Role of Raktamokshana in The Integrated Ayurvedic Management of Vicharchika: A Single Case Report

Abstract

Vicharchika is described under Kṣudra Kuṣṭha in Ayurveda and is characterized by Kandu (severe itching), Pidika (lesions), Shyava Varṇa (hyperpigmentation), Rukṣhata (dryness), Bahusrava ( discharge)and Tvak Sputanta ( scaling). Its clinical manifestations  resemble with chronic inflammatory skin disorders described in modern dermatology, particularly eczema. Persistent and severe itching with repeated scratching may lead to lichenification, skin thickening, roughness, and hyperpigmentation, which are characteristic features of lichen simplex chronicus. A 37-year-old female patient presented to an Ayurvedic hospital with complaints of severe itching and chronic skin changes over the ankle region for since 3 years. She had previously received treatment from AIIMS Raipur but did not obtain satisfactory relief. The patient reported aggravation of itching following the consumption of Viruddha Ahara, particularly curd with fish, sweets, excess salt, and dairy products. She also had a history of repeated use of topical  steroidal creams and ointments. Persistent itching and repeated scratching were associated with progressive hyperpigmentation, roughness, and thickening of the affected skin. Clinical examination revealed severe itching, dryness, scaling, hyperpigmentation, roughness, and thickening of the affected skin. The clinical presentation was suggestive of chronic eczema with lichenification/lichen simplex chronicus, with an Ayurvedic correlation to Vicharchika. The patient was managed with an Ayurvedic therapeutic approach comprising Nitya virechana  and  Raktamokshana (leech therapy), Samana Chikitsa, along with appropriate Pathya Ahara and Vihara. Following treatment, the patient showed favourable clinical improvement, particularly in severe itching and associated skin manifestations. This case suggests that an integrated Ayurvedic approach involving  without Sodhana Chikitsha, only Samana,  & Raktamokshana (leech therapy), Nitya virechan and appropriate dietary and lifestyle measures may be beneficial in the management of chronic pruritic dermatoses resembling Vicharchika.