• Users Online: 160
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 28-32

Ayurvedic management of herpes zoster in Rakta-pradoshajaroga (Gilbert's syndrome): A case report


1 Clinical Research, Regional Ayurveda Research Institute, Gwalior, Madhya Pradesh, India
2 Department of Samhita - Sidhanta, Bundelkhanda Govt. Ayurvedic Medical College, Jhansi, Uttar Pradesh, India
3 Department of Sharir - Kriya, Gopabandhu Ayurveda Mahavidyalaya, Puri, Odisha, India
4 Department of Chemistry, Institute - Incharge, Regional Ayurveda Research Institute, Gwalior, Madhya Pradesh, India

Date of Submission24-Sep-2021
Date of Acceptance08-Mar-2022
Date of Web Publication20-Apr-2022

Correspondence Address:
Dr. Neelam Kumari Singh
Research Officer (Ayu), Regional Ayurveda Research Institute, Gwalior - 474001, Madhya Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_82_21

Rights and Permissions
  Abstract 


Herpes zoster is an acute viral infection of sensory ganglia and the corresponding cutaneous areas of innervations characterized by fever and localized pain with vesicular skin eruption over single dermatomes. The available conventional treatments such as the use of antiviral drugs, corticosteroids, and topical agents have certain limitations. The condition, if not treated in early stages, becomes a great challenge to the clinician due to a higher rate of complications such as the neurological sequel, palsy, stroke, and cardiovascular events. In Ayurveda, this condition closely resembles Pittajavisarpa. Gilbert's syndrome is an inherited condition in which the liver does not properly process bilirubin, which causes a slight increase in bilirubin level that can be correlated with Kamala (~jaundice) in Ayurveda. Visarpa and Kamala both diseases are Rakta-pradoshajaroga (~blood vitiated disorders). The principle of treatment is Raktapittanashak-kriya (~remedies which balance the Rakta and Pitta dosha). In this case report, a 20-year-old male patient, with Gilbert syndrome presented with herpes zoster was managed with Ayurvedic internal medications such as Sutashekhara rasa, Arogyavardhini vati, Kaishora guggulu, Avipattikara churna, Paripathadi kwatha, and local application of Shatadhouta ghrita. Improvement had been observed in symptoms and in skin lesions after 14 days, whereas hepatic biochemical parameters were restored to normal after 42 days of treatment. No adverse effect pertaining to the prescribed drug was reported during the study period, inferring that, Ayurvedic medicines offer a good approach to manage Rakta-pradoshajaroga.

Keywords: Gilbert syndrome, herpes zoster, Rakta-pradoshajaroga, Visarpa


How to cite this article:
Singh NK, Sengar AS, Khuntia BB, Meena AK. Ayurvedic management of herpes zoster in Rakta-pradoshajaroga (Gilbert's syndrome): A case report. J Ayurveda Case Rep 2022;5:28-32

How to cite this URL:
Singh NK, Sengar AS, Khuntia BB, Meena AK. Ayurvedic management of herpes zoster in Rakta-pradoshajaroga (Gilbert's syndrome): A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2022 May 28];5:28-32. Available from: http://www.ayucare.org/text.asp?2022/5/1/28/343509




  Introduction Top


Herpes zoster is caused by the reactivation of latent zoster virus infection in posterior root ganglia long after an overt or subclinical varicella infection.[1] The first symptom is severe burning or shooting pain that precedes the skin eruptions by 2–4 days. Local skin hyperalgesia is a clue to the neural origin of the dermatomes. T3-L3 is commonly affected. It is characterized by several groups of vesicles containing clear fluid appearing on erythematous and edematous base along with the dermatomal distribution, later the blisters become purulent and confluent, healing takes place in 1–2 weeks leaving behind hypopigmentation and varioliform scarring. Postherpetic neuralgia, anesthesia, disseminated zoster, and recurrent zoster in immunocompromised persons are some of the complications of herpes zoster.[2]

In Ayurveda, this condition has a close resemblance with Pittajavisarpa, which is caused by the predominant vitiation of Pitta along with Vata and Kapha dosha. Dushya involvement is Rasa (~primary product of digested food), Rakta (~blood tissue), Twak (~skin), and Mansa dhatu (~muscle tissue) characterized by fever, vesicular skin eruptions usually on one side of the face, neck, or on the trunk with extensive burning sensation and pain,[3] which is commonly seen in herpes zoster. It spreads easily to other parts of the body along the affected dermatome.

Gilbert's syndrome is an inherited condition in which the liver does not properly process bilirubin which causes a slight increase in bilirubin level,[4] considering symptomatology, this condition can be correlated with Kamala (~jaundice) in Ayurveda. Visarpa (~spreading cellulitis/erysipelas) and Kamala are the diseases that have been mentioned in Raktaja roga (~blood vitiated diseases).[5] In Raktaja roga, principles of treatment are Rakta pittanashaka kriya (~remedies that pacify vitiated Rakta and Pitta), Rakta mokshana (~bloodletting), Virechana (~therapeutic purgation), and Langhana (~fasting).[6]


  Patient Information Top


A 20-year-old male, a known case of Gilbert syndrome for the last two years visited to the outpatient department (OPD) on 19/04/2021 with complaints of eruptions over the right lateral side of the chest and in the back region with burning sensation and itching for the last two days. There were two episodes of jaundice in the last 18 months for which he had taken modern medications, however, prescriptions were not with him. For the last six months, he was not using any medicines. His personal, family, and psychosocial history were non-significant.


  Clinical Findings Top


The patient was afebrile, pulse rate was 76/min, and blood pressure was 110/70 mm of Hg. His appearance was icteric. Multiple clusters of blisters and pustules of varying sizes on an erythematous base were present over the right lateral side of the chest and in the back region. Systemic examination did not reveal any abnormality. Poor digestive power, poor built, skin eruptions, burning sensation, and icterus were due to the vitiation of Rasavaha and Raktavaha srotas (~macro and microchannels of blood).

On Ashtavidha parikshana, his Nadi (~pulse) was Vatapittaja, Jihva (~tongue) was Sama (~coated), Aakriti was Krishta (~poor built), and bowel habits were normal. Icterus was present. Dashavidha pariksha (~ten factors of examination) revealed Pitta-vata prakriti (~constitution), Sara (~excellence of Dushya or tissue elements), Satwa (~psycic condition), Satmya (~homologation), and Vyayama shakti (~power of performing exercise) were Madhyama while Abhyavaharana (~power of ingestion) and Jarana shakti (~digestive power) were Avara (~poor). As the symptoms of Visarpa were associated with Daha (~burning sensation), Sphota (~blisters) and Haridratva (~yellowishness of nail, eye, and urine) were suggestive of Pitta dominant while Krishta (~poor built) and Mandagni (~poor digestive power) were due to Vatakapha dosha. The patient had presented with blisters in the right lateral side of the chest spreading to the back region with burning sensation and itching [Figure 1].
Figure 1: Skin lesion over the right lateral side of chest and back region before treatment

Click here to view



  Diagnostic Assessment Top


On local examination, the patient was found to have multiple clusters of blisters and pustules of varying sizes on an erythematous base present over the right lateral side of the chest spreading to the back region. The rashes were started initially as a cluster of vesicles over an erythematous base with itching which precedes with burning sensation, which were increased gradually [Figure 1]. Similar clinical features have been mentioned in Ayurvedic texts in the context of Pittaja visarpa where Haridratva, Sphotabahulta (~local area with spreading blisters and pustules with redness), Daha, and Sambheda (~breaking pain) are present. Based on history, clinical symptoms, and examination findings, the diagnosis of herpes zoster was made. His hematological investigations were normal, whereas indirect bilirubin and Serum Glutamic-Oxaloacetic Transaminase (SGOT) and Serum Glutamic-Pyruvic Transaminase (SGPT) were raised [Table 1].
Table 1: Biochemical investigations of the patient

Click here to view



  Timeline and Therapeutic Interventions Top


By considering the history, clinical examination, and investigation, treatment was prescribed in the present case [Table 2].
Table 2: Timelines

Click here to view



  Follow-up and Outcome Top


The patient was followed up telephonically (due to COVID-19 pandemic) through video call on 7th day, where crusting was noted on some vesicles, numbers and size of vesicles were reduced. Itching, pain, and burning sensation were also subsided on 7th day. On 14th day, the patient was followed up physically in OPD for any residual lesion or symptoms and was found to be free from lesions and symptoms [Figure 2]. The subsequent observations were also noted on 14th day [Table 2]. The changes observed in photographs taken before and after treatment to exhibit the changes in the skin lesion [Figure 2]. This shows a considerable improvement in the lesion following the therapy to the before-treatment status. After the 14th day, Arogyavardhini vati and Paripathadi kwatha were continued till 42nd day, whereas other medications were stopped. On 42nd day, the patient showed improvement in jaundice. Liver function tests including indirect bilirubin, SGOT, and SGPT were also became to normal levels [Table 1]. No adverse effect pertaining to the prescribed drug was reported during the course of treatment.
Figure 2: Improvement in skin lesion after 14 days of treatment

Click here to view



  Discussion Top


Ayurvedic perspective of this case presenting with Kamala, pruritus, erythema, and blisters has been attributed to vitiated Pitta due to Vata-kapha dosha.[7] Itching and pain are the features of Kapha and Vata dosha, whereas Raga (~redness/congestion), Sphota, Daha, and Kamala are due to vitiated Pitta dosha.[8] As the Yakrit (~liver) is the Moola-sthana (~origin) of Raktavaha srotas and plays an important role in metabolism. Its vitiation results in the manifestation of various diseases including skin diseases. Visarpa and Kamala are Pitta and Rakta pradoshaja vikara manifesting in skin.

The prognosis of Gilbert syndrome is excellent, and hyperbilirubinemia can be treated.[9] Kamala and Piitaja visarpa are also curable and have good prognosis too.[10] The main objective of the treatment was to treat the symptoms and to restore the raised bilirubin, SGOT, and SGPT levels. Considering the predominance of Dosha and Dhatu, Raktapitta hara, Pitta shamaka, and Vrana ropana (~wound healing) medicines along with dietary and lifestyle modifications were planned.[11] In diet, old grains such as Yava (~barley), Godhum (~wheat), Sashtishali (~oryza sativa), Moonga (~green gram), Masoor (~lentil), Chana (~bengal gram), and Arhar (~yellow split pigeon pea) and bitter substances such as bitter gourd, pointed gaurd, Masura yusha (soup prepared from Lens culinaris Medic.), Mudga yusha (soup prepared from Phaseolus radiatus Linn.), and Amalaki (Emblica officinalis Gaertn.) were advised while avoiding excessive salty, sour, spicy, heavy food, curd, and nonveg. Day sleep, excessive anger, stress, and excessive exposure of sun and wind were also suggested to avoid.[12] Mantha (~churning), Dadima (Punica granatum L.), Kharjura (Phoenix dactylifera L.), and grapes were blended in grinder with four times of cold water and then stirred. It was suggested for drink.[13]

Arogyavardhini vati is indicated in Kustha (~skin disorders), Medo-dosha (~obesity), Yakrit-vikara (~liver disorders), and Jirna-jwara (~chronic fevers).[14] The ingredients of Arogyavardhini vati are useful in the management of skin diseases. It is helpful in Pachana (~metabolism) of Amavisha (~toxins) and corrects vitiated Rasa dhatu in the body.[15] Arogyavardhini vati shows significant improvement in the liver function of non-alcoholic fatty liver disease due to its hepatoprotective, choleretic effects, and antioxidant action of Katuki (Picrorhiza kurroa Royle ex Benth.), Tamra (~copper), and Abhraka bhasma (~mica ash). Katuki has promising effects on bilirubin, SGOT, and SGPT and has cytotoxic activity.[16] It also promotes liver generating activity by restoring cytochrome.[17] Sutashekhara rasa corrects Mandagni, Sama-pitta dosha (~Pitta associated with toxins derived from improper digestion of food), and vitiated Rakta dhatu in the body.[18],[19]

Kaishora guggulu helps in the correction of Mandagni and relives obstruction of Kapha dosha.[20] Triphala (Haritaki [Terminalia chebula Retz.], Bibhitaki [Terminalia bellirica (Gaertn.) Roxb.], Amalaki [Emblica officinalis Gaertn.]), Trivrit (Operculina turpethum [L.] Silva Manso), and Danti (Baliospermum montanum [Willd.] Muell-Arg), the ingredients of Kaishora guggulu induce purgation thus removing excess Pitta dosha from blood circulation and gastrointestinal tract and helps in promoting skin health.[21] Guduchi another ingredient of Kaishora guggulu has virucidal activity due to the presence of phytoconstituents such as saponin, alkaloids, phytosterols, and terpenoids in it which explains its antiherpetic properties.[22] Amalaki contains variety of tannins, which have shown antimicrobial, antiviral, anti-inflammatory, and immune-regulating activities in vitro study.[23],[24]

Avipattikara churna contains Haritaki, Bibhitaki, Amalaki, Musta (Cyperus rotundus L.), Trivrit, Ela (Elettaria cardamomum Linn. Maton), and Lavanga (Syzygium aromaticum L.)[25] as a Pitta virechaka (~cholegogue) and Pitta shamaka dravya, which helps in relieving burning sensation. Haritaki and Trivrit act as Visarpa shodhana.[26]

Paripathadi kwatha possesses Pachana and Rakta shodhana (~blood purifier) properties and helps in digestion and correction of Sama pitta dosha at Rasa and Rakta level thereby reduces burning sensation, skin rashes, and blisters associated with herpes and restores the disturbed liver function too.[27] The main ingredient of Paripathadi kadha is Paripatha (Cyclea peltata [Lam.] J. Hooker and Thoms.), a well-known substitute of Patha (Cissampelos pareira Linn.). Its antipyretic and analgesic effect has been demonstrated in clinical study.[28]

Shatadhouta ghrita (~100 times processed ghee) when applied repeatedly by mixing equal quantity of fine powder of Panchvalkal, subsides the Daha and Visarpa.[29] It possesses Kashaya rasa, Sheeta veerya (~cold potency) and is Varnya (~complexion enhancer), and Vrana-ropaka(~promotes wound healing).[30] In Kushta chikitsa (~treatment of skin diseases), for Daha-shamanartha (~for pacification of burning sensation), Charaka has advised Abhyanga (~massage with ghee) with Tikta-ghrita (~medicated with bitter herbs) or Shatadhouta-ghrita.[31] When Rakta is vitiated due to Vata and Pitta dosha then only ghrita will be applied on skin lesions. It is an effective remedy for Visarpa, it subsides Daha, Shula in Vrana (~wound), and helps in the management of Visarpa.[32]


  Conclusion Top


Ayurvedic management of the condition with internal and topical medicines was yielded good clinical results in the patient. Restoration of hepatic profiles with two months of treatment infers safety aspects of the drugs used in the treatment. No adverse effects pertaining to the prescribed drug were reported in this case. Ayurvedic medicines offer a good approach to manage Rakta-pradoshaja roga but to establish this fact further studies with adequate sample size are required.

Declaration of patient consent

Authors certify that they have obtained the patient consent form, where the patient has given his consent for reporting the case along with images and other clinical information in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khanna N, Singh S. Viral infections. In: Bhutani Color Atlas of Dermatology. 6th ed., Ch. 3. New Delhi: Jaypee Brother Medical Publisher Ltd.; 2015. p. 53.  Back to cited text no. 1
    
2.
Sainani GS. Herpes virus infections. In: API Textbook of Medicines. 6th ed., Ch. 63. Mumbai: API Mumbai Publisher; Reprint 2001. p. 1182.  Back to cited text no. 2
    
3.
Acharya BT, editor. Chikitsa sthana. In: Charaka Samhita of Agnivesha. Ch. 21, Ver. 32. Varanasi: Chaukhamba Surbharti Prakashana; Reprint 2004. p. 711.  Back to cited text no. 3
    
4.
Available from: https://www.nhs.uk/conditions/gilberts-syndrome/. [Last accessed on 2021 Jul 09].  Back to cited text no. 4
    
5.
Acharya BT, editor. Sutra sthana. In: Charaka Samhita of Agnivesha. Ch. 28, Ver. 11. Varanasi: Chaukhamba Surbharti Prakashana; Reprint 2002. p. 548.  Back to cited text no. 5
    
6.
Acharya BT, editor. Sutra sthana. In: Charaka Samhita of Agnivesha. Ch. 24, Ver. 18. Varanasi: Chaukhamba Surbharti Prakashana; Reprint 2002. p. 431.  Back to cited text no. 6
    
7.
Acharya BT, editor. Chikitsa sthana. In: Charaka Samhita of Agnivesha. Ch. 21, Ver. 24. Varanasi: Chaukhamba Surbharti Prakashana; Reprint 2004. p. 709.  Back to cited text no. 7
    
8.
Acharya YU, editor. Sutra sthana. In: Astanga Hridaya. 7th ed., Ch. 12, Ver. 49-52. Varanasi: Chaukhamba Sanskrita Sansthan; Reprint 1980. p. 94.  Back to cited text no. 8
    
9.
Owens D. Population studies on Gilbert's syndrome. J Med Genet 1975;12:152.  Back to cited text no. 9
    
10.
Acharya YU, editor. Nidana sthana. In: Astanga Hridaya. 7th ed., Ch. 13, Ver. 27. Varanasi: Chaukhamba Sanskrita Sansthan; Reprint 1980. p. 267.  Back to cited text no. 10
    
11.
Acharya BT, editor. Chikitsa sthana. In: Charaka Samhita of Agnivesha. Ch. 16, Ver. 124. Varanasi: Chaukhamba Surbharti Prakashana; Reprint 2004. p. 611.  Back to cited text no. 11
    
12.
Mishra SN, editor. Bhaisajya Ratanavali of Sen GD. Ch. 57, Ver. 30-2. Varanasi: Chaukhamba Surbharti Prakashana; Reprint 2005. p. 919.  Back to cited text no. 12
    
13.
Acharya RT, editor. Chikitsa sthana. In: Charaka Samhita of Agnivesha. Ch. 21, Ver. 108-14. Delhi: Chaukhamba Sanskrit Pratishthan; Reprint 2012. p. 517.  Back to cited text no. 13
    
14.
Anonymous. The Ayurvedic Formulary of India. Part-1. 2nd Revised edition. New Delhi: Ministry of Health and Family Welfare, Department of ISM & H; 2003. p. 258.  Back to cited text no. 14
    
15.
Singhal P, Nesari T, Gupta GS. Efficacy of herbomineral compounds and pathya (Ayurvedic dietary regime and physical exercise) in the management of Yakṛt Roga (Non-alcoholic fatty liver disease). Anc Sci Life 2015;34:216-22.  Back to cited text no. 15
    
16.
Vaidya AB, Antarkar DS, Doshi JC, Bhatt AD, Ramesh V, Vora PV, et al. Picrorhiza kurroa (Kutaki) Royle ex Benth as a hepatoprotective agent-experimental & clinical studies. J Postgrad Med 1996;42:105-8.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Panda AK, Bhuyan GC, Rao MM. Ayurvedic intervention for hepatobiliary disorders: Current scenario and future prospect. J Tradit Med Clin Naturop 2017;6:210.  Back to cited text no. 17
    
18.
Anonymous. The Ayurvedic Formulary of India. Part-1. 2nd Revised edition. New Delhi: Ministry of Health and Family Welfare, Department of ISM & H; 2003. p. 278.  Back to cited text no. 18
    
19.
Mishra SN, editor. Bhaisajya Ratanavali of Sen GD. 1st ed., Ch. 56, Ver. 24-8. Varanasi: Chaukhamba Surbharti Prakashana; Reprint 2005. p. 903.  Back to cited text no. 19
    
20.
Anonymous. The Ayurvedic Formulary of India. Part-1. 2nd Revised edition. New Delhi: Ministry of Health and Family Welfare, Department of ISM & H; 2003. p. 67.  Back to cited text no. 20
    
21.
Mishra SN, editor. Bhaisajya Ratanavali of Sen GD. 1st ed., Ch. 27, Ver. 104-13. Varanasi: Chaukhamba Surbharti Prakashana; Reprint 2005. p. 582.  Back to cited text no. 21
    
22.
Pruthvish R, Gopinatha SM. Antiviral prospective of Tinospora cardifolia on HSV-1. Int J Curr Microbiol Appl Sci 2018;7:3617-24.  Back to cited text no. 22
    
23.
Bhattacharya A, Ghosal S, Bhattacharya SK. Antioxidant activity of tannoid principles of Emblica officinalis (amla) in chronic stress induced changes in rat brain. Indian J Exp Biol 2000;38:877-80.  Back to cited text no. 23
    
24.
Gaire BP, Subedi L. Phytochemistry, pharmacology and medicinal properties of Phyllanthus emblica Linn. Chin J Integr Med 2014;14:1984-2.  Back to cited text no. 24
    
25.
Anonymous. The Ayurvedic Formulary of India. Part-1. 2nd Revised ed. New Delhi: Ministry of Health and Family Welfare, Department of ISM & H; 2003. p. 106.  Back to cited text no. 25
    
26.
Shastri BS, editor. Visarpa chikitsa. In: Commentary Vidyotini Hindi of Shastri Laxmipati on Yogaratanakara, Uttaradhra. 4th ed., Ver. 6. Varanasi: Chowkhamba Sanskrit Sansthan; 1988. p. 247.  Back to cited text no. 26
    
27.
Sharma PV, editor. Dravyaguna Vijnana II. Varanasi: Chaukhambha Bharti Academy; 2006. p. 627.  Back to cited text no. 27
    
28.
Singh SG, Nishteswar K, Patel BR, Nariya M. Comparative antipyretic and analgesic activities of Cissampelos pareira Linn. and Cycleapeltata (Lam.) Hook. F. and Thomas. Ayu 2016;37:62-6.  Back to cited text no. 28
    
29.
Shastri BS, editor. Visarpa chikitsa. In: Commentary Vidyotini Hindi of Shastri Laxmipati on Yogaratanakara, Uttaradhra. 4th ed., Ver. 2. Varanasi: Chowkhamba Sanskrit Sansthan; 1988. p. 246.  Back to cited text no. 29
    
30.
Mutnali K, Roopa BJ, Shivaprasad T, Yadav R. Ayurveda management of oro-facial herpes: A case report. J Ayurveda Integr Med 2020;11:357-3.  Back to cited text no. 30
    
31.
Acharya RT, editor. Chikitsa sthana. In: Charaka Samhita of Agnivesha. Ch. 7, Ver. 133. Delhi: Chaukhamba Sanskrit Pratishthan; Reprint 2012. p. 325.  Back to cited text no. 31
    
32.
Shastri BS, editor. Visarpa chikitsa. In: Commentary Vidyotini Hindi of Shastri Laxmipati on Yogaratanakara, Uttaradhra. 4th ed., Ver. 6. Varanasi: Chowkhamba Sanskrit Sansthan; 1988. p. 248.  Back to cited text no. 32
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patient Information
Clinical Findings
Diagnostic Asses...
Timeline and The...
Follow-up and Ou...
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed285    
    Printed4    
    Emailed0    
    PDF Downloaded28    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]