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| CASE REPORT |
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| Year : 2023 | Volume
: 6
| Issue : 1 | Page : 19-22 |
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Prachchanna and Pratisarana in the management of Shitada: An experience
Shraddha Chaudhary1, DB Vaghela2
1 Department of Shalakya Tantra, COER Medical College of Ayurveda and Hospital, Vardhman Puram, Roorkee, Uttrakhand, India
2 Institute of Teaching and Research in Ayurveda (ITRA), Institute Building, 4th Floor, Opposite Reliance Mart, Jamnagar, Gujarat, India
| Date of Submission | 28-Jan-2022 |
| Date of Acceptance | 10-Feb-2023 |
| Date of Web Publication | 21-Mar-2023 |
Correspondence Address:
Dr. Shraddha Chaudhary
Department of Shalakya Tantra, COER Medical College of Ayurveda and Hospital, Vardhman Puram, Roorkee - 247667, Uttrakhand
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jacr.jacr_5_22
Shitada, one of Dantamoolagata roga (~gum disorders), can be correlated with gingivitis based on similar symptomatology. A 30-year-old male patient presented to the outpatient department of an Ayurveda hospital with the complaints of bleeding, inflamed, mild blackish discolored gums associated with halitosis for three years. The condition was managed by Raktamokshana by Prachchanna vidhi (~bloodletting by scarification or multiple incisions), Pratisarana (~rubbing of medicated paste over gums) with Priyangvadi churna mixed with Madhu (~honey), and Triphala churna orally with lukewarm water. The total treatment period was 30 days, and the patient was followed up for the next two months. Satisfactory improvement was noticed after the treatment.
Keywords: Pratisarana, Prachchanna, Shitada, Triphala
How to cite this article:
Chaudhary S, Vaghela D B. Prachchanna and Pratisarana in the management of Shitada: An experience. J Ayurveda Case Rep 2023;6:19-22 |
How to cite this URL:
Chaudhary S, Vaghela D B. Prachchanna and Pratisarana in the management of Shitada: An experience. J Ayurveda Case Rep [serial online] 2023 [cited 2023 May 30];6:19-22. Available from: http://www.ayucare.org/text.asp?2023/6/1/19/372251 |
| Introduction | |  |
Mukha (~oral cavity) is said to be a doorway of the gastrointestinal tract, is an indicator of body health, and is considered to be one of the important parts of the Urdhawanga (~head and neck). Gingiva is part of the oral mucosa that covers the alveolar processes of the jaw and surrounds the neck of the teeth. It is of great importance to have a healthy oral mucosal cavity, teeth, and gingiva, which gives benefits beyond a fresh breath and a good smile. Shitada is considered one of Dantamoolagata roga (~gum disorders).[1] Sudden bleeding from gums, foul smell, blackish, moistened, softened gums, and necrosed and suppurated gums are one after the other signs and symptoms of Shitada which are caused by vitiated Kapha and Rakta dosha.[2] Shitada is the possible result that takes place due to the lack of oral hygiene and the following unhygienic methods. Accumulation of debris, plaque, and calculus at the tooth margin exacerbates the condition.[3] Acharyas have mentioned Raktamokshana (~bloodletting), Pratisarana (~rubbing medicinal paste over gums), Gandusha (~holding of medicated liquids in mouth), etc., to keep gingiva healthy and manage Shitada-like conditions.[4]
| Patient Information | | |
A 30-year-old male patient, a teacher by profession, visited Shalakya tantra (dental) outpatient department on October 12, 2021, with the chief complaints of bleeding painful blackish discolored gums associated with halitosis for three years. The patient had a consultation of dentist; however, the relief was unsatisfactory. Thus, he opted for Ayurveda for possible management.
| Clinical Findings | | |
The patient was afebrile. Pulse was 76 beats/min. His blood pressure was 130/90 mmHg. No abnormality was noticed in the functioning of the respiratory and circulatory systems. To assess the effect of therapy, an in-house scoring criterion was developed [Table 1]. On oral cavity examination, oral hygiene was average. Calculus was traced at the gingival margin or between teeth (grade I), bleeding gums (grade III), halitosis (grade III), inflamed gums (grade II), and discoloration of gums, reddish blue (grade II). The bleeding index was grade III, and the gingival index was grade II [Figure 1].
| Timeline | | |
The timeline of the present case is depicted in [Table 2].
| Diagnostic Assessment | | |
Before treatment, hemoglobin was 13.2 g %, bleeding time was 2 min 30 s, clotting time was 7 min 20 s, and random blood sugar was 118 mg/dl. Serological parameters (human immunodeficiency virus infection, hepatitis B surface antigen, venereal disease research laboratory test, hepatitis C virus) were negative, and urine analysis was within the normal limits.
Dashavidha pareeksha (~tenfold examination)
The patient has Vata Kaphaja prakruti (~physical constitution). Vikruti (~morbidity) was Kapha raktaja. Satwa (~psyche), Sara (~excellence of tissue elements), Samhanana (~compactness of organs), Vyayama shakti (~power of performing exercise), Satmya (~homologation), and Pramana (~body constituents) of the patient were of Pravara (~excellent) level. Ahara shakti (~digestive power) was Avara (~poor).
| Therapautic Interventions | | |
Priyangvadi churna pratisarana (Priyangu [Callicarpa macrophylla Vahl.], Musta [Cyperus rotundus Linn.], Haritaki [Terminalia Chebula Retz.], Bibhitaki [Terminalia bellirica Roxb.], and Amalaki [Phyllanthus emblica Linn.]) in 3 g dose with honey twice a day in the morning and night after the meal and Triphala churna (Haritaki, Bibhitaki, and Amalaki) orally 3 g with lukewarm water twice a day at least 15 min after the meal for 30 days were advised. Three sittings of Raktamokshana with Prachchanna vidhi were done at the interval of 15 days. At first, the patient was asked to sit in low Fowler's position; after that cleaning of the mouth was done by Povidone-iodine solution antiseptic gurgle. Then, with the help of 26 no. needle, the inflamed gums were pricked at a measurement of 2-3 mm deep and left the site to bleed until the bleeding cease [Table 2].
| Follow-up and Outcome | | |
After treatment of 30 days, the patient got a complete relief in bleeding gums, inflamed gums, discolored gums, and halitosis. No calculus was seen. The gingival index and bleeding index recorded were of grade 0. Halitosis was also completely cured [Figure 2]. The patient was followed up for the next two months at the interval of 15 days where no recurrences were complained.
| Discussion | | |
The manifestation is normally seen in individuals with poor oral hygiene. Simple Ayurveda measures are beneficial in its management. The management followed here, in this case, are Pratisarana with Priyangvadi churna, Triphala churna orally, and Prachchana karma.
Pratisarana
The patient was advised to do Pratisarana two times (in the morning and evening) after proper cleaning of the mouth. A paste was prepared by taking Priyangvadi churna (3 g) and mixing it with Madhu (~honey). Then, he was advised to take the paste in the index finger and apply it all over the gums with a slight pressure for 3–5 min in a clockwise direction. After that, proper rinsing was advised with lukewarm water.
In Priyangvadi churna,[4] Priyangu is Tridosha shamaka (~vitiation of all three Doshas), Rakta prasadaka (~blood soothers), and Dahaprashamaka (~relieve burning sensation).[5] Musta is Shothahara (~anti-inflammatory) and Krimighna (~antihelminthic). Haritaki is Tridosha shamaka, Shothahara, and Rasayana (~rejuvenator).[6] Amalaki is Laghu, Ruksha, Tridosha shamaka, and Rasayana.[7] Bibhitaka is Laghu (~lightness), Ruksha (~dry), and Kapha-pitta shamaka (~alleviates Kapha and Pitta Dosha), and possesses Chedana property.[8]
The main Rasa in Priyangvadi churna is Katu (~pungent), Kashaya (~astringent), and Tikta rasa (~bitter taste). Katu rasa (~pungent taste) has Shodhana (~purify), Lekhana (~scraping), Deepana (~increases digestive fire), Pachana (~increases appetite), Krimighna (~antihelminthic), Kapha prashamaka (~alleviates Kapha), and Vaktra shodhaka (~cleans mouth) properties.[9] Tikta rasa (~bitter taste) has Chedana and Shodhana (~detoxify) properties.[9] Kashaya rasa (~astringent taste) has Ropana (~healing), Shodhana (~purification), Lekhana (~scraping), and Raktastambhana (~hemostasis) properties.[9] Laghu (~light) and Ruksha guna (~dry quality) are responsible for Kapha shamana. Ushna virya is responsible for Vata-kapha shamana. Katu vipaka balances vitiated Kapha.
Priyangvadi churna was applied with Madhu as the Anupana, which possesses Madhura and Kashaya rasa, Laghu and Ruksha guna, Katu vipaka, Shita virya, Kapha shamaka, Chedana, Vedanasthapana, Shothahara (~anti-inflammatory), Vranashodhana (~cleansing of wounds), Vranasandhana (~wound healing), Vranaropana (~wound healing), Lekhaneeya (~scraping), and Dahaprashamaka (~pacifying burning sensation) properties.[10] In addition to the previously mentioned properties, Madhu has Yogavahi guna, which is capable of increasing the efficacy of the drugs.[11] The method of application in Pratisarana provides the two main activities to support the actions of the ingredients of the drug, i.e. eliminating biofilm, food debris, and microorganisms in the oral cavity and increasing blood supply to the gums. It helps the ingredients of the drugs to direct contact with the gums and exerts their pharmacological action directly. Furthermore, gingivitis as mainly a plaque-induced disease, it is mandatory to remove the causative factor by a mechanical force, which is fulfilled by Pratisarana. By the gentle mechanical rubbing action of Pratisarana, blood circulation increases and stimulates the healing process and regeneration of gums. It provides the functions like Vranashodhana, Vranaropana, Shothahara, Lekhana, etc., that facilitate healing of Shitada.
Triphala churna
Triphala possesses Kashaya rasa, Laghu and Ruksha guna, and Ushna virya, and also possesses Deepana, Tridosha Shamaka, and Rasayana properties.[12] Triphala has Lekhaneeya guna due to Kashaya rasa and Ushna virya.[13] Therefore, it can reduce inflammation and consequently aid in tissue regeneration.[14] Due to its properties of free radical scavenging, immunomodulating, and antioxidants,[15] it promotes the healing of gums. It also helps in reducing halitosis by acting as an antimicrobial agent. It also helps in relieving constipation, thus keeping the gastrointestinal tract healthy.
Raktamokshana (Prachchanna vidhi)
In this study, Raktamokshana is done by Prachchanna vidhi. As Dantamoolagata roga is under the heading of Mukharoga,[1] Raktamokshana is not possible by Jaluka, Alabu, Gati yantra, Shringa, etc., Hence, for the convenience of patient, Prachchana vidhi was adopted by 26 no. needle. Prachchanna-karma is adopted when Doshas are situated in Twak and Rakta remains in the vitiated state. This procedure was done in gingivae and was repeated three times with a gap of 15 days. Blood flow is a key in healing the damaged area. The diminution of the mass of the blood by which the overloaded capillary or larger vessels of some affected part may be relieved. The patient was asked to avoid intake of Ruksha (~dry items) and Amla ahara (~sour items).
| Conclusion | | |
The case report demonstrates clinical improvement in Shitada with Ayurvedic management. The treatment used here is simple, effective, easily approachable with easily available drugs, simple procedures, and hence, economically cost-effective. As this is a single case study, it may open a new path to clinicians and researchers for exploring the treatment of Shitada.
Declaration of patient consent
Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case with the images and other clinical information in the journal. The patient understands that his name and initial 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 | | |
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| 14. | Kumar NS, Niar AS, Nair AM, Murali M. Pharmacological and therapeutic effects of Triphala – A literature review. Journal of Pharmacognosy and Phytochemistry 2016;5:23-7. |
| 15. | Baliga MS, Meera S, Mathai B, Rai MP, Pawar V, Palatty PL. Scientific validation of the ethnomedicinal properties of the Ayurvedic drug Triphala: A review. Chin J Integr Med 2012;18:946-54. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]
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