The
present clinical study entitled “Efficacy of Panchashirisha
Agada and Vishaghna Lepa in the Management of Vicharchika w.s.r
to Eczema - A Single arm Open-Labelled clinical trial was planned under the
following sections.
1. Introduction:
Vicharchika has been described under Kshudra Kustha, is a
common skin disease described as Kapha pradhan
Tridoshaja Vyadhi characterized by Kandu, Pidaka, Shyavata, Daha, Rukshata, Vedana which
is similar to the Eczema in modern science. Disease have nature of recurrence
which leads to significant morbidity & emotional stress which requires a
effective and safer management so Ayurveda offers a holistic approach towards
the disease Panchashirisha Agada a classical Ayurvedic formulation mentioned in various
classical texts, which is used as Sarvavishahara
drug and Vishaghna Lepa having Shirisha
& Sindhuwara is also used as
Sarvavishaghna, but the both the drugs having properties such as Kandughna, Kushthaghna, Twakdoshahara,
Varnya, Vishaghna, these formulations comprises
multiple constituents with documented pharmacological activities, including
anti-allergic, anti-inflammatory, immunomodulatory, antioxidant and
anti-histaminic properties.
The present clinical study aimed to evaluate
the the
clinical efficacy of Panchashirisha Agada
administered internally along
with external application of Vishaghna Lepa in the management of Vicharchika (eczema) and
to perform analytical profile of Panchashirisha Agada & Vishaghna
Lepa.
2. Pharmacognostical
Study
This study was carried out to verify the authentication of the both the
trial drugs to validate its quality standards. The evaluation was carried out
by studying the organoleptic parameters & microscopic characters of
prepared formulations, Panchashirisha
Agada Vati & Vishaghna Lepa
at the Pharmacognostic Laboratory of ITRA, Jamanagar. Organoleptic evaluation
revealed a Greyish-Black colour, Smooth texture & Characteristic Rasa and Gandha of Panchashirisha
Agada & Brownish-Black colour, Smooth to touch Characteristic Gandha of Vishaghna Lepa. Microscopic Evaluation revealed diagnostic elements
of both the drugs Shirisha & Sindhuwara like Stone cells, Rhomboidal
crystal, Scleroids, Trichome, Crystal Fiber, Cork cell, Starch grains.
3. Pharmaceutical Study:
In the present clinical trial both
the Formulation was prepared at the Pharmacy of ITRA, Jamnagar as per the SOP.
Physicochemical evaluation done at the pharmaceutical Laboratory of ITRA,
Jamnagar, Loss on Drying of Panchashirisha
Agada Vati was 12.80% & Vishaghna
Lepa was 20.48% which indicates lower
microbial contamination. Ash value of Panchashirisha
Agada Vati was 30% & Vishaghna
Lepa was 18% which exhibited amount
of inorganic residue left over after burning. The normal extractive value of
both the drugs suggesting moderate presence of water in both the formulations. Panchashirisha
Agada Vati having 8 pH value and
Vishaghna Lepa having pH value of 6 which is mildly alkaline in nature. The
Hardness of Vati was 5.01 kg/cm2 indicating good mechanical
resistance while handling or shipping and Deviation of vati were less than 5% proves uniformity of weight. These values
are taken as standard for further studies of both the formulation as there is
no standard available in API .
4.
Microbiological Study
Microbiological
evaluation was carried out to assess the stability and safety of both
formulations with respect to microbial and fungal contamination over different
time intervals and environmental conditions. Samples of Panchashirisha Agada Vati & Vishaghna Lepa were tested for 10
months under different climatic conditions. All samples showed no microbial
growth except one sample of Panchashirisha
Agada Vati, which showed mild growth of Escherichia coli due to high
humidity and suboptimal storage. This isolated finding emphasizes the need for
airtight storage and maintenance of low humidity, both the trial drugs remained
microbiologically stable throughout the storage period and also demonstrated
that the manufacturing process was sterile.
5. Clinical
Study
An open-labelled,
Single-arm interventional clinical trial was conducted on 30 patients which
were diagnosed with Vicharchika (eczema) at the OPD of Agad Tantra
department, ITRA, Jamnagar, aged between 18 to 60 years. Ethical
approval was obtained from the Institutional Ethics Committee (IEC No:
PGT/7/A/Ethics/2023-24/2958), and the study was registered under the Clinical
Trial Registry of India (CTRI/2024/04/064950).
A total 32 patients
fulfilling the inclusion criteria were registered, of which two patients were
dropped out during the study. Detailed documentation regarding demographic
data, Subjective & Objective parameters done using specific research
proforma. The assessment was done before & after the treatment and follow up.
6. Observation
The majority of patients (34.38%) were between 31–40 years of
age, followed by 28.13% in the 41–50 age group. Males (53.13%) slightly outnumbered
females (46.88%). Most of the patients were Hindus (84.38%), married (90.63%),
and educated up to higher secondary level (46.87%). Occupationally, housewives
are at highest numbers (43.75%), followed by laborers (28.12%).
Socioeconomically, 59.3% of patients belonged to the middle class, and 34.4%
were from the lower middle class. A majority of patients resided in semi-urban
(46.87%) and urban (43.75%) areas.
Clinically, all patients presented with Kandu (itching), Shyavata
(discoloration), and Rukshata
(dryness), each seen in 100% of cases. Daha
(burning sensation) was observed in 53.12% of patients, while Pidaka (eruption) and Vedana (pain) were found in 37.5% each.
Most patients (96.87%) reported a gradual onset of the disease, and only 12.5% had
a positive family history. Regarding previous treatments, 62.5% had taken
allopathic therapy, 6.25% Ayurvedic Shamana
Chikitsa, and 3.12% Shodhana Chikitsa. A majority (68.75%) was vegetarians and 84.37% preferred
home-cooked food. Assessment of Agni
showed 31.25% patients with Mandagni
and 28.12% with Vishamagni. Tea
consumption was the most common addiction (71.87%). Regular bowel habits were
observed in 78.12% of patients and 90.62% had normal sleep patterns.
Emotionally, 59.37% were normal, 37.5% anxious, and 9.37% tense. Most patients
(56.25%) had normal BMI, and 21.87% were obese. Pitta-Kaphaja Prakriti (56.25%) predominated among
patients, followed by Vata-Pittaja.
In lesion characteristics, localized lesions (84.38%) were most common,
followed by single (68.75%) and bilateral (59.38%) types. Lesions were highly
distributed on the lower limbs (56.25%), followed by upper limbs (21.88%) and
abdomen (15.63%). The majority of lesions had diffuse borders (90.62%) and were
hyper pigmented in 59.37% of patients. Scaling lesions (46.88%) were most
common, followed by papular (31.25%) and plaque lesions (25%).
7. Result:
Therapeutic evaluation showed highly significant results. Subjective
symptoms such as Kandu, Rukshata,
Shyavata, Daha, Vedana, and Pidaka
showed marked reduction, with percentage improvement ranging from 58.33% to
82.86%. Daha and Vedana showed the highest relief (above 80%). Objective parameters
also revealed significant improvement—Number of patches reduced by 45.27%, and
Area of patches decreased by 93.07%. The EASI score showed a 44.54% reduction,
indicating significant recovery in disease severity. Hematological analysis
showed a notable reduction in TLC (13.05%), monocytes (10.72%), and ESR
(24.85%), reflecting anti-inflammatory activity, while other parameters like Hb
and RBC remained stable, indicating safety of the formulation.
Overall effect of
therapy: Overall, 60% of patients showed marked improvement, 23.3% had
moderate improvement, and 16.7% achieved complete remission. No patient experienced
adverse drug reactions or recurrence within one month of follow-up. The study
concluded that the combined use of Panchashirisha
Agada and Vishaghna Lepa was
effective and safe in the management of Vicharchika
(eczema), providing significant symptomatic relief and clinical improvement
without any side effects.
8.
Discussion
In this research, the drugs were standardized through various
parameters, including pharmacognostical, pharmaceutical, and analytical
evaluations. The clinical aspect of the study, along with its observations and
results, was carefully analyzed and interpreted using scientific reasoning.
9.
Conclusion
The conclusions were derived based on the observations and
outcomes presented in the earlier sections. This part summarizes the overall
findings of the study. Collectively, the insights gained from the literature
review, pharmacognosy study, analytical study, clinical evaluation, and
discussion contributed to drawing the final conclusions.