Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Ayurvedic Management of Vicharchika vis-à-vis Atopic Dermatitis: A Case Report
Correspondence Address :
Dr. Vaibhavi Chitmulwar,
Postgraduate Scholar, Department of Kayachikitsa, Mahatma Gandhi Ayurved College, Hospital and Research Centre (DMIHER), Salod, Wardha-442005, Maharashtra, India.
E-mail: chitmulwarvaibhavi91@gmail.com
In this fast-paced developing world, regular day-to-day activities like diet and sleep are neglected, leading to various skin disorders (Kushtha). Kushtha is a generalised term used for all skin diseases in Ayurveda. It is mainly divided into two types: Maha kushtha and Kshudra kushtha. Vicharchika is a type of Kshudra kushtha characterised by symptoms like blackish discolouration (Shyava varnata), vesicles (Pidika), discharge (Strava), and itching (Kandu), which can be correlated to atopic dermatitis/eczema. There is no adequate treatment to cure the root cause in contemporary medicine other than topical steroids and antihistaminic agents. The main treatment protocol according to Ayurveda involves the use of both purification (Shodhana) and palliative treatment (Shaman chikitsa). A 21-year-old female patient presented with small blackish papules on both upper limbs, oosing, and itching on the lesions. She was given medication for both internal use and external application, resulting in significant improvement in symptoms. The patches resolved, and the discharge, itching, and vesicles disappeared.
Kshudra kushtha, Maha kushtha, Papule, Shodhana, Shyava varnata
A 21-year-old female patient presented in the Outpatient Department (OPD) of Kayachikitsa with complaints of small blackish papules oosing from both upper limbs (at the palmar aspect of the forearm) for the last six years. The condition was associated with itching at the site. During examination, she mentioned that the itching was more intense at night, leading to the oosing of clear fluid from the lesions. There was no history of any skin disorders in the family. The patient had been diagnosed with bronchial asthma 10 years ago and was on regular medications, including inhalation of Salbutamol respules once a day. Her bowel habits and urination were normal. She experienced loss of appetite and disturbed sleep due to excessive itching. The patient noted that consumption of oily, spicy, salty, and sour foods, sesame (Tila), black gram (Masha), jaggery (Guda), milk (Dugdha), garlic, indigestion, heavy physical exertion, and exposure to extreme heat worsened the symptoms. On examination, the lesions appeared grouped, circular, 3-4 cm in size, rough in texture, salmon pink in colour with crusts, itching marks, and no associated bleeding, while the surrounding skin was brownish-black. The presence of Pidika (papules), Shyavata (blackish discolouration), Kandu (itching), Bahustrava (copious oosing), and Rukshata (dryness) (Table/Fig 1) led to the diagnosis of Vicharchika (atopic dermatitis), and a treatment plan involving both Shodhana (purificatory management) and Shamana chikitsa (palliative management) was devised. All routine haematological investigations were within normal limits, and all vitals were stable (Table/Fig 2). A second follow-up was scheduled after one month.
Dermatological Examination
On the initial examination, the skin over the mouth, scalp, nails, trunk, and lower body appeared normal. However, lesions were discovered on both upper limbs (palmar aspect of the forearm) ranging between 3 to 4 centimeters in size. The lesions were salmon pink in colour, round in shape, grouped, symmetrically distributed, and had a crusty texture.
Systemic Examination
• system: Chest is bilaterally symmetrical, with no abnormal sounds heard.
• Cardiovascular system: S1S2 normal.
• Musculoskeletal system: Superficial and deep reflexes are intact.
• Gastrointestinal system: Soft, non tender, non palpable.
Samprapti Ghataka (Elements of pathogenesis)
Dosha- Tridosha (predominantly Kapha Pitta)
Dushya- Rasa, Rakta
Strotas- Rasavaha, Raktavaha
Strotodushti- Vimargagamana
Vyadhimarga- Bahya
Doshagati- Tiryaka, Vriddhi
Agni- Manda
Udbhavasthana- Aamashaya
Vyaktasthana- Twaka
Swabhava- Chirakari
Treatment Plan
When the patient first visited the OPD, she was not willing to undergo Shodhana Chikitsa (purificatory management). Therefore, only Shamana Chikitsa (palliative management) (Table/Fig 3) was planned.
During the first follow-up after 15 days, improvements were noted in the size and texture of the lesion, along with a reduction in itching. Consequently, the patient agreed to undergo Shodhana (purificatory management) (Table/Fig 4). A second follow-up was scheduled after Samsarjana Karma (dietary regimen) (Table/Fig 5). These medications are indicated in Kushtha (skin disorders) (Table/Fig 6) (1),(2),(3),(4),(5),(6).
After completing Shodhana Chikitsa, a seven-day Samsarjana Karma (dietary regimen) was prescribed to normalise the appetite. Therefore, the second follow-up was conducted after 15 days.
Diet and Hygiene
Considering the Dosha predominance, the diet was tailored to pacify the primary vitiated Dosha. Foods such as hot and spicy items like chilies, garlic, and raw onions, excessive salt, fried food, sour fruits, fermented foods like curd, pickles, and yogurt, ice cream, cold drinks, nuts, and strong tea were restricted. The patient was advised to consume nutritious, easily digestible foods such as masoor dal, moong dal, khichadi, seasonal fruits, and so on. Additionally, maintaining proper hygiene was also emphasised.
The patient presented with Pidika (papules), Shyavata (blackish discolouration), Kandu (itching), Bahustrava (copious oosing), and Rukshata (dryness). These parameters were graded as 0, 1, 2, and 3 (Table/Fig 7). After 15 days, there was significant improvement in Kandu, Strava, and Rukshata, and the patient was able to sleep properly. By the end of Vaman Karma (1 month), marked improvement in the signs and symptoms was observed. During the third follow-up (Table/Fig 4), which was after three months of complete treatment, all symptoms had completely resolved (Table/Fig 8),(Table/Fig 9).
The skin, the largest organ of the body, serves as a vital barrier between the body and the external environment, protecting it from various physical, biological, and chemical threats. It is more than just a protective cover, as it encounters a high volume of pathogens at the interface between the torso and the surroundings (7). Skin disorders are prevalent worldwide due to increasing neglect of diet, sleep, and elevated stress levels resulting from work pressure. Dermatitis encompasses a broad spectrum, with erythematous rashes ranging from minor to severe forms (8),(9). Eczema is triggered by delayed hypersensitivity reactions from the adaptive immune system, which targets infected host cells, activating other immune cells to produce cytokines that cause an inflammatory response (10),(11). Eczema can manifest as acute or chronic, depending on the severity of the antigenic response (12).
When Vicharchika is analysed in terms of causative factors (Nidana), prodromal symptoms (Purvarupa), clinical features (Rupa), pathogenesis (Samprapti), and management (Chikitsa), it is undoubtedly correlated with atopic dermatitis. The Charak Samhita describes Vicharchika as pruritic, oosing, and black pimples (13), while the Sushruta Samhita characterises it as extremely painful and itchy (14). According to Ayurvedic classics, Vicharchika is a Kapha Pradhana Tridoshaja Vyadhi (15) that affects Rasa, Rakta, Mamsa, and Kleda in the form of Dushya as it progresses (16). Key features include Pidika, Shyavata, Kandu, Lichenification (Raji) (17), Pain (Ruja), Copious oosing (Bahustrava) (18), and excessive dryness (Rukshata). The fundamental cause of all disorders is a decrease in the metabolic process (Agnimandya) (19).
Vicharchika, as a Kaphaja condition according to Acharya Charak, involves Kapha aggravation and accumulation in the Annavaha Strotas, obstructing the Rasavaha and Raktavaha Strotas and eventually settling in the Mamsavaha Strotas, leading to itching, swelling, and exudation. Charakacharya categorises all skin disorders as Sannipataja, but the variation in clinical presentation depends on the dominance of a specific Dosha. Kushthas with similar causative factors have distinct presentations based on colour, symptoms, type of pain, name, effects, and treatment, determined by the association, variation, and location of Doshas (20). The initiation of Dosha accumulation and vitiation begins in Rasa Dhatu, progressing to Rakta Dhatu, which affects and enlarges the Rasa, Rakta, and Mamsa. The course of Vicharchika involves multiple Doshas and Dhatu involvement, making the process complex. Evidence indicates that Rakta Dushti is a major contributing factor to skin issues (21).
Vicharchika occurs due to an adulterated lifestyle and dietary habits that lead to afflicted digestion and the aggravation of Kapha Dosha (22). Similarly, allergic conditions are one of the leading causes of Atopic Dermatitis. In present case study, the contents of Arogyavardhini vati act as Vata-reducing agents (Vata shamaka) and Kapha-reducing agents (Kaphaghna) that help reduce symptoms like Kandu, Shyavata, and Rukshata. This herbomineral formulation decreases the symptoms of Kushtha (Kushthaghna) but also acts as Deepaka, Pachaka, and Malashodhaka. It is hence, accountable for Agnideepana, Kushthaghna, Shodhana, and Dosha Shamana. Takzema cream is a non steroidal, herbal topical remedy for eczema. Its contents have inflammatory and immunomodulatory properties which reduce symptoms like Rukshata, Kandu, and scratching of skin. It exhibits antimicrobial properties that help in wound healing and prevent infections. It is also an antioxidant that protects skin cells and strengthens skin barrier functions. Its antibacterial and antifungal properties make it an effective microbial agent (22),(23). A 777 oil has moisturising ability that helps reduce dryness, keratinocytes, irritation, and softens the skin. Shodhana has been given great importance in the treatment of Kushtha. So, for purgation (Nitya Virechana), to attain purification of the GIT (Koshtha Shuddhi), Haritaki churna was administered for seven days. Panchtikta ghrita has contents that are spicy (Katu), bitter (Tikta), astringent (Kashaya), sweet (Madhur), light (Laghu), cool (Sheeta), dry (Ruksha), oily (Snigdha), and hot in potency (Ushna Virya) that help in Tridosha Shamana. The pacification of Vata Dosha helps in reducing Rukshata and Shyavata. Pacified Pitta Dosha decreases Pidika and Strava. The reduced Kapha Dosha helps in decreasing Kandu. Marichyadi taila contains drugs that calm the Vata Kaphaja conditions, which include Vrana, Kushtha, Vicharchika, among others (23).
Taila (Sneha) is considered one of the best for Vata Kaphaghna Twak Vikara due to its cleansing and wound-healing (Vrana Shodhaka) properties, according to the treatment protocol (Chikitsasutra) of Kushtha. It is a wonderful antioxidant (Rasayana), antiseptic (Vishghna), cleanser (Shoshaka), and antihelminthic (Krimighna), making it highly in demand for Vicharchika. Cutis cream, a herbal preparation, contains mostly antifungal content, thereby acting as a broad-spectrum agent against bacteria and fungi. P-sora powder contains drugs possessing properties like Kanduhara, healer (Ropana), and Kushthahara. Hence, when used with Gomutra Arka, it yielded marvelous results in reducing symptoms like Kandu, Rukshata, and scratching of the skin (22),(23). Gomutra is termed as a medicine in almost all classical texts. According to Bhavaprakash, it is Vishghna and Rasayana, rejuvenating the old, purifying the blood (Rakta Shodhaka), and curing all skin issues. The contents of Patolakaturohinyadi Kashaya, being Rakta Shodhaka and containing Tikta Rasa, aid in Rakta Dhatu formation. It is also Kushthahara, making it ideal for use in most skin disorders, as in present case. Vamana karma was also performed, as it is utilised in all skin disorders. Vamana yoga, consisting of Vacha churna, Pippali churna, Madanaphala churna, Saindhava, and Madhu, is also used in dermatological conditions. Vamana, which induces emesis, helps in detoxifying the body, aiding in reducing the symptoms of Vicharchika in present case study. The Poorva karmas or oleation (Snehana) and steaming (Swedana) provided a Samshodhana effect. The Vamana yoga helped reduce the Kapha Dosha, progressively eliminating the disease. This expulsion of toxins purified the Dushyas of Vicharchika. The therapy contents possessed Krimighna, Kushthaghna, Kaphaghna, and Amapachana properties that reduced the symptoms. The process cleared all the channels (Strotas), improving the nourishment process by clearing the external channels (Bahya Rogamarga) and elevating the sensory effect (Indriya Bala of Twacha), thus eliminating the severity of the disease (23).
There have been many cases (24),(25) reported on the management of Vicharchika, with most of them emphasising Shamana Chikitsa or palliative management. However, as the root cause has not been addressed, the chances of its recurrence are always present. Acknowledging all these factors, a treatment protocol needs to be designed that would eliminate the cause and reduce the chances of recurrence. In the present case study, a detailed dermatological examination of the patient was conducted to identify the Nidana (causative factor), Dosha, and Dhatus involved in the pathogenesis. Since breaking the pathogenesis would eliminate the disease, Shodhana (purificatory procedures) was performed along with internal medications. In the past, most case studies and case series have been published in which the treatment for Vicharchika was given with only internal medication. However, in the present case, the patient was treated with both Shamana and Shodhana Chikitsa to remove the root cause.
Vicharchika, a complex disorder, greatly impacts the quality of life of those affected. Based on the results of present case report, it can be concluded that ayurvedic formulations can help cure such severe dermatological conditions if, drugs are selected wisely, providing a dignified life to patients. Therefore, it can be inferred that internal medicines as per the classical texts of Ayurveda prove to be effective in managing Vicharchika compared to atopic dermatitis.
DOI: 10.7860/JCDR/2024/67529.19194
Date of Submission: Sep 14, 2023
Date of Peer Review: Nov 21, 2023
Date of Acceptance: Dec 26, 2023
Date of Publishing: Mar 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 15, 2023
• Manual Googling: Nov 29, 2023
• iThenticate Software: Dec 22, 2023 (1%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com