From

Dr. Siba Prasad.

Amrita School of Ayurveda,
Amrita Viswavidyapitham, Amritapuri, Clappana P.O.
Kollam – 690525. Kerala.

To,

The Editor
Heritage Amrita
Email; amruth@frlht.org

Sub: - submission of manuscript for publication—reg

Respected Sir,

With honour, it is to draw your kind attention that, in regards to the above cited subject, I
am furnishing a paper for the publication entitled “Traditional Management of Sheetapitta
- : A Case Report: -“. Please do the needful & obliged.
Thanking you, with regards.

Place: -Amrita Puri Campus yours faithfully

Date: 19th may 2010

(Dr. Siba Prasad)

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 Traditional Management of Sheetapitta
- : A Case Report: -
* Dr. Siba Prasad**Dr. R.N. Tripathy *** Dr. Abhaya Mishra

Sheetapitta with a clinical co-relation to Urticaria being a skin disease is a common

condition encountered in clinical practice. Since ancient days to till date it is a challenge for the
physician & society as well. 15-20% of the general populations are often affected & at the same
time incidence of acute urticaria are similar in both sexes, but chronic urticaria occurs more
frequently in women (60%). Though urticaria is more common in the fourth and fifth decades of
life still, it can occur at any age. Many researches were undertaken to overcome this problem but
no promising management was evolved till yet.

Sheetapitta is a Tridoshajanya Vikara manifested on the skin (Twacha) keeping the blood
i.e. Rakta Dhatu as its base & commonly in the month of December to march (Spring),
characterized by dark red skin rash, raised & itchy bumps. Modern medical literature explains
Urticaria as Nettle rash or Hives due to a hyper sensitive allergic trigger. Hence anti histaminics
like Chloro pheniramine maleate, cetrizine, loratidine etc. are the drug of choice, often
accompanied by corticosteroid (Dexamethasone). But this treatment often fails & may not give a
long standing relief. The contributing factor for this failure is the allergen, which is difficult to
identify by any means of investigation.

With reference to Ayurvedic classics Urticaria co –related to Sheetapitta can be treated

by traditional approach. So keeping in view the basic principle of Ayurvedic management a case
of sheetapitta was treated and successfully relieved from sign & symptom. Further the efficacy
of the treatment was proved by absence of same type of sign & symptom within one year of
recurrent study.

*Lecturer,Dept. of Panchakarma, e-mail: drsibaprasad@gmail.com, Mob no- 09020896342

**Reader, Dept. of Shalya, e-mail: drrabi73@gmail.com, Mob no – 08129292391
***Lecturer, Dept of Rasa sastra, e-mail: drabhayamisha08@gmail.com, Mob no- 09633240362
Amrita school of Ayurveda, Vallikavu, Clappana P.O. Kollam, Kerala

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Sheetapitta Vs Urticaria

Sheeta pitta is a kind of skin rash notable for dark red, raised, itchy bumps. In ayurveda it
is considered as Tridoshajanya (Kapha+Pitta+Vata), which gradually spreads to the
Skin(Twacha) and the other tissues (Raktadi dhatu). It commonly manifests during the Spring.
It is diagnosed clinically basing upon the symptoms like heat, redness, swelling, restlessness,
being aggravated by exposure to cold or heat or even moist winds, perspiration and irritation.
The common symptoms are-

 Usually intensely itching intra dermal vascular reaction (wheals or hives).

 No epidermal changes such as scaling, papules, or blisters.
 Burning sensation
 Fever and Vomiting

The same has been described in modern symptomatology of urticaria, most often has an
unknown, nonspecific etiology, but can be related to medications, foods, and similar vascular
stimulating agents. Hives are frequently caused by allergic reactions; however, there are many
non-allergic causes also. For example, most cases of hives lasting less than six weeks (acute
urticaria) are the result of an allergic trigger. Chronic urticaria (hives lasting longer than six
weeks) are rarely due to an allergy. The majority of patients with chronic hives have an unknown
(idiopathic) cause. 30-40% of patients with chronic idiopathic urticaria, have an autoimmune
cause. The clinical classifications are as follows.

 Acute urticaria
 Chronic urticaria
 Allergic urticaria
 Autoimmune urticaria
 Non-allergic urticaria
 Dietary histamine poisoning
 Stress and chronic idiopathic urticaria

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Others

 Cholinergic: Reaction to body heat, such as when exercising or after a hot shower

 Cold (Chronic cold urticaria): Reaction to cold, such as ice, cold air or water - worse with
sudden change in temperature
 Delayed Pressure: Reaction to standing for long periods, bra-straps, elastic bands on
undergarments, belts
 Dermatographic: Reaction when skin is scratched (very common)

 Solar: Reaction to direct sunlight (rare, though more common in those with fair skin)

Management Modalities

Sheetapitta(Urticaria) can be managed conservatively after a critical evaluation of its cause. The
causative antigen should be avoided & the altered hypersensitivity can be treated by anti-
histaminics & corticosteroids.

With reference to the ayurvedic Compendia, avoidance of the causative factor is the foremost
principle of management of any disease. Further the management of Sheetapitta is possible by
Snehana, Swedana followed by Virechana & administration of specific internal (Samana
Oushadhi) medication. The usual advised Shamana yoga’s are -

1. According to Bhaishajya Ratnavali 55/6

• Drava nishyauta(drava + Haridra) lepa

• Kshara prayoga (Yavakshara + Saindhava lavana + Tila taila)
• Yasti choorna + Madhura pushpa + Rasna + Chandana + raktha chandana +
Nirgundi + Pippali made into kwatha and give for drink
• Amrithadi yoga (Amrutha + Haridra + Nimba twak + Duralabha made into
kwatha and then add honey)

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 • Goghrutha Marichadi yoga (Gogrutha – 1 karsha + Maricha choorna – ½ karsha)
• Agnimandha yoga(Agnimandha moola choorna – 3-6 masha with goghrutha)

2. According to Yoga ratnakara sheetha pitta chikitsa.

• Kashmari prayoga : Pakwa kashmari phala ksheerapaka.

• Gambheeraka phaladi yoga - Ripened dryed gambhariphala soked in water, with
milk.
• Yavanyadi yoga :Ajamoda + Vyosha equal part along with milk.
• Pippali vardhamana yoga or lashoona prayoga.
• Kustadi yoga - Kusta, Haridra, Surasa, Patola, Nimba, Ashwagandha, Suradaru,
Shirgu, Sarshapa, Tumburu, Danyaka, taken in equal quantity and made into
paste in takra and do the udvarthana).
• Sindhavadi lepa - Sindhava lavana and kusta churna take equal part mix with ghee
or tulasi swarasa do the udvarthana with this paste.

Besides these the patient should be advised to take meal with moolaka yusha, kulatha swarasa,
titira or lava mamsa rasa.
Case Report

A female patient named as Kimura Satomi aged about 41yrs resident of Japan during her
visit to AMMA Amritanandamayi Ashram suffered from some skin problem & was approached
to the OPD of Amrita Hospital, attached teaching hospital of Amrita school of Ayurveda.
Amritapuri Campus, Vallikavu, Kollam, Kerala on 10th August 2008 with complaint of skin
rashes bodyache, stress, numbness, itching, low appetite, disturbed sleep and general weakness.
To assess the general condition B.P., Pulse, Temperature, weight, DC, TLC & Hb% was done.
The pulse, Heart rate, BP, Body temperature, Micturation were found normal with constipated
Bowel and disturbed sleep.

After a thorough examination the patient was diagnosed as sheetapitta. On the first day
the B.P. was 110/60 mmHg, Pulse 72/min, Temp – normal, differential count and total leucocyte
count were within normal range, where as the weight was 55kg and Hb% was 12.5gm%. On
clinical examination it was found that per abdomen, the abdomen was soft & hyper-erythematous

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rashes all over body. As a routine examination and for the proposed Panchakarma therapy per
rectal examination was also done, which revealed nothing specific pathology.

Proposed Management

The patient was admitted in the Inpatient Dept. for 10days & had undergone both external and
internal therapy. The patient was advised to take 1. Amithothara kashaya 15ml 2. Saddharana
choorna 1tsf twice daily, 3. Haridrakhanda 2tsf twice daily at morning and evening with a
interval of one hour. Each medicine was administered with the anupana of luke warm warter.

Further she was advised panchakarma treatment. Pancha tikta Ghrita was given in a dose of 30ml
& as per arohana Krama 60ml & 120ml in the consequent days as, Snehanapana. Abhyanga was
done with Narayana taila followed by Sasthikasali pindasweda. As pradhana karma 1.Virechana
(Purgation) therapy is given with Tivrit avaleha for 1 day. 2. Nasya is given with Ksheerabala
taila 101 for 5 days. 3. Shiodhara is done with Ksheerabala taila for 7 days.

Follow up

The patient had advised to take the wholesome diet and regimen, not to do heavy exercise and
should not consume the spicy food. Haridrakhanda 10gm twice daily and a capsule of 500mg
composed of Neem and Triphala was advised twice daily for one month.

Discussion and Result

Urticaria being a frequently encountered disease was treated conservatively by keeping

the basic principle of Sheetapitta Chikitsa. Hence, initially the patient was administered with
Agni-deepan treatment followed by Panchakarma. On the first visit the patient was given 1.
Amritothara Kasaya 2. Saddharana Churna to enhance the quality of Agni i.e. digestive capacity
as well as metabolic value. Along with Haridra khanda was also started to reduce itching &
allergic reactions. Prior to Virechana (Pradhana Karma) Snehana & swedana was given, keeping
an aim to alleviate the accumulated Dosha (To bring the Dosha from sakha to kostha)for its
expulsion through the alimentary tract. Nasya & Sirodhara was also administered as a part of
Pradhana karma as the patient was in stress & insomnia. As a whole the patient was treated for
10days as an inpatient.

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 Haridra khanda & Neema-triphala capsule was continued for further one month & the
patient was kept under recurrent study for a period of one year. Finally it was assessed clinically
& found effective to cure Urticaria.

Summary & Conclusion

A markedly change has found after the treatment. The itching had reduced completely.
The appetite and sleep maintained well. The patient was happy while discharging from the
hospital.

References

1. Bhaisajya Ratnavali (Hindi) 11th Edn. Sastri Ambika Dutta – Choukhamba Sanskrit
Bhawan Varanasi. (U.P.): 1993 Dwaraknath .C, Introduction to Kayachikitsa, 2nd edi.
Choukambha orientalia, Varanasi; 1986.

2. Gupta A, Ashtanga hridaya, 11th edi. Choukambha Sanskrit sansthan, Varanasi, 1993.

3. Gupta A, Ashtanga samgraha, Hindi commentary, 1st edi. Nirnaya sagar press, Bombay.
1927.

4. Shukla V.D. Ayurvedic Vikruti vijnana, Choukambha Sanskrit sansthan, Varanasi. 1990.

5. Vidyalankara Atrideva, Astanga Sangraha, Hindi commentary, 1st edi. Choukambha

Sanskrit sansthan, Varanasi. 1962.

6. Sastry L.V, Yogaratnakar – Vata vyadhi nidan, 5th Edition - Chaukambha Sanskrit
Sansthan, Varanasi, 1993

Testimonial from the patient

My experience of Ayurvedic treatment in the Amrita School of Ayurveda

I stayed at the, Amrita School of Ayurveda is a very beautiful and had great facilities. I
am not sure whether it is the Kerala style of architecture or else, however it was a place with
good atmosphere. In front of the school there is an herbal garden, the real Ayurvedic herbs can
be seen, I was very happy.
The types of treatment I had received are Abyanga, Shirodara, Nabarakizi, Nasya .

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Although it was a short stay of 9 days, I could experience one of Panchakaruma, Nasya. I was
so lucky. In Japan, I have had Nasya many times, but medicinal smoke (Dhuma pana) type of
Nasya was the first time to me. During the treatment, my nose was intensely painful, and after
finished, the symptoms of allergy were eliminated.
Though it was really excellent facilities in order to become more globalized, from the
eyes of foreigners, I felt they would be still required still improvement. At the same time, I also
felt the possibility in the future. I appreciate all the staff were hospitable to me. Thank you

Kimura Satomi