basis of the size of lesion (example, 1 cm = 1 leech). Out of total 29 patients 14 were registered in the group, only 1 patient discontinued course of treatment.
Siravedhana (B) group
In this group, two sittings of Siravedhana Karma were carried out on every 15 days. Siravedhana Karma was performed by venesection at the median cubital vein. In the present study, amount of blood removed from one sitting was decided by measuring of one Anjali. Patient was told to take water in his Anjali, that water was taken in measuring glass and amount was measured. The blood to the equal quantity of the water measured by patient's Anjali was removed by venesection (Average, 63.75 ml). 15 patients were registered in this group, out of them 13 completed course of treatment.
1) Jalaukavacharana: Jalaukavacharan karma was done after local abhyanga and swedan on the effected part of the body. There were four sitting of Jalaukavacharana in one month with gap of seven days. Jalauka, three water bowl, cotton, bandage and paper tap were used for this process.
2) Siravedhana Karma: Siiravedhana Karma was done after local Abhyanga and Swedana on the whole body. There were two sitting of Siravedhana Karma in one month with gap of 15 days. Needle no 16, IV set, measuring glass (200ml), bandage and gloves were used in the process.
Pathya-Apathya was advised to the patient as per classics.
Maximum numbers of patients, (24.14%), were of the age group 21 to 30 years, 41.38 % were housewives and 86.21% were habituated to vegetarian diet. Maximum numbers of patients, (62.07%), were having regular bowel habit, and 100% were having Madhura and Amla Rasa dominency in their diet. The 82.76% were having dietary pattern of Visamashana and 68.96% were addicted to Tea. Maximum, (51.72%), patients were having Pitta-Kapha Prakriti. Maximum numbers of patients, (100%), were taking Viruddha Ahara (milk + Khichadi, New Annasevana, and excess intake of salt). Chinta (Stress) was reported in maximum, (40.70%), of patients. The 17.24% of patients were having contact irritant with rubber.
In the present study, Kandu was observed in maximum (96.55%) number of patients. Signs and symptoms like Vaivarnya (discoloration), Raji (lichenification), Raktima (redness), and Rukshata (dryness) were observed in 93.10%, 72.41%, 68.96%, and 58.62% of patients, respectively. Pidika (boil) and Daha (burning) were observed in 65.52% of the patients. Symptoms like Srava (discharge) (37.93%), Shotha (inflammation) (24.14%), and Ruja (pain) (17.24%) were observed in some of the patients. The 93.10% of patients were having gradual onset, while 72.41% of the patients were having chronic course of the disease. The 68.96% of the patients were having Sushka (dry) type of Eczema.
In winter season, aggravation was observed in 24.14% of the patients. The 51.72% of the patients were having lesion size 5 to 10 cm. On maximum, 46.67%, patients, average 11 to 15 number of Jalauka were applied during full course of treatment. During four sittings in 15 patients’ treatment, maximum 47.50% Jalauka sucked the blood for average 30 to 35 minutes. Average sucking time for Jalauka was found to be 20 minutes.
Of two sittings in 14 patients’ treatment, in maximum (71.42%), patients, 3-minute bleeding time was noted during Siravedhana. Average bleeding time for Siravedhana was 3.5 minutes. During two sittings in 14 patients’ treatment, in maximum, (64.28%), patients, 51 to 60 ml of bloodletting was done during each sitting of Siravedhana. Average quantity of bloodletting for Siravedhana was 63.75 ml.