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ANVESHANA
AYURVEDA MEDICAL JOURNAL
Review Article
ISSN: 2395-4159
ROLE OF JALAUKAVACHARANA (LEECH THERAPY) IN THE
MANAGEMENT OF VICHARCHIKA (ECZEMA)
Chhabra Shailly1, Kaur Rimpaljeet1, Singh Amitabh2
1
PG Scholars, 2HOD, Dept. of Kayachikitsa,
PG School of Ayurveda & Research, Desh Bhagat University, Mandigobindgarh, Punjab, India
Corresponding Author: [email protected]
ABSTRACT
Skin is one of the five „Gyanindriyas’ (sensory organs) as described in Ayurvedic texts.
It is a highly complex organ which plays a vital role in the body‟s general working. About 30%
of all the skin diseases are eczematous. It is a second commonest cause of loss of function.
Vicharchika may be defined as a clinical entity; in which the lesion is covered with Shyava
coloured pidika (skin eruption with dark discolouration), kandu (profuse itching) and ruja
(pain), which may develop anywhere in the body and it may be either wet or dry. In
comparison with modern disease, Vicharchika can be easily correlated with Eczema. The first
appearance is erythema or reddening of the skin. These vesicles or papules break down then
and oozing from the affected area of the skin starts. If the condition persists, the skin tends to
become thickened and scales may develop. Despite of great advance in dermatology and the
advent of powerful antibiotics and antifungal as well as steroids, Eczema continues to
challenge the best effort of dermatologists. Shodhana therapy is the speciality of Ayurveda and
plays a key role as a preparatory procedure for further progressive treatment. In this process
morbid Dosha, the root cause of diseases are eliminated from main site of lesion and thus the
main cause of disease is eradicated. Jalaukaavcharan (bloodletting by leech) as a Shodhana karma
is found to be very effective in Vicharchika. It is cost effective and has less adverse effects.
Key words: Vicharchika, Jalaukaavcharan, Kandu, Ruja, Pidika, Shodhana
INTRODUCTION
Vicharchika (Eczema) is very old disease mentioned in ancient science among the
Kushtha (Skin Disease). Though the disease,
Vicharchika is not a life threatening, it makes
worried the patient due to its appearance,
severe itching, disturbing routine and its nature susceptible to be chronic. Vicharchika is
described under Kshudra Kushtha in Ayurvedic texts1 and also mentioned as a curable disease yet there lapsing nature of this
disease makes it much harassment for pa-
tient and troublesome for physician too. Vicharchika as explained by Charaka, is
characterized by pidika, kandu and srava (profuse discharge).2 Sushruta, the Father of Surgery has mentioned the symptoms as rukshata (dryness of the skin) with kandu (intense itching) and raji (marked linings).3
A similar clinical presentation in
modern dermatology is seen in Eczema,
which is defined as a non-contagious inflammation of the skin characterized by erythema, scaling, oedema, vesiculation and
Shailly et. al: Role of Jaloukavacharana in Vicharchika
oozing.4 Particularly at the site of lesion,
there is blockage of sweat glands which creates Aswedanam (loss of sweating) or
hyperactivity of sweat glands which creates
Atiswedanam (excessive sweating). Modern
medical science treats eczema with
corticosteroids, antifungal /antiseptics but
the therapy gives symptomatic relief only
and also the therapy has some side effects
like liver and kidney failure, bone marrow
depletion etc. With long term use of topical
steroids, the skin may develop permanent
stretch marks (striae); bruising and it can
also change the skin colour. This change is
more noticeable if the patient has dark skin.5
The Ayurvedic texts consider Raktadushti as one of the primary cause of skin
disease and patient get relief after letting out
the vitiated blood.6Among various methods
for bloodletting, Jalaukaavcharan (bloodletting by leech) is considered as the ideal
method to expel out the vitiated blood
safely, quickly and effectively.7
In general all the Kushtha are said to
possess a Tridoshaja origin,8 in Vicharchika,
kandu is caused due to Kapha, srava is due to
Pitta and shyavata (blackish discolouration)
is caused due to Vata. Despite of its Tridoshaja nature Acharya Sushruta categorised
Vicharchika as Pittapradhan Kshudra kushtha9
and Jalaukaavcharan as its ideal treatment.
Lakshana (Symptoms)
Sr. No.
1.
2.
3.
4.
5.
6.
7.
8.
Samprapti (Etiopathogenesis)
Disease Vicharchika is caused due to
the following of improper and unwholesome
dietary practices (viruddha ahaar-vihaar).
Viruddha ahaar like intake of fish with milk,
mulak and lasuna with ksheera, excessive use
of alcohol with milk, Gramya, audaka and
anupamamsa with milk, intake of articles
having sour taste with milk and viruddha vihaar like sudden diving into cold water or
drinking cold water after fear, exhaustion
and coming from sunlight, 10 doing physical
exercise and sun bath after heavy meal, suppression of urges of emesis. All these factors
lead to vitiation of three doshas moving in
the blood.
Nidanasevana
Tridosha Prakopa
Reaches to
Twaka, Rakta, Mamsa, Ambu and produce
Shaithilya
Further vitiation of Doshas occurs
These Doshas gets enlodged at the place of
Dhatushaithilya
Produce Kushtha11
Table 1: Correlation of symptoms of Vicharchika and Eczema
Lakshanain Vicharchika
In Eczema
Itching
Kandu
Pain
Atiruja
Burning sensation
Daah
Skin eruption with dark discolouration
Shyava pidika
Profuse discharge
Bahusrava
Marked linings
Raji
Dryness
Rukshata
Loss of sensation
Sparshhani or suptata
According to Acharya Sushruta, the
lesion of Vicharchika is Ruksha, so it becomes
Ruksha Vicharchika (dry Eczema) while others have mentioned either Srava12 or Lasika
in lesions called ardra Vicharchika (wet type
AAMJ / Vol. 1 / Issue 3 / May – June 2015
of Eczema). Vicharchika is a Sadhya type of
Kushtha. According to modern science, eczema is curable condition but cure of this
disease is affected in tropical countries by
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Shailly et. al: Role of Jaloukavacharana in Vicharchika
heat, humidity and prevalent unhygienic
condition.
Management
Ayurveda has given prime important
on two types of treatment i.e., Shodhana and
Shaman especially for chronic and recurrent
diseases. Shodhana therapy is most important
measure for Bahudoshjavyadhi. If doshas are
depleted with shaman therapy, there is a
chance to provoke that doshas again, but if
they are removed by Shodhana therapy, there
is no chance to provoke again.13
Raktamokshana
As per Ayurveda, Jalaukavacharana is
one of the procedures of Raktamokshana.
Raktamokshana is a technical term employed
to denote a para surgical procedure to expel
out the vitiated blood from selected areas of
the body by specific methods.14 Jalaukavacharana is claimed to be the Supreme therapy
because of its safety and high efficacy in the
disorders involving the vitiation of blood.
Raktamokshana not only purifies the channels
but also let the other parts become free from
disease and action is faster than other remedies.
Instructions for Raktmokshana
1. It should be done according to Aturabala,
Rogabala and Ashaya (site of diseases)15
2. The bloodletting should be done once in a
week or performed even 3 – 4 times. For
achieving more effect, it should be done after
15 days with Snehana and Swedana.
3. Season should be neither hot nor cold nor
can cloudy/windy atmosphere.16But in case
of emergency Raktamokshana can be done at
any time. It should be done in SharadaKala.
4. Matra (Quantity of expellation): According to Charaka, it depends upon the roga-rogibala, but it should be performed till the Rakta
become “Shuddha” (purified).
According to Sushruta and Vagbhata it
should be 1 Prastha = 64 tolas = 768g.
1 tola = 12 g.
Uttama Matra
1 Prastha = 768 g.
AAMJ / Vol. 1 / Issue 3 / May – June 2015
Madhyama Matra ½ Prashta = 384 g.
Adhama Matra
¼ Prastha = 192 g.
Jalauka (leech) is defined as a creature with distended abdomen living either in
water or mud. These are antiphlogistic,
blood suckers and are also having anticoagulants in saliva.
Leech should be stored in well labelled container having multiple pores on
the top for proper aeration. Temperature
should be maintained around 5-270 C.16 The
water of container should be declorinated
and should be replaced after 5-6 days.17
Leech Application
Leech should be kept in fresh water,
cool, shady and calm place in a large glass
and refill daily by low mineral water. Actually the application of leeches demands passion, place and silence. The patient should be
placed on a rubber towel. Wash the part
with natural odourless soap, rinse it cleanly,
don‟t use any perfume in skin area.18 If
needed, shave the eventually marked bite
area and slit it a bit with a haemo lancet.
Take leech out of the jar with the help of a
blunt tweezers and put it with its hand onto
the small wound. After fall of put into a
fixed lockable containers and set them free
in a clear water or at a damp place in the forest. Eventually kill them with the help of
concentrated acetic acid. Leeches may only
be used once and have to be disposed after
doing so.
Morning is the best time for application, without emergency it should not be put
at evening. Before starting Leech therapy,
patient should be given snehana and swedana.
Secondary haemorrhage may occur after removing leech. On excessive loss of blood
various haemostatics are used such as burnt
cotton, desiccated alum, copper sulphate,
tannin, turmeric etc. Pressure with the finger over the bite may be useful. Even a very
fine point of caustic nitrate of silver is inserted into the wound with benefit. Apply a
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Shailly et. al: Role of Jaloukavacharana in Vicharchika
bandage with lot of absorbent cotton wool
after approximately seven hours – mostly in
the evening. Until then the patient must
holds still while lying. Change the bandage
after 24 hours and remove it three days later.
Chemical Constituents of Leech Saliva
During the process of feeding, leeches
secrete a complex mixture of different
biologically and pharmacologically active
substances into the wound. Hirudin is the
best known component of leech saliva. Hirudin is sometimes used to describe all active
substance in leech saliva. In reality, components of medicinal leech saliva that exert its
effect in the hosts body are – Heparin like
substance Hirudin-A 65-prevents the clotting of blood by inhibiting the cleavage by
thrombin of fibrinogen and a synthetic
tripeptide substance. Hirudin (mainly from
leech) having approximately three times
more anti-thrombin activity than pseudohirudin (mainly from leech whole body).
Calin has also anti-coagulant effect
which inhibits blood coagulation by blocking
the binding of von-wille brand factor to
collagen. It inhibits collagen-mediated platelet aggregation. Destabiliase has thrombolytic effect which dissolve the clots of
blood as well as it also breakup the fibrins
that have formed. An enzyme called hyaluronidase, which breaks down hyaluronic
acid, the bonding material of connective tissue, thus fostering the flow of blood and fluids from affected areas. It is “spreading factors” that ensures that the other active substances which are active at the bitten areas
can be spread.
Eglin restrains digestive proteasis.
Bdellin is a plasma hindrance. They both
have effects on the coagulation hindrance
having different effective mechanisms together with Apyrase and Collagenase. Piavit
contains leech prostanoids and highly purified destabilase fraction. It has protective
antithrombotic effects.19
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Pathya apathya:
After Raktamokshana, patients should
be given Laghu and Deepaniya Ahara and neither too hot nor too cool.20 Acharya Vagbhatta
added with Snigdha and Shonita (Rakta)
Vardhaka Ahara.21 While Mamsa Rasa of deer
and goat, milk, Sali rice was advised. Patient
should avoid Vyayama (exercise), Maithuna
(coitus), Krodha (anger), Sheeta Snana (cold
water bath) – Vayu (breeze), Shoka, Diwaswapna (day sleep), Kshara (alkalis), Amla
(sour), Lavana (salt), Katu Ahara (pungent
diet).
CONCLUSION
Vicharchika is a type of Kushtha, Rakta
pradoshaj and Tridosha prakopaj and chirkari
(chronic) vyadhi. Leeches gives best effect in
Vicharchika by expelling the morbid, vitiated
Dosha and Dhatu. But the effect of therapy is
not only by expelling the vitiated blood but
leech also emits some enzymes in the
wound. So Jalaukavacharana has also provided normalization and improvement of
capillary as well as collateral blood circulation, expressed anti-inflammatory effect,
Immuno-stimulation and Immuno-modulating effect and early wound healing effect.
This action may be effect of such salivary
enzymes like Hirudin– anticoagulant effect
with diuretics, antibiotic action, Calin – prevent blood coagulation, eglin, hyaluronidase,
antithrombin,
antitrypsin
and
antichymotrypsin etc.
Leeches are the perfect solution for
many skin diseases. Demand of leeches is
increased day by day from physicians all
over the world. The clinician who knows all
about the leeches, habitat, and their method
of collection, varieties, storage and method
of application is successful in treating the
disease.
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How to cite this article: Shailly et. al. Role of Jalaukavacharana
(Leech Therapy) in the Management of Vicharchika (Eczema).
AAMJ 2015; 1: 142-6
Source of Support: Nil. Conflict of Interest: None declared
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