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Introduction

Herpes Zoster is also known as Shingles which is mainly due to reactivation of latent Varicella Zoster virus in Dorsal Root ganglia. There is Unilateral Dermatomal eruption with severe pain. It starts with mild pain along the Dermatome -> 48to 72 hours later there is formation of Maculopapular Rash then converting to Vesicular Rash and Pustular Rashes which continues for 3 to 5 days. This Pain usually subsides within 2 to 4 weeks. But in some patients the Pain persists which is termed as Post Herpetic Neuralgia which is complication of Herpes Zoster. This pain is specifically described as Sharp/Stabbing/Burning pain along the Dermatome without any eruptions over skin. Post Herpetic Neuralgia impacts the quality of life.[2]

Post Herpetic Neuralgia is one of the late complications of herpes zoster which is characterized by persistent Sharp,Intense,Unrelenting pain where the pain persists for more than span of 3 to 4 weeks. With advancing age the risk for Post Herpetic Neuralgia increases. Prevelance Rate is 9 to 19% of all Herpes Zoster patients. The incidence is age dependent where 2% in younger than 50 years, 20% in patient above 50 years and 35% over age of 80 years.[3] Mainly treated with Tricyclic antidepressants and Anticonvulsants. But majorly has side effects of Weight gain, Dizziness, Fainting, Constipation and many more.

Twacha word is derived from the word ‘tvac’ which means to cover something. Twacha is protective layer against external environment. Ayurvedic Samhitas describes almost 51 disorders related to skin. These Twacha Roga are formed by disturbance in Tridosha-Dhatu Mainly Rakta.

Among many skin disorders described in classical texts Herpes Zoster can be corelated to Visarpa Vyadhi on basis of symptomatology. The disease which spreads in all the direction is termed as Visarpa/Parisarpa.[4] The movement of disease spreads in all direction with Spota and Shopha present. As it is rapidly spreading in nature, it is compared to Aashivisha or Sarpavisha. It is described as Agnidagdhavata as it is Ashukari in nature spreading rapidly with lakshanas of Aashu anunnata shopha, Pidika, Daha,Jwara and Vedana.[4]

The rationale of above study is –

1.High prevalance rate 2. Conventional treatment limitations - less drugs with many adverse effects and relaspe of pain post medicine withdrawal. Restricting the treatment for patients.3. Ayurvedic treatment targets immediate results reducing the severity of pain and no relapse with less or no side effects.4. Patient centred outcome which is cost effective.

Hence, this study in Post Herpetic Neuralgia helps to know more about the Ayurvedic methods of treatment.

Case study

A 37 years old male patient came to Kayachikitsa OPD on 05/11/2025 at Shri Eknath Ayurved Rugnalaya, Shevgoan with C/O –

 Severe burning sensation since 2 weeks

Sharp pain at Right Face region since 2 weeks

Maculo – Papular Rash, Vesicular Rash and Pustular Rash over Right Face region 3 weeks back now completely healed had already taken modern treatment but had no relief for severe pain.

Hence, patient was assessed started with Ayurvedic management.

HISTORY OF PAST ILLNESS – No any K/C/O – DM/HTN/IHD

MEDICINAL HISTORY – No any Known

FAMILY HISTORY – MATERNAL- No Any Known

PATERNAL- No Any Known

SURGICAL HISTORY- No Any Known

ALLERGY HISTORY- No Any Known

Personal History-

General Examination

Asthavidha Pariksha

Dashavidha Pariksha

Systemic Examination

Local Examination -

Inspection - Rash Marks Are Present At Right Face Region.

Palpation – Affected Area Was Tender On Touch- Hyperesthesia

                                   Warm On Touch

NIDANA –

SAMPRAPTI –

NIDANA SEVANA

PITTA PRADHANA TRIDOSHA PRAKOPA

SHITHILATA IN DHATU

RAKTA VITIATES WITH PITTA DOSHA

STHANA SAMSHRAYA AT TWACHA ON RIGHT SIDE FACE

UTSEDH ,SPOTA - DAHA,BHEDANA,TULYAVARNA SRAVA

PITTAJA VISARPA ON RIGHT SIDE

SAMPRAPTI GHATAKA –[5]

Chikitsa –

Nidana Parivarjan,Visarpa Chikitsasutra and Yukti Chikitsa are used to treat Post Herpetic Neuralgia.

Raktamokshana and Virechana is main line of treatment for Pittaja/Agneya Visarpa. [6]

Shita Guna Pradhana Chikitsa is mainly indicated.[7]

Discussion

1.Raktamokshana With Jalauka Awcharana[6]

Pitta and Rakta vitiates -> situates on Right side of Face -> Utsedh ,Spota on face then with Daha and Bhedanavat vedana-> Pitta Visarpa.

In Charaka Chikitsasthana- Visarpa Chikitsa Adhyaya,all the curative measures mentioned in Visarpa Chikitsa are on one side while Raktamokshana on other they are found equal. As Visarpa never occurs without association of Rakta and Pitta. Hence, Raktamokshana is prime treatment for Visarpa.As Jalauka is mainly Shita Guna Pradhana it acts against Ushna guna of pitta and rakta and removes Dushit Rakta and Ashrit Pitta.

2.Lepa Chikitsa[7][8][9]

Locally,there is Pitta+Rakta +Vata Dushti on right face region causes burning sensation. Sheeta guna pradhana chikitsa is indicated in pittaja visarpa. Hence, sheeta dravya lepa application is indicated for local application reducing local pitta and rakta dushti.

3.Shatadhauta Ghruta[10]

Locally,there is Pitta+Rakta +Vata dushti on right face region causes burning sensation. Ghruta has Vata,Pitta Shamaka property. Here,we used Shatadhauta Ghruta prepared by washing ghruta in water for 100 times. Hence,Shatadhauta Ghruta reduces Vata Pitta locally and give a cooling effect and maintain skin hydration.

4.Mahamanjisthyadi Kashaya[11]

Pitta and Rakta vitiates -> situates on Right side of Face -> Utsedh ,Spota on face then with Daha and Bhedanavat vedana-> Pitta Visarpa.

Mahamanjistadi Kashaya is Raktashodhaka, Raktaprasadana,Dahaprashamana and Pittashamaka reducing Pittaja Visarpa and reduces Daha and Vedana.

5.Kamadudha Rasa[12]

As there is vitiation of Pitta+ Rakta dosha by vyana vayu at Twacha, Mamsa. Kamadudha Rasa improves the Jataragni as well as Sthanik Agni of Rakta Dhatu by Deepana and does Shodhana of Raktadhatu. Improves quality of Rakta Dhatu. There is Shita Guna pradhanata in all the drugs which equalizes vitiated Pitta Dosha.

6.Avipattikar Churna [13]–

Pitta and Rakta vitiates -> situates on Right side of Face -> Utsedh ,Spota on face then with Daha and Bhedanavat vedana-> Pitta Visarpa.

Best therapy for vitiated Pitta is Virechana Karma. Avipattikar Churna along with Manuka Phanta is used for Virechana Karma. Avipattikar Churna works as Deepana but when used in higher dose it acts as Virechaka along Manuka is Virechanopag drug which will support proceding Virechana Karma. Here, in this case we are giving patient Nitya Virechana so that vitiated Pitta is removed on daily basis.

With help of Laghu, Ruksha,Sara guna Avipattikar Churna does Deepana, Virechana with Vataanulomana. Hence, removes the vitiated Pitta by Mala marga. In this way Vyadhishamana is done.

Observation and Result

PATHYA – APATHYA[14][2]

Conclusion

Decoding Post Herpetic Neuralgia Pathogenesis in Ayurveda and Treating Patient by Samprapti Vighatana was fulfilled.Patient succesfully treated with Panchkarma and Ayurvedic Oral Formulations .Burning,Stabbing Sharp Pain was subsided and Improved Quality of Life.From results of above Single case study we can use this treatment protocol for large scale population  and expand the depth of research for Post Herpetic Neuralgia.This treatment is patient oriented and cost effective.

Declaration of Patient’s Consent-

Patient’s written consent has been taken to publish patient’s information without disclosing identity of patient.

Conflict Of Interest –

The author declares no conflict of interest.

Source Of Support –

None