AN AYURVEDIC APPROACH TO THE MANAGEMENT OF DARUNAKA WITH SHEETAPITTA: A CASE STUDY *Corresponding Author

Abstract

Dandruff and Urticaria are few of the most common worries in adulthood. Dandruff, the visible desquamation of scalp, is the mildest manifestation of seborrheic dermatitis. Chronic urticaria has a significant impact on quality-of-life due to the constant sensation of itching, regular recurrence, and unknown etiology. Dandruff can be considered as Darunaka in Ayurvedic parlance possessing resemblance in their clinical manifestations. Similarly, Urticaria can be correlated with Sheetapitta. Urticaria and Dandruff, both conditions do not have any satisfactory cure in contemporary system of medicine, relapses being the main cause for inclining towards Ayurvedic system of medicine. Ayurveda can provide a virtuous effect in dandruff with the help of Panchakarma procedures, daily regimen, and many Aushadha Yoga. A 25 years old patient approached with complaints of Shirah Kandu (Itching over scalp), Keshabhoomi Rukshata (dryness of scalp), Twak Sphutana (~Cracks in the skin), and Kesha Chyuti (~Hair fall). He also had itchy rashes over his trunk region. In present case, classical Shodhana (Major purification therapy) was planned followed by Shamana (~Pacification) drugs. The improvement provided by the Shodhana therapy was assessed based on sign and symptoms before and after the treatment. The therapies were found effective in controlling sign and symptoms of Darunaka and Sheetapitta.

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Kumawat et al. World Journal of Pharmaceutical Research
www.wjpr.net Vol 9, Issue 12, 2020.
1112
AN AYURVEDIC APPROACH TO THE MANAGEMENT OF
DARUNAKA WITH SHEETAPITTA: A CASE STUDY
*1Dr. Achala Ram Kumawat and 2Dr. Gopesh Mangal
1PG Scholar, Department of Panchakarma, National Institute of Ayurveda, Jaipur Rajasthan
India 302002.
2Associate Professor, PG Department of Panchkarma, National Institute of Ayurveda, Jaipur.
ABSTRACT
Dandruff and Urticaria are few of the most common worries in
adulthood. Dandruff, the visible desquamation of scalp, is the mildest
manifestation of seborrheic dermatitis. Chronic urticaria has a
significant impact on quality-of-life due to the constant sensation of
itching, regular recurrence, and unknown etiology. Dandruff can be
considered as Darunaka in Ayurvedic parlance possessing
resemblance in their clinical manifestations. Similarly, Urticaria can be
correlated with Sheetapitta. Urticaria and Dandruff, both conditions do
not have any satisfactory cure in contemporary system of medicine,
relapses being the main cause for inclining towards Ayurvedic system
of medicine. Ayurveda can provide a virtuous effect in dandruff with
the help of Panchakarma procedures, daily regimen, and many Aushadha Yoga. A 25 years
old patient approached with complaints of Shirah Kandu (Itching over scalp), Keshabhoomi
Rukshata (dryness of scalp), Twak Sphutana (~Cracks in the skin), and Kesha Chyuti (~Hair
fall). He also had itchy rashes over his trunk region. In present case, classical Shodhana
(Major purification therapy) was planned followed by Shamana (~Pacification) drugs. The
improvement provided by the Shodhana therapy was assessed based on sign and symptoms
before and after the treatment. The therapies were found effective in controlling sign and
symptoms of Darunaka and Sheetapitta.
KEYWORDS: Dandruff; Darunaka; Samshodhana; Sheetapitta; Urticaria.
World Journal of Pharmaceutical Research
SJIF Impact Factor 8.084
Volume 9, Issue 12, 1112-1119. Case Study ISSN 2277– 7105
Article Received on
16 August 2020,
Revised on 06 Sept. 2020,
Accepted on 26 Sept. 2020,
DOI: 10.20959/wjpr202012-18820
*Corresponding Author
Dr. Achala Ram Kumawat
PG Scholar, Department of
Panchakarma, National
Institute of Ayurveda, Jaipur
Rajasthan India 302002.

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INTRODUCTION
Hair is associated with youthfulness and beauty in women and virility and masculinity in
men; so, it is no surprise that hair loss can make any men and women feel self-conscious.
Pollution, unhygienic conditions, and many more factors can cause hair problem. Studies
show a prevalence of dandruff of up to 50%.[1] Dandruff is an irritative disease of the scalp in
which shedding of dead tissue from the scalp with itching sensation is the cardinal feature.
‘Urticaria’ is a disease characterized by itchy red rashes on skin almost all over the body. An
estimated 15% to 23% of adults have experienced at least 1 episode of acute urticaria at some
time in their lives, and the prevalence of chronic urticaria in adults is estimated at 0.5% to
5%.[2] However the disease is not a life threatening disorder, the distress caused by Urticaria
seriously affects the quality of life.
Darunaka is a Vatakapha Dosha (regulatory functional factors of the body) Predominant
Disease, which manifests as Kandu, Keshachyuti, Rukshta, and Twak Sphutana,[3] which can
be correlated with Dandruff. In present case, patient suffering from Dandruff and urticaria
after having been under allopathy treatment for same complaint for more than 6 years, but
without persistent relief and continuous reoccurrence of symptoms was treated with classical
Vamana Karma (~Therapeutic emesis) followed by Virechana Karma (~Therapeutic
purgation). Shamana Chikitsa was followed thereafter for one month.
CASE REPORT
A 25 years male patient, diagnosed with seborrheic dermatitis and Urticaria in Allopathy,
approached with chief complaints of dryness in scalp, dandruff, and excessive hair fall. He
also had associated complaints of rashes over anterior and posterior trunk region with
excessive itching and sweating for more than 6 years that would exacerbate with seasonal
transition. Patient was admitted in IPD ward of National Institute of Ayurveda Hospital on
15/4/2019 (OPD Registration no.-21809042019). Patient was diagnosed based on signs and
symptoms as a case of Darunaka along with Sheetapitta. Patient belonged to Jangala
Pradesha, was a married graduate from Lower middle class. The Sharirika Prakriti (~Body
constitution) of the patient was Vatakaphaja and Manasika Prakriti (~Mental constitution)
was Rajasika. He had Madhyama Samhanana (Moderate Body Compactness), Madhyama
Pramana (Moderate anthropometry), Madhyama Koshtha (~Moderate Bowel habits),
Madhyama Vyayama Shakti (~moderate physical strength) with Madhyama Satva (~moderate
psychological strength). He had Madhyama Abhyavaharana Shakti (moderate power of

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ingestion), Madhyama Jarana Shakti (moderate power of digestion) with Vyamishra Satmya
(~Habitual of 2-5 tastes) and habit of drinking alcohol occasionally.
Predominant Dosha in Darunaka is Vata in association with Kapha and Sheetapitta is Pitta
in association with Vatakaphaja.[4] Ayurveda focuses on eradication of Dosha and
purification of body by means of Panchakarma.[5] Since Vata and Kapha were vitiated along
with Pitta, Classical Shodhana was planned, (Classical Vamana followed by Classical
Virechana [Table1,2]) Shamana Chikitsa was followed for one month thereafter to achieve
better therapeutic efficacy in this case [Table 3]. The patient was followed up for six months
with no medications given in follow up period.
ASSESSMENT CRITERIA: The efficacy of the procedures on Darunaka was assessed
before treatment and after treatment based on criteria [Table 4].
OBSERVATION AND RESULTS
Vega (Urges) during Vamana were 8, and during Virechana were 20. After complete
Shodhana, variations in results were found on each symptom associated with Darunaka and
Sheetapitta. Patient got relief in sign and symptoms with gradual improvement. Effects of
treatment on patient of Darunaka and Sheetapitta are presented in Figure1-4. Assessment on
each considering symptom of Darunaka and Sheetapitta have been presented in Table 5.
These are the observations before and after Shodhana Karma. Patient did not report any
incidence of relapse of symptoms in six months of follow up. This was for the first time in
last six years that patient could appreciate complete relief from his symptoms.
Table 1: Method of drug administration for Vamana Karma and Virechana Karma.
S.N.
Days
Treatment
Drug used Dose
Anupana
Duration
1.
1-3
Dipana- Pachana
(digestion and
metabolism
enhancing)
Triphala Churna- 2gm
Vidanga- 1 gm
Shankha Bhasma- 250
mg
Ushnodaka
(Lukewarm
water)
3 Days
2.
4-8
Vamanartha
Snehapana (Internal
oleation for Vamana)
Panchatikta Ghrita
Doses are placed at
Table 2
Ushnodaka
3 Days
3.
9
Sarvanga Abhyanga
(Therapeutic whole-
body massage)
Bashpa Svedana
(~Steam sudation)
Dashmoola Taila (Oil)
Dashmoola Kwatha
(Decoction)
Once a day
-
1(Gap day) +
1(Vamana
day)

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4.
10
Vamana karma
Madanphala- 3gm
Vacha-1gm
Saindhava-1gm
Yashtimadhu Phanta
Lavanodaka
Honey
1
5.
11-17
Samsarjana Krama
(post dietic regimen)
Peyadi Krama
7 Days
6.
18
Normal Diet on 8th day of Vamana Karma
7.
19-21
Virechnartha
Snehapana
(Internal oleation of
Virechana)
Panchatikta Ghrita
Doses are placed at
Table 2
Ushnodaka
3 days
8.
22-24
Sarvanga Abhyanga
Bashpa Swedana
Dashmoola
Taila
Dashmoola
Kwatha
Once
a day
-
3 (Gap Days)
+1
(Virechana
Day)
9.
25
Virechana Karma
Ichhabhedi
Rasa (3
tablets)
-
-
1
10.
26-30
Samsarjana Krama
Peyadi Krama (thin gruel of rice etc.)
5 Days
Table 2: Details of Snehapana for Vamana Karma and Virechana Karma.
Day 1
Day 2
Day 3
Day 4
Day 5
Sneha Matra (Dose)
50 ml
75 ml
100 ml
125 ml
150 ml
Sneha Sevana Kala
(Administration time)
6.15 am
6.20 am
6.30 am
6.15 am
6.30 am
Kshudha Pravrutti Kala
(~Time of appetite)
12.15 pm
12.30 pm
2 pm
3.15 pm
3.30 pm
Mala Pravrutti (~Bowel
frequency)
1 time
1 time
2 times
2 times
2 times
Virechnartha Sneha
Sneha Matra
50 ml
75 ml
100 ml
Sneha Sevana Kala
6 am
6.10 am
6.30 am
Kshudha Pravrutti Kala
12.30 pm
2 pm
3.15 pm
Mala Pravrutti
1time
1time
2 times
Table 3: Shamana Aushadha.
S. No.
Aushadha
Dose
Frequency
1
Avipattikara Choorna 3 gm
Pittantaka Yoga
Shuddha Gandhaka
3gm
500 mg
250 mg
Twice daily
2
Aarogyavardhini Vati
2 Vati
Twice daily
3
Panchatikta Ghrita Guggulu
2 Guggulu
Twice daily
4
Manjishthadi Choorna
3 gm
Twice daily
5
Mahamarichyaadi oil
Daily once for local application

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Table 4: Gradation scale.
Symptoms of Darunaka
Grade
1. Kandu (Itching)
Absent
0
Occasionally
1
Frequently
2
Constantly
3
2. Kesha Bhumi Rukshata (Roughness of scalp)
Absent
0
Negligible
1
Without discomfort on scalp
2
With discomfort on scalp
3
3. Keshachyuti (Hair fall)
Absent
0
Occasionally
1
Moderate loss
2
Maximum loss
3
4. Twak Sphutana (Scaling of the scalp skin)
Absent
0
Visible inside the hair
1
Visible over the hair
2
Spreaded over the shoulder
3
Symptoms of Sheetpitta
Symptom
Grade 0
Grade 1
Grade 2
Grade 3
Varati Dansh Sansthana
Shotha (Swelling as if
bitten by the wasp)
Absent
In specific area
Present on
some parts of
body
Present all over
body
Kandu (Itching)
Absent
Occasionally
Disturbing the
sleep
Disturbing the
sleep and normal
activity
Toda (Pricking
sensation)
Absent
Occasionally
Disturbing the
sleep
Disturbing the
sleep and normal
activity
Vidaha (Burning
sensation)
Absent
Occasionally
Disturbing the
sleep
Disturbing the
sleep and normal
activity
Duration of wheals
Absent
<1 Hour
1-12 Hours
>12 Hours
Frequency of
appearance
Absent
Once a week
2-3 times a
week
Daily
Frequency of use of
antihistamines
Absent
Once a week
2-3 times a
week
Daily
Table 5: Effects on symptoms.
Assessment criteria for Darunaka
Score before treatment
Score after treatment
Kandu
3
0
Keshachyuti
3
1
Kesha Bhoomi Rukshata
2
0
Twak Sphutana
2
0

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Assessment criteria for Sheetapitta
Varati Dansh Sansthana Shotha
2
0
Kandu (Itching)
3
0
Toda
3
0
Vidaha
3
0
Duration of wheals
2
0
Frequency of appearance
2
0
Frequency of use of antihistamines
2
0
Figure 1: Scalp before Shodhana. Figure 2: Scalp after Shodhana.
Figure 3: Trunk before Shodhana. Figure 4: Trunk after Shodhana.
DISCUSSION
Owing to the Vata Kaphaja involvement in Darunaka and association of Kapha, Pitta and
Vata in Sheetapitta, Vitiation of Tridosha (three regulatory functional factors of the body)
can be considered in present case. Vamana is indicated in Kapha disorders as well the
conditions where Kapha along with Pitta or Vata is vitiated. Similarly, Virechana is indicated
in Pitta vitiation either alone or in association with Kapha.[6] Moreover, Pidika (eruptions),
Kotha (wheal like skin eruptions) and Kandu, are mentioned as Bahudosha Avastha (~State
of Dosha vitiation in large quantity) in classics.[7] Urdhwa (~upward), Adhah (~downward)

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Shodhana has been advised considering the Bala (Physical endurance) of patient and Vyadhi
(disease). Since the disease was chronic (more than 6 years) and patient was of medium age,
complete Shodhana was planned. Dandruff may be a consequence of improper nutritional
supply to the scalp resulting in cracking of scalp, dryness, and Hair fall. Its treatment should
aim at clearing off the obstruction to ensure proper nutritional supply to the scalp. The same
can be achieved through Shodhana Karma. Vitiation of Kapha Dosha is responsible for
Kandu, and elimination of this vitiated Dosha through Vamana might have relieved the
itching over scalp and trunk region. Virechana Karma does elimination of vitiated Pitta and
Vatanulomana (proper functioning of Vayu), and thus might have relieved the redness over
trunk region, itching, Kesha Bhoomi Rukshata and Twak Sphutana, providing overall relief in
sign and symptoms of Darunaka and Sheetapitta. Apart from the Srotoshuddhi, Shodhana
does Manahprasada (Mental cheerfulness), and Psychogenic factors, as anxiety, stress are
said to play an important role in producing Urticaria. Relieving these factors might also be a
contributing factor to the subsidence of symptoms. Raktavaha Srotodushti cannot be denied
in cases of Pidika and Raktamandala (reddish circular patches on skin) as in present case.[8]
Though Samshodhana does Dhatu Sthirata i.e. it makes Dhatu capable of proper functioning,
but after Shodhana, Shamana drugs, mainly Pitta- Vata Shamaka and Raktashodhaka
(~blood purificatory) were advised for better therapeutic effects and to avoid remissions.
Among them, Panchatikta Ghrita Guggulu, Arogyavardhini Vati and Manjishthadi Churna
are Raktashodhaka, and are indicated in skin disorders. Shodhana should be followed by
Rasayana, thus Gandhaka Rasayana, indicated in Sheetapitta was prescribed.
Mahamarichyaadi Taila was prescribed for local application. These Shamana drugs were
administered for one month after Shodhana.
CONCLUSION
The treatment protocol in present case was based on Ayurvedic principles and Classical
Samshodhana provided considerable relief in Darunaka and Sheetapitta. Shamana drugs
should be administered thereafter for better therapeutic effects. The recovery in present case
was promising and worth documenting.
Conflict of Interest: None.
Consent: The consent was signed by the patient and the original article is attached with the
patient’s chart.

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