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Introduction

Urticaria is a dermatological conditioned which is characterized by itchy wheals which suddenly appear on skin or mucous membrane. They are commonly known as hives, wheals, welts and nettle rash. It usually occurs due to an allergic reaction trigged by food seasonal or external factors or medication.[1] In urticaria the individual lesion typically last for few minutes to few hours then subside without leaving any trace.[2] Urticaria is divided into two categories based on how long it lasts 1) acute urticaria which stay less than six weeks 2) chronic urticaria which stay longer than six weeks.[3] As Shitapitta is Tvak Vikar i.e., skin diseases in which wheels or hives appear all over the body with itching, burning sensation and pain these all are the symptoms of Shitapitta[4] and this can be related with urticaria. This condition occurs due to the dominance of Shita (cold) over Pitta Dosha, when someone is exposed to cold weather, Kapha and Vata Dosha aggravates and combine with Pitta Dosha, they spread all over the body and creates rashes on the surface of the skin. Varati Damstavat Shotha and Kandu caused by Kapha Dosha vitiation, Shul caused by Vata Dosha vitiation and Daha caused by Pitta Dosha. In modern science, antihistamines and steroids are used to treat urticaria and their long term uses can cause adverse effects on the human body.[5] In Ayurveda, Shitapitta Chikista can be divided into three phases they namely are Langhana for Alpadosha, Langhana with Pachan for Madhya Dosha Avastha, Shodhan for Bahudosha Avastha.[6] In Shitapitta Shodhan like Vamana , Virechan and Raktamokshan are the ideal treatment and they are very effective, as they eliminates vitiated Dosha from the body, and the recurrence can be avoided.[7] As in this case due to Shodhan Chikista all symptoms are gone completely and it can be considered as main Chikista (Apunarbhav Chikista) as this Shodhan Chikista helps to remove the obstructed Kapha and Pitta Dosha. As in this case Jala Dhauti, Virechana are planned to treat Shitapitta

CASE REPORT: Detail of the case Here by presenting a case of 42-year female patient who visited Government Ayurved College and Hospital, with presenting complaints of Varati Damshavat Shotha and Kandu all over the body as the symptoms more aggravates in the evening time. She was diagnosed with urticaria by the physician and advised to take tablet cetirizine 5mg od daily.

Personal history: No history of HTN / DM / Thyroid Dysfunction / any other allergic illness

Family history: Not any significant

Medical history: Tab Cetirizine 5mg once a day (Antihistamine drug)

General examination

Pulse: 72/min

? Blood Pressure: 120/70mmHg

? Respiratory Rate: 16/min

? Temperature: 97 F

? Weight: 55kg

? Height: 145cm

? BMI: 26.2

Systemic examination

? CNS: NAD

? CVS: - NAD

? RS: -NAD

table shows the result obtained before and after treatment. In this condition mainly three symptoms are observed like rashes, itching and burning sensation, these three symptoms are marked with the help of Urticaria activity scale, as shown in table no 4. The result and observation obtained after treatment i.e., at the 25th day assessed by using subjective and objective criteria, all the symptoms reduced completely.

Discussion

Shitapitta is a Tridoshaja Vyadhi, according to Nidaan Sevana (Etiological factor) [10] there is a vitiation of Kapha and Vata, which spreads throughout the body, both externally and internally, by mixing with Pitta. The Tridoshas spreading internally cause Dushti (pathogenesis) of Rasa and Rakta Dhatus and their Dushti appear causing symptoms such as Varati Damstavat Sotha (rash), Kandu (itching), Shul (pain) and Daha (burning sensation), respectively caused by Vata, Pitta and Kapha, which reached to Twaka.[11] This all symptoms can be correlated to urticaria i.e., hives which are red, raised, itchy spots and rash caused by allergens.[12]

Pharmacological Action of Drug: In Ayurveda the presentations and prognosis of the diseases depends upon multiple factors, As Shitipitta is a condition found in Bahudosha Avastha or Lakshana as mentioned in Charak Sutra Sthan chapter 16. Various Formulations are prescribed for treatment of such serious illness out of which One such Agad compound is Champakadi Agad. Champakadi Agad contains 8 constituents. Out of which 6 are herbal drugs. They are mixed with honey and Ghee. Champakadi Agad is useful in treatment of Keeta-Loota Visha. It can be used in various ways like oral administration or local application (Lepa). Many of the symptoms of Keeta- Loota Visha (Insect bite) are manifested on skin. Symptoms include Ruja (pain), Daha (burning), Raga (redness), Shotha (inflammation) etc. Keeta Visha is Manda, Nati Ushna, Bahu Vata-Kapha. Therefore, it is indicated to treat Keeta Visha with Ushna Karyas. Most of the contents of Champakadi Agada are Ushna in Veerya. Also, most of them have Katu Vipaka, Ushna Veerya, Tikta, Madhura, Katu Rasa and Vishaghna, Twakdoshahar, Shothahar, Raktashodhak Karma. Pharmacological action of these drugs is antibacterial, anti-inflammatory, antioxidant, analgesic and antifungal etc. So, it can be used in insect bite. It may be useful in some of the skin diseases too. But further research and clinical trials are needed.

Conclusion

Aacharya Vagbhata described Champakagada in Uttartantra for treatment of Keeta- Loota Visha. Ingredients of Champakagada are having Vishaghna, Twakdoshahar, Shothahar, Raktashodhak Karma. Most of the Dravyas present in Champakagada are Ushna. So, these Ushna Dravyas act on Keeta Visha which is Vata-Kapha dominant.

Most of the drugs in Champakagada are used in skin diseases, gastric disorders, diabetes, ophthalmic disorders, jaundice etc. This review article provides collective information on pharmacological, therapeutic action and antioxidant property of Champakagada in the treatment of one such skin ailment i.e Shitapitta.More such clinical trials are required for the clear establishment of the this Research work and more future studies are invited.