AYURVEDIC MANAGEMENT OF VICHARCHIKA (HAND ECZEMA) WITH KOSHTA SHODHANA AND SHAMANOUSHADHI: A SINGLE CASE REPORT

Kalpana Metri*, Sumai M. A. and M. D. Samudri

Background – Chronic hand eczema (CHE) is common and burdensome, affecting an estimated 9-14% of adults and frequently leading to relapsing symptoms, occupational impairment, and diminished quality of life despite standard care with topical corticosteroids, immunomodulators, or phototherapy. Therapeutic limitations include tachyphylaxis, local atrophy, and recurrence after treatment cessation. In Ayurveda, Vicharchika is described as Kapha-pradhana Tridoshaja condition with characteristic kandu (itching), pidika (vesicles), bahusrava (oozing), and shyava varna (discoloration), suggesting a rationale for initial dosha elimination followed by a focused Shamanoushadhi regimen measured with the validated Hand Eczema Severity Index (HECSI). Objectives – To evaluate the clinical efficacy and safety of sequential Koshta Shodhana (therapeutic purgation) and Shamanoushadhi (internal and topical medication) for chronic Vicharchika, using HECSI to quantify disease severity at predermined timepoints. Methods – A 58-year-old male farmer with a 2-year history of bilateral hand eczema refractory to conventional therapy underwent a staged Ayurvedic protocol. Phase I comprised Koshta Shodhana with Icchabhedi Rasa (single-day purgation,4 stools achived with post-virechana convalescent diet). Phase II comprised a 30-day Shamanoushadhi regimen: Panchanimbadi Vati, Punarnava Mandura, Aragwadadi Kashaya, Khadirarishta, and topical Jatyadi Gritha, with Kapha-Pitta pacifying diet and occupational counseling (irritant avoidance, sun protection). Primary outcome was change in HECSI from baseline to Day 15 and Day 30. Secondary outcomes included changes in symptoms grades (itching, oozing, vesiculation, dryness, discoloration), tolerability, and functional recovery (sleep, daily activities). Results –HECSI decreased from 87 (severe) at baseline to 28 (moderate) at Day15 and to 2 (almost clear) at Day 30, corresponding to a 98.4% reduction. Symptom resolution was complete for itching, oozing, and vesicles by Day 30, with marked improvement in dryness and discoloration. The regimen was well tolerated: purgation was uneventful (no dehydration, syncope, or cramps), no adverse events were recorded, adherence exceeded 90%, and sleep and daily functioning improved notably by the second week. Conclusion – A sequential Ayurvedic approach-initial Koshta Shodhana to address Kapha-Pitta predominance and subsequent Shamanoushadhi for anti-inflammatory, antimicrobial, and Ropana (healing) support- was associated with rapid and substantial improvement in chronic Vicharchika, quantified by large HECSI reductions and full resolution of key symptoms, with excellent tolerability. These findings support feasibility and justify prospective controlled studies to confirm effectiveness, durability of remission, and generalizability across CHE subtypes and occupational exposures.