|Year : 2021 | Volume
| Issue : 4 | Page : 173-178
Effect of add-on Ayurveda treatment in the management of chickenpox
Ranjita Ekka1, Ekta Dogra2, Parvathy G Nair3, Amit K Dixit1, Kuldeep Choudhary4, Debajyoti Das1, Peyyala Vara Venkatesh Prasad1
1 Central Ayurveda Research Institute, Kolkata, West Bengal, India
2 Central Ayurveda Research Institute, Guwahati, Assam, India
3 National Ayurveda Research Institute for Panchakarma, Cheruthuruthi, Kerala, India
4 RRAP-Central Ayurveda Research Institute for Cancer (Under CCRAS, Ministry of AYUSH, Govt. of India), Podar Medical College Campus, Worli, Mumbai, Maharashtra, India
|Date of Submission||10-Sep-2021|
|Date of Decision||08-Mar-2022|
|Date of Acceptance||11-Mar-2022|
|Date of Web Publication||29-Apr-2022|
Central Ayurveda Research Institute, 4, CN Block, Sector 5, Bidhannagar, Kolkata, West Bengal 700091
Source of Support: None, Conflict of Interest: None
BACKGROUND: Chickenpox is a contagious infection caused by the Varicella-zoster virus with the clinical manifestation of itchy rashes with fluid-filled blisters and fever. Although it is a self-limiting disease, to shorten the recovery period as well as to avoid complications, Ayurveda medicine could be effectively used in the management of chickenpox. In the present case study, the effects of Ayurveda add-on treatment are studied in treating chickenpox and in healing papules. CLINICAL PRESENTATION AND DIAGNOSIS: A 38-year-old woman presented to the Out-Patient Department (OPD) of Central Ayurveda Research Institute, Kolkata, with severe itchy and painful papules all over the body and malaise along with difficulty in swallowing because of pain in the throat since 15 days. On the basis of clinical presentation, it was diagnosed as a case of chickenpox. INTERVENTION AND OUTCOME: Before visiting the Ayurveda OPD, the patient took allopathic medicine (acyclovir 800 mg TID, paracetamol SOS, and calamine lotion local application) for 15 days, but the disease continued to progress and developed painful lesions with itching and other difficulties. The Ayurveda intervention started after 2 weeks of the onset of the disease. The patient was advised to take Tribhuvankirti Rasa (250 mg BD) before food for 7 days, Haridrakhanda (3 g BD) after food, Panchatiktaghrita (5 mL BD) after food, and Guduchyadi Taila for local application for 15 days. RESULTS: Papules of chickenpox were healed in 15 days of the treatment. After taking Ayurveda medicines, the patient got relief from severe itching and pain within 2 days and also completely recovered within 15 days. CONCLUSION: Results suggest that the Ayurveda interventions effectively reduced the signs and symptoms of chickenpox and hastened the healing process. It may be concluded that Ayurveda medicines either alone or as add-on give promising therapeutic results in the management of chickenpox.
Keywords: Ayurveda, case report, chickenpox, Masurika, Tribhuvankirti Rasa
|How to cite this article:|
Ekka R, Dogra E, Nair PG, Dixit AK, Choudhary K, Das D, Prasad PV. Effect of add-on Ayurveda treatment in the management of chickenpox. J Res Ayurvedic Sci 2021;5:173-8
|How to cite this URL:|
Ekka R, Dogra E, Nair PG, Dixit AK, Choudhary K, Das D, Prasad PV. Effect of add-on Ayurveda treatment in the management of chickenpox. J Res Ayurvedic Sci [serial online] 2021 [cited 2022 Aug 13];5:173-8. Available from: http://www.jrasccras.com/text.asp?2021/5/4/173/344413
| Introduction|| |
Chickenpox is a highly infectious disease caused by Varicella-zoster (V-Z) virus, characterized by vesicular rash accompanied with fever and malaise, and occurs in both epidemic and endemic forms. Chickenpox is usually a mild self-limiting disease that often affects children. However, it also affects adolescents and adults and may cause severe complications in individuals with immune-compromised conditions and other pre-existing chronic diseases. This disease has a high infectivity rate because of its transmission through airborne droplets. In India, Varicella vaccination is not included under the national immunization schedule because of high cost of the vaccine; only small percentage of children gets vaccinated every year. The conventional management of chickenpox is to provide symptomatic relief, which includes antiviral drugs like acyclovir, antipyretics, and some topical applicants for relief from itching.
A clinical manifestation similar to chickenpox is explained as Masurika in Ayurveda, in which multiple eruptions, with the size and shape of red lentils, develop all over the body with fever and associated symptoms. Ayurveda system also has an effective management for this condition. The conventional system of medicine is preferred to manage the disease chickenpox by most of the population because of its acute condition with fever and painful blisters; on the other hand, Ayurveda treatment is often preferred for the management of chronic illness. In this study, a case report of chickenpox has been presented that has not shown much response to conventional treatments but showed quick response to the Ayurveda medicines in terms of reduction of signs and symptoms. This case report highlights the possibilities of exploring the integrated approaches in the management of chickenpox for speeding the recovery.
| Patient Information|| |
A 38-year-old woman presented to the Out-Patient Department (OPD) of Central Ayurveda Research Institute, Kolkata, with a complaint of painful eruptions all over the body associated with severe itching, malaise, body ache, throat pain, and difficulty in swallowing since last 15 days. As per the patient, the symptoms started as mild body ache, fever, and sore throat, but after 24 hours, fluid-filled eruptions were developed over the abdomen, which later progressed and appeared all over the body. Following the same, the patient took the tablet acyclovir 800 mg TID, paracetamol SOS, and calamine lotion local application from over the counter (OTC) after 48 hours of the onset of symptoms as a self-medication, suspecting the condition to be chickenpox. The patient took medications for 7 days and then stopped on her own as the symptoms continued and no relief was observed; the condition worsened with painful blisters, severe itching all over the body, and then she consulted Ayurveda treatment on the fifteenth day of the disease onset.
| Clinical Findings|| |
On physical examination, the patient was afebrile, blood pressure was 114/70 mmHg, and pulse rate was 80/min. The patient was well conscious with normal mental functions, and the systemic examination was also normal. The skin examination showed erythematous papules and vesicles all over the body [Figure 1], most abundant clusters over the trunk and face. The examination of the oral cavity revealed vesicles over the palate and posterior pharyngeal mucosa, making it difficult for the patient to swallow food and saliva. There was no history of diabetes and hypertension or any other skin disease, and the patient was not on any other kind of medications. The chest was clear on auscultation; the cardiac and abdominal examination was also unremarkable.
| Timeline|| |
Based on the observations of centripetal distribution of lesions, red blistering rashes [Figure 1] over the face, trunk, hands, and oropharyngeal region presented by the patient with fever, malaise, and body ache, the diagnosis was confirmed as chickenpox. It matched with the clinical manifestations of Masurika explained in Ayurveda classics.
After the complete assessment of clinical feature, the patient was prescribed with the following medicines. Patient was treated symptomatically. All medicines were continued for 15 days except Tribhuvankirti Rasa, which was given only for 7 days.
Patient was advised to take Tribhuvankirti Rasa 250 mg two times a day before food with honey, Panchatiktaghrita 5 mL two times a day after meal, Haridrakhanda 3 g two times a day after meal for 15 days. Along with the same, Guduchyadi Taila was also given for local application [Table 1] and [Table 2].,,,
| Follow-up and Outcome|| |
The patient started to notice relief in pain and itching after 2 days of the intake of medicines [Figure 2] and was able to swallow food without any difficulties. From the fourth day of treatment, scab formation was noticed [Figure 3], and all lesions subsided within 7 days [Figure 4][Figure 5][Figure 6]. The patient continued all medications for 15 days except Tribhuvankirti Rasa (discontinued after the seventh day) because of the subsidence of inflammatory symptoms. Other medicines were continued till the patient felt complete recovery.
Reporting of adverse event
No adverse reaction was reported for any Ayurveda medication prescribed as a treatment.
| Discussion|| |
Chickenpox is an acute disease caused by V-Z virus and is considered to be highly contagious disease. The incidence and severity of chickenpox increase with age; the first attack gives durable immunity making the chance for a second attack rare. In conventional medicine, several antiviral compounds, V-Z immunoglobulin, are available for the effective management and prevention of the condition. Oral antiviral agents such as acyclovir are found to be effective only if administered within 24 hours of the onset of rash. The reported case did not take any medical consultation and took OTC antiviral, antipyretics, and local applicants. The intake of acyclovir after 48 hours of the disease onset might be the reason the patient did not get a better response. As per Ayurveda, based on the size and rate of eruption of lesions, the presented clinical condition of this case matches with the disease Masurika, which can be correlated to chickenpox. A number of herbal and herbo-mineral compounds are mentioned under these contexts to treat such conditions. Ayurveda management of any disease is planned on the basis of the stage of disease with special reference to Dosha (the body vital) predominance and clinical features. The presented case was considered to be the vitiation of Tridosha because of the presence of features such as fever, painful blisters, and itching. By considering these, Ayurveda interventions such as Tribhuvankirti Rasa, Panchatiktaghrita, Haridrakhanda, and Guduchyadi oil were prescribed to the patient.
Tribhuvankirti Rasa is a classical herbo-mineral preparation that is used in the management of acute and chronic fever and other conditions’ predominance of Vata and Kapha Dosha. It is prepared by the trituration of powders of Aconitum ferox, purified Cinnabar, combination of dried rhizome of Zingiber officinale, fruit of Piper nigrum and fruit of Piper longum, Piper longum root, purified Tankana (Borax) in the decoction of Ocimum sanctum, juice of fresh rhizome of Zingiber officinale and leaf of Dhatura metel. Pharmacological studies have already revealed the anti-inflammatory, analgesic, and antiallergic and antiviral potential of various drugs such as Tulsi (Ocimum sanctum), Trikatu (dried rhizome of Zingiber officinale), fruit of Piper nigrum and fruit of Piper longum, Hingula (purified Cinnabar), and Tankana (Borax).,Tribhuvankirti Rasa is a safe herbo-mineral formulation. The presence of Aconitum ferox, which can have many untoward actions if not used cautiously, is already balanced with the antidote of Borax and Dhatura metel (possessing natural alkaloids with anticholinergic effects).
Haridrakhanda is a classical drug mentioned under Sitapttarogadhikara and is useful in the treatment of conditions such as Sitapitta, Kandu, Visphota, etc. Haridra (Curcuma longa), the main ingredient in Haridrakhanda, pacifies all the three Doshas (the vital factors of body), enhances complexion, and is effective in reducing itching and effective for skin diseases. Other ingredients present in this formulation also add to the therapeutic efficacy of the combination. Thus, Haridrakhanda becomes an ideal therapeutic agent for the management of chickenpox.
Panchatiktaghrita is a medicated ghee used in the management of various skin diseases for pacifying all three Doshas. It contains Nimba (Azadirachta indica), Patola (Trichosanthes dioica), Kantakari (Solanum xanthocarpum), Guduchi (Tinospora cordifolia), Vasa (Adhatoda vasica), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), and Vibheetaki (Terminalia bellirica). All these drugs possess anti-itching properties, pacify all the three Doshas, and are useful in the cure of all kinds of skin disease. This medicine was prescribed to treat the blisters and itching, and for healing of scars. The formulation containing Tikta Rasa drugs prepared in the medium of ghee is effective in the treatment of signs and symptoms presented in chickenpox.
Guduchyadi Taila given for local application contains Guduchi (Tinospora cordifolia) as the major ingredient. Tinospora cordifolia is a widely used medicinal plant in Ayurveda system for its antispasmodic, anti-inflammatory, antipyretic, antiarthritic, antiallergic, antidiabetic, and general tonic properties. Phytoconstituents in Tinospora cordifolia such as tinosporine, tinosporide, tinosporaside, cordifolide, cordifol, heptacosanol, clerodane furano diterpene, diterpenoid furanolactone, tinosporidine, columbin, b-sitosterol, berberine, palmatine, tembetarine, magniflorine, choline, and tinosporin are reported from the stem of the plant. Epicatechin, tinosporin, isocolumbin, palmatine alkaloid, and diterpenoid of Tinospora cordifolia have been reported to possess antioxidant activity. Furanolactone, tinosporin, tinosporide, jateorine, columbin, and clerodane derivatives are diterpenoid lactones present in Tinospora cordifolia with anti-inflammatory activity. The medicine Guduchyadi Taila described in Ayurveda is in context of the disease Vatarakta (a type of arthritic pain). It is therapeutically indicated for the treatment of itching pain and pigmentation associated with this condition. Thus, it was prescribed as a topical applicant in this case for reducing the itching and pain and for healing acceleration. The mentioned therapeutic regimen was effective in providing quick symptomatic relief (pain, itching, malaise, body ache, throat pain, difficulty in swallowing, and posthealing scars) and thereby hastening the healing process in the reported patient.
| Conclusion|| |
In the presented case study, considerable relief was observed after the administration of Ayurveda intervention to the patient. Panchatiktaghrita, Haridrakhanda, and Guduchyadi Taila improve the healing of scar as observed in the present case. Results of the case study suggest that add-on therapy with Ayurveda medicines gives promising results in the management of chickenpox. As one case may not be sufficient to draw any inference, there is a need for more studies with an integrative approach to establish such results.
We would like to thank the patient, who consented to have her case presented and published.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
The medicine given to the patient was available free of cost in the OPD of Central Ayurveda Research Institute, Kolkata.
Conflicts of interest
There are no conflicts of interest.
Credit author statement
RE treated the patient. ED and PGN analyzed and interpreted the data. KC and DD drafted the article. AKD helped in writing and editing. PVVP approved the final version to be submitted.
The patient was fully satisfied as the relief of symptoms was observed soon after the initiation of Ayurveda treatment. The patient followed all the instructions and responded well to the prescribed treatment with healing of scars within a very short period.
| References|| |
Park K. Epidemiology of communicable diseases. In: Park K, editor. Park’s Textbook of Preventive and Social Medicine. 24th ed. Jabalpur: Ms. Banarsidas Bhanot Publishers; 2017. p. 152.
Lee BW. Review of Varicella zoster seroepidemiology in India and Southeast Asia. Trop Med Int Health 1998;3:886-90.
Upadhyaya YN, editor. Uttarardha. In: Madhukoshavyakhya commentary by Sashtri S. Madhav Nadanam. 30th ed. 54/3. Varanasi: Chaukhamba prakashan; 2001. p. 182.
Anonymous. Ayurveda Formulary of India (Part I). 2nd ed. Ghaziabad: Government of India, Ministry of Health and Family Welfare, Department of Indian System of Medicine and Homeopathy; 2003. p. 684-5.
Anonymous. Ayurveda Formulary of India (Part I). 2nd ed. Ghaziabad: Government of India, Ministry of Health and Family Welfare, Department of Indian System of Medicine and Homeopathy; 2003. p. 270-1.
Anonymous. Ayurveda Formulary of India (Part I). 2nd ed. Ghaziabad: Government of India, Ministry of Health and Family Welfare, Department of Indian System of Medicine and Homeopathy; 2003. p. 162-3.
Anonymous. Ayurveda Formulary of India (Part II). 2nd ed. Ghaziabad: Government of India, Ministry of Health and Family Welfare, Department of Indian System of Medicine and Homeopathy; 2000. p. 107-9.
Bano N, Ahmed A, Tanveer M, Khan GM, Ansari MT. Pharmacological evaluation of Ocimum sanctum. J Bioequiv Availab 2017;9:387-92.
Cohen J, Breuer J. Chickenpox: Treatment. BMJ Clin Evid 2015;2015:0912.
Kaushik R. Trikatu—A combination of three bioavailability enhancers. Int J Green Pharm2018;12:s437-41.
Gaikwad VA, Wadnerwar N, Chalakh S. Therapeutic review of herbo-mineral preparations with special reference to Tribhuvankirti Rasa. J Indian Sys Med 2021;6.
Manish D. Mode of action of Haridra Khanda
in management of Sheetapittaudarad-kotha. Int Res J Ayu Yoga 2019;2:8-17.
Saha S, Ghosh S. Tinospora cordifolia: One plant, many roles. Anc Sci Life 2012;31:151-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]