Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Lichen Planus
It’s a persistent inflammatory situation which impacts the pores and skin. It additionally impacts the arms, legs, scalp, oral mucosa, nails and genitals. It presents as purple and flat elevated lesions on the pores and skin that are intensely itchy. The lesions are also known as bumps. They usually develop over a number of weeks.
They current as lacy white patches, generally accompanied by painful sores – particularly in mouth and genital areas. This situation is extra frequent in center aged individuals. It could resolve in a couple of months but additionally does recur.
Associated Studying – ‘Lichen Planus – causes, signs, prevention, therapy modalities’
Lichen Planus: Ayurveda Understanding
There isn’t a one explicit situation which will be immediately in contrast with lichen planus. However we’ll attempt to perceive this situation by the lens of Ayurveda.
1. Dosha Relation
Lichen Planus is a persistent inflammatory situation. Due to this fact, involvement of pitta on this situation is inevitable. Extreme itching discovered on this situation is both as a consequence of vitiation of kapha or mixed vitiation of kapha and vata. Ache related to lichen planus is brought on by vitiated vata.
Kushta is a situation which encompasses many pores and skin circumstances / illnesses underneath its umbrella. All forms of Kushtas are stated to be ‘tridoshaja’ i.e. brought on by vitiation of all three doshas, with predominance of a number of doshas.
Being an inflammatory situation, lichen situation is initially brought on by pitta. Itching is extreme on this situation and therefore kapha will get related and established in later time. Pitta can also trigger itching related to ama or kapha. Ama can also be concerned in inflammatory processes happening in any illness. Bumps could also be fashioned as a consequence of involvement of all three doshas, with vata inflicting dryness of kapha on the backdrop of irritation brought on by pitta.
2. Dhatu Relation
4 different parts apart from the three doshas have been talked about within the pathogenesis of kushta. They’re twak – pores and skin, rakta – blood, mamsa – muscle and ambu – watery parts of the physique.
Amongst these, the pores and skin is an abode of rasa dhatu. Rakta and mamsa are additionally dhatus. So, these three are the dhatus concerned. Ambu or Ap can also be thought-about as dhatu as a consequence of its supportive function.
3. Kushta and Lichen Planus
Since lichen planus is manifested on the pores and skin and is a pores and skin situation, it may be grossly included underneath ‘kushta’.
The under talked about forms of kushta will be thought-about in shut correlation with lichen planus.
a. Alasaka Kushta
It’s a sort of kshudra kushta – minor pores and skin illness which presents with boils or eruptions (patches) that are itchy and with reddish shade across the boils. It’s brought on by joint vitiation of vata and kapha.
b. Udumbara or Audumbara Kushta
It’s a sort of Maha Kushta – larger pores and skin illness. The patches / lesions on this situation appear as if a ripe fruit of Udumbara (Ficus racemosa). There are golden yellow-colored hairs across the patch. There’s reddish discoloration and this situation is related to itching, ache and burning sensation. It’s brought on by predominant vitiation of pitta.
c. Mandala Kushta
It is usually a kind of Maha Kushta – larger pores and skin illness. The patche / lesions are within the type of a round raised patch that are white or pink in shade. They’re stiff, elevated and unmovable, round in form and mingled with each other. There’s a feeling of heaviness across the patches.
d. Pundareeka Kushta
That is additionally a kind of Maha Kushta. The patches / lesions resemble the petals of a pink number of lotus flower (pundareeka dala), white in shade within the periphery and pink within the heart, elevated from the floor of the pores and skin and related to burning sensation. It’s brought on by mixed vitiation of kapha and pitta.
e. Pama Kushta
It’s a sort of Kshudra Kushta – minor pores and skin illness brought on by predominant vitiation of pitta and kapha. It’s introduced with itchy boils of white, golden yellow or blackish brown shade.
4. Locations of manifestation of lichen planus vs doshas and dhatus
Specific areas of manifestation of lichen planus have been talked about as occurring within the arms, legs, genitals and so forth. the identical has not been talked about in case of forms of Kushta talked about above, although we are able to discover specification relating to web site of manifestation in a single or two circumstances. However we are able to perceive these unrevealed and unexplained elements by inference.
The three doshas are concerned within the causation of kushta. So, it’s apparent that kushta can happen in anywhere the place these three doshas lodge when vitiated. Pores and skin, blood, muscular tissues and watery parts are the primary tissues concerned. So, these tissues are invariably concerned, which incorporates the pores and skin of arms, legs, scalp, round nails and genitalia.
The reason of dhatugata kushta factors out in direction of all of the tissues of the physique concerned within the illness, when the illness goes deeper into the tissues. Irritation of pores and skin of limbs, oral mucosa, genitals and nails in lichen planus will be understood as being brought on by vitiated / aggravated blood or an infection passing by blood – and generally is a case of raktagata kushta or pittaja kushta.
5. From the angle of Causative Components
The causative elements talked about for the under talked about will be thought-about as causative for lichen planus additionally –
– Causes talked about for Kushta
– Causes talked about for contamination / vitiation of Rasavaha, Raktavaha and Mamsavaha Srotas
– Causes talked about for collective dosha imbalance
Immune part is alleged to be concerned in causation of Lichen Planus. When the etiological elements talked about for Kushta are collectively consumed or uncovered to, the immunity will certainly be compromised and can pave the way in which for manifestation of this situation. Aside from meals and actions which could be causal or triggers for kushta, Ayurveda has additionally talked about some unseen elements like papa karma – doing sins, insulting Brahmins, lecturers and so forth. The identical may trigger stress and tensions in an individual – as a consequence of guilt or curse. Trendy medication too has talked about that lichen planus is an idiopathic situation whereby the causes of the illness are clearly unknown and likewise that stress is a crucial trigger or set off for lichen planus.
In line with trendy medication, there’s a genetic part to this illness. In Shukragata Kushta i.e. when the pores and skin illness or doshas inflicting pores and skin illnesses affecting the semen and male reproductive system, significantly sperms, and likewise when the artava / raja – ovum of the lady – is affected by kushta or doshas inflicting the illness, the kid born to those couple can even endure from kushta.
Allergens defined within the trendy medication as causal for lichen planus will be thought-about much like the reason of virodhini anna panani i.e. mutually incompatible and antagonistic meals, and extreme consumption of meals like navanna – new paddy, dadhi – curds, Matsya – fish, lavana – salt, amla – bitter meals, masha – black gram, mulaka – radish, pishtanna – dishes ready with flour, tila – sesame, kshira – milk merchandise and guda – jaggery talked about amongst the checklist of etiological elements of kushta.
Viral infections are talked about as causal of lichen planus. Although not precisely a virus, the involvement of microorganisms has been highlighted in Kushta. Kshateshu krimi sambhavaha – formation of microorganisms within the wounds or lesions has been talked about amongst the signs of asthi majjagata kushta – kushta lodged in deeper tissues like bones and bone marrow. Kushta whereby krimi have developed, is brought on by tridoshas and related to different problems is alleged to have a nasty prognosis and is incurable.
6. Evaluation of signs of lichen planus in relation to doshas and dhatus
Elevated lesions or bumps of lichen planus are as a consequence of kapha and likewise as a consequence of kushta lodged in muscular tissues. The firmness of the patches are additionally as a result of identical causes.
Painful sores of lichen planus are as a consequence of vata, and partly as a consequence of pitta and rakta and the irritation it causes. It is usually as a result of kushta situated in mamsa – muscular tissues. Sores within the mouth are as a consequence of vitiated pitta or rakta.
Redness and painful sores occurring in genitals is because of contamination of shukra dhatu by doshas or lodgment of kushta in shukra dhatu (shukragata kushta). Shepha – penis is among the roots of channels conveying shukra dhatu within the physique. So, when shukra will get contaminated by doshas or troubled by kushta, the penis too will get affected. These sores are additionally induced as a consequence of vitiated pitta or rakta.
Darkish strains on the nails and loss or scarring of nails is as a result of asthi dhatu – bones being affected by kushta or when the illness is rooted within the bones. It is because nakha i.e. nails are stated to be the mala – excreta or waste product of the bone tissue.
Pidakodgama and Sphota – i.e. manifestation of tiny eruptions or bumps has been talked about among the many signs of ‘kushta lodged in mamsa dhatu – i.e. muscular tissues’. When these happen on the scalp, they could injury the hairs, skinny them out and likewise trigger their fall or loss, as they characteristically happen in lichen planus.
Residual hyperpigmentation which is a symptom or complication of lichen planus seems much like Vaivarnya talked about in Twak gata kushta – kushta lodged within the pores and skin (rasa tissue) and Shyava Aruna Varna – blackish brown or yellowish brown / crimson shade in vataja kushta or raga – reddish coloration in pittaja kushta.
Additionally
Something resembling lacy white patches on the tongue or within cheeks has not been talked about within the context of kushta and its subtypes. However vipuya – which truly means pus assortment, will be taken as white patches (which seem like pus), karkashyam – which suggests roughness – lacy patches of lichen planus and vaktra shosha which truly means dryness within the oral cavity – involvement of mouth and tongue have been talked about within the context of raktagata kushta. The identical may be induced as a result of involvement of vitiated kapha – kapha predominance in lichen planus. Tongue and oral cavity is among the essential seats of bodhaka kapha.
Itching in lichen planus factors in direction of kapha predominant kushta or kapha predominance within the illness. Affiliation of pitta and vata isn’t dominated out. Itching can also be one of many signs of raktagata kushta. This factors in direction of the vitiation of blood, unfold of an infection and function of vitiated blood in inflicting the inflammatory reactions in lichen planus.
Lichen Planus: Ayurveda therapy rules
Nidana Parivarjana – Avoidance of causative elements is the primary precept to forestall the illness from manifesting, for treatment of current illness and to forestall triggering of the present signs. All of the etiological elements talked about within the context of ‘Kushta Nidana’ shall be stored away. Equally, the causative elements of tridosha aggravation, vitiation of rasavaha, raktavaha, mamsavaha srotas shall be prevented.
Kushta Chikitsa – Lichen planus shall be handled on the strains of ‘Kushta Chiktsa’ – therapy rules of treating pores and skin issues together with medicines, therapies, dietary and life-style adjustments.
Panchakarma Therapies – Relying on the dosha predominance in Lichen Planus, Vamana in kapha / kapha-pitta predominance and Virechana in pitta / pitta-vata predominance are ultimate therapies. They aren’t solely healing but additionally are preventive. They successfully treatment the situation and relieve the signs and likewise would stop the recurrence of the illness.
Exterior therapies – needs to be executed on the rules laid in kushta and vatarakta therapy. This primarily contains lepa – software of medicinal pastes and parisheka / dhara – showering or sprinkling medicated liquids like Taila (oils), Kashaya (decoctions) and Ksheera (medicated milk).
Rasayana – Rasayana remedy needs to be deliberate for enhancing the general and pores and skin immunity and likewise to forestall the recurrences of the illness.
Sattvavajaya Chikitsa – Psychotherapy and counseling are vital components of interventions.
Daiva Vyapashraya Chikitsa – Divine and perception therapies are additionally vital inclusions within the therapy of Lichen Planus due to the idiopathic part concerned within the causation of the illness.
Different rules
– Krimi Chikitsa – to seek out out if microorganisms are concerned and tackle them
– Doshika Chikitsa – to seek out out the primary concerned dosha and administering dosha particular medicines and interventions, particularly if the illness can’t be identified or the illness named
– Visha Chikitsa – treating the situation contemplating that toxins are collected within the physique, although shodhana / panchakarma additionally helps in attaining this purpose
Additionally,
Each aspiring mother and father needs to be administered with shodhana therapies adopted by Rasayana in order that they’ll get ready to carry a wholesome child into the world, particularly if there’s a household historical past of lichen planus in both facet of the households.
Helpful medicines for Lichen Planus
– Tiktakam Kshayam / Ghritam
– Mahatiktaka Kashayam / Ghritam
– Patoladi Kashayam / Ghritam
– Patolakaturohinyadi Kashayam
– Mahamanjishtadi Kashayam
– Aragwadhadi Kashayam
– Khadirarishtam
– Aragwadarishtam
– Gandhaka Rasayanam
– Trivrit Lehyam
– Arogyavardhini Ras
