UNDERSTANDING SHEETAPITTA (URTICARIA) IN AYURVEDA

Urticaria refers to an area of focal dermal edema secondary to a transient increase in capillary permeability. Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. On certain body sites such as the lips and hands the edema spreads and is traditionally referred to as angioedema. By definition the swelling lasts less than 24 hours. An episode of Urticaria (hives) can start as itching, followed by swollen red wheals. The itching may be mild or severe. Scratching, alcohol beverages, exercise and emotional stress may worsen the itching. Urticaria affects about 15-20 % of total population. This condition can interfere in routine activities of the patient. It is intermittent and frustrating for both the patients and physicians. Urticaria is generally manifested due to foods such as eggs, nuts, shellfish etc. and resolves with only symptomatic treatment. Acute urticaria maybe associated with angioedema of the lips, face, throat and rarely wheezing, abdominal pain, headaches and even anaphylaxis. Whilst severe angioedema can be life-threatening due to respiratory obstruction, this condition is extremely rare in a dermatological context.

The symptoms and signs of urticaria are due in large part to mast cell degranulation with release of histamine and a variety of other vasoactive mediators. That more than histamine is involved is reflected by the fact that potent histamine blockers, whilst frequently improving the itch of urticaria and the number of weals, do not abolish all the symptoms or signs in many patients.

CAUSES

• Autoimmune due to the production of antibodies that cross link the IgE receptor on mast cells
• Allergens ( in foods, inhalants and injections)
• Drugs
• Contact (eg. animal saliva, latex)
• Physical ( heat, cold, pressure, sun, water)
• Infection (eg. viral hepatitis, infectious mononucleosis, HIV infection during seroconversion)
• Otlher conditions (eg. systemic lupus erythematosus, pregnancy, intestinal parasites)

Diagnosis is typically based on the appearance. Patch testing may be useful to determine the allergy. Prevention is by avoiding whatever it is that causes the condition. Treatment is typically with antihistamines such as diphenhydramine , ranitidine and steroids are used in the treatment of urticaria, long term use of which may cause adverse effects in the human body

In severe cases, corticosteroids or leukotriene inhibitors may also be used. Keeping the environmental temperature cool is also useful. For cases that last more than six weeks immunosuppressants such as ciclosporin may be used.

 

AYURVEDIC VIEW OF URTICARIA: SHEETAPITTA

In Ayurveda urticaria is correlated with Sheetapitta. Sheetapitta is a disease caused when a patient is exposed to cold breeze which results in vitiation of Kapha dosha and Vata dosha. These two vitiated doshas later combine with Pitta dosha and circulate all over the body producing the signs and symptoms externally over the skin and internally in blood and other tissues and manifest Sheetapitta. There is no satisfactory treatment in contemporary science for this disease but can be effectively managed by Ayurveda.

CAUSES

• Sheeta Maruta Samsparshat/ Exposure to cold
• Vegavarodha/ Suppression of natural urges

POORVARUPA (PREMONITORY SIGNS)

• Pipasa (Thirst)
• Aruchi (Loss of Appetite)
• Hrillasa (Nausea)
• Dehasada (Feeling of tiredness)
• Angagaurava (Feeling of heaviness)
• Raktalochanata (Redness of eyes)

SYMPTOMS

• Varati Damshta Samsthana Shotha (Inflammation like an insect bite/ Nettle sting)
• Kandu Bahula (Severe itching)
• Toda Bahula (Excessive pain like pricking)
• Chhardi (Vomiting)
• Jvara (Fever)
• Vidaha (Burning Sensation)
• Hrillasa (Palpitation of heart)
• Aruchi(Anorexia)
• Dehasada (Feeling of tiredness)
• Angagaurava (Heaviness of body parts)
• Pipasa (Thirst)

 

SAMPRAPTI- ETIOPATHOGENESIS

Aggravated Vata and Kapha (Pradushtau Kapha Marutau) due to cold winds (Sheeta Maruta Samsparshat) when being combined with Pitta (Pittena Saha Sambhooya) spreads internally and externally (Bahir-Antah Visarpatah) and results in ‘Sheetapitta’

Samprapti Ghataka

• Dosha: Tridosha (all the three doshas)
• Agni: Manda ( digestion- mild )
• Doshagati:Vriddhi, Tiryak, Shakha Vyadhi (the direction of doshas; to all extremities )
• Marga: Bahya (route of disease: external)
• Dushya: Rasa, Rakta (body tissues involved: circulating fluid, blood)
• Srotas: Rasavaha, Raktavaha (channels of circulation involved: : circulating fluid, blood)
• Srotodushti prakara: Vimargagamana (vitiation of channels: deranged)
• Udbhava Sthana: Aamashaya (site of origin of disease: stomach)
• Vyakti Sthana: Tvak (manifested site of disease : skin)
• Svabhava: Ashukari (nature of disease : spread easily)

 TREATMENT

• Nidana parivarjana: Avoidance of causative factors
• Shodhana: biopurificatory procedures; If the doshas vitiated are in excess (Prabhoota) treatment adopted is Shodhana to expel them out completely.
• Vamana: medicated emesis; decoction of Patola and Arishtaka.
• Virechana: medicated purgation; decoction of Triphala, Guggulu, Pippali.
• Shamana: medications which pacify the aggravated doshas. Vata predominant tridosha pacifying drugs which are mentioned for vitiation of the body tissues involved (Rasa Rakta dushti) are beneficial in controlling the symptoms of the disease.
• Shamana Chikitsa: Parada, Swarna, Loha, Tamra, Abhraka, kasisa, ghandaka, gairika, pravala and shanka are the major mineral drugs that have action on Sheetapitta. Among ingredients most of the minerals possess sweet taste, unctuous, cold potency and are pacifying vata, kapha and tridosha Apart from these, drugs which are antimicrobial (krimighna), complexion enhancing (varnya), skin protecting (kushtagna), kandugna (good for itching) is mainly used for sheetapitta.

Few formulations in the texts

• Charaka Samhita : Udarda Prashamana Mahakashaya, Katu Taila, Mustadi Churna.
• Sushruta Samhita : Eladi Gana
• Bhavaprakasha : Navakarshika Guggulu Trikatu +Sharkara Yavani+Vyosh +Yava kshara Aardraka Rasa +Purana Guda Yavani + Amalaki Nimba Patra + Ghrita +Amalaki Aardraka Khanda
• Chakradatta : Visarpokta Amritadi Kwatha Agnimantha Moola +Ghrita Shushka Pakva Gambhari Phala after boiling with milk.
• Bhaishajya Ratnavali :Yashtyadi Kwatha
• Yogaratnakar : Vardhamana Pippali,  Vardhamana Lasuna  Prayoga

SINGLE HERBS

• Guduchi/ Heart-Leaved Moonseed
• Nimba/ Margosa
• Haridra/ Turmeric
• Yashtimadhu/ Licorice
• Ajamoda/ Parsley
• Gambhari/ Beechwood, Gmelina, Goomar teak, Kashmir tree, Malay beechwood, White teak,
• Durva/ Conch grass, Bermuda grass
• Agnimantha/ Dusky Fire Brand Bark
• Amalaki/ Indian gooseberry
• Parnayavani / Indian borage

MEDICINES

• Kamadugdha rasa : 250-500mg repeatedly
• Sootasekhara rasa : 125-250 mg thrice a day
• Suvarna sootasekhara rasa : 125-250 mg thrice a day
• Bruhat Haridrakhanda : 5 grams in hot water
• Chandrakala rasa : 125-250 mg thrice a day
• Patoladi kwatha : 20 ml to 30 ml twice a day
• Triphala kwatha : 20 ml to 30 ml twice a day
• Mahamarichadi taila: external application as required
• Mustard oil : external application all over body
• Yavakshara and saindava lavana mixed with mustard oil: external application all over body
• Medicinal oil prepared by drugs of Eladi gana : external application all over body
• Maricha churna : external application over affected area with ghee

PATHYA – Dos

• Jeerna Shali/ Old rice
• Jangala Mamsa/ Lean meat
• Triphala (Three myrobalans; Chebulic myrobalan, Belleric myrobalan and Indian gooseberry)
• Madhu/ Honey
• Mudga Yusha/ Green gram soup
• Kulatha Yusha/ Horse gram soup
• Ushnodaka/ Hot water
• Karkotaka Shaka/ Spine gourd or Bitter melon
• Karavellaka Shaka/ bittergourd
• Moolaka Yusha/ Radish soup

 

APATHYA– Donts

• Ksheera vikarani / milk products, dairy
• Chhardi Nigraha/ Suppression of urge to vomit
• Ikshu Vikarani/ Sugarcane products
• Divaswapna/ Day sleep
• Matsya/ Fish
• Avoid all pitta and rakta vitiating foods like excess salt, too much sugar, pungent, fried and oily foods
• Purva and Daksheena Disha Pavana/ Exposure to eastern and southern winds
• Anupa- Udaka Mamsa/ meat of marshy and aquatic animals
• Snana / Bathing many number of times
• Naveena Madhya/ Freshly prepared liquor
• Atapa Sevana/ Exposure to sun
• Avoid all cloths that do not absorb water
• Don’t work near heat, furnaces, colors, paint dyes, petrol etc

Editor: Dr. Anu PK

Email: editor@ayurvedam4you.webc.in