E-ISSN:2456-3110

Case Report

Amapachana

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 8 August
Publisherwww.maharshicharaka.in

Amapachana - A Boon to Long Standing Adversely Affected Corticosteroid Resistant Urticaria: A Case Report

Benakanahalli B1*, Chandrika Urs P2, Prasad M3, Patil AK4
DOI:10.21760/jaims.10.8.51

1* Bhuvaneshwari Benakanahalli, Post Graduate Scholar, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Chandrika Urs P, Assistant Professor, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Mrudulaa Prasad, Post Graduate Scholar, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

4 Abhijit Kumar Patil, Post Graduate Scholar, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Urticaria, commonly known as hives, is a distressing skin condition characterized by the sudden appearance of itchy, raised wheals on the skin. While it may seem like a minor issue to some, Urticaria can have a profoundly debilitating impact on an individual's quality of life. The present case of Urticaria was treated with administration of synthetic corticosteroids for 1 year, gradually patient noticed increased body weight, impairment in metabolism with constipation, disturbed sleep, anxiety with temporary reduction of Urticarial symptoms only during administration of medication. On withdrawal symptoms used to reoccur with much more severity. on examination the case was found with predominance of Vata and Kapha Dosha with the presenting complaints of Kandu (itching), Rukshata (dryness), Varati Dastha Samsthan Shotha (Erythamatous reddish wheals all over body) and Utsedha (skin thickening). The approach was done with Amapachana for first 15 days followed by classical Vamana Karma (therapeutic emesis therapy) with internal administration of Patola Katurohinyadi Kashaya, Avipattikara Churna and Dooshivishari Gulika along with complete withdrawal of synthetic corticosteroids. Significant results were found during the Amapachana stage itself with noticeable reduction in body weight and improvement in metabolism, recurrence of symptoms were also negligeable followed by Vamana Karma even after withdrawal of synthetic steroids. The overall quality of life physically, mentally and socially has improved satisfactorily. Considering these satisfactory results in the present case; similar strategies can be adopted in suitable cases of Urticaria in large sample size to generate evidences and disseminate usefulness of traditional interventions in the management of Urticaria.

Keywords: Amapachana, Corticosteroids, Metabolism, Quality of Life, Urticaria

Corresponding Author How to Cite this Article To Browse
Bhuvaneshwari Benakanahalli, Post Graduate Scholar, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Benakanahalli B, Chandrika Urs P, Prasad M, Patil AK, Amapachana - A Boon to Long Standing Adversely Affected Corticosteroid Resistant Urticaria: A Case Report. J Ayu Int Med Sci. 2025;10(8):306-310.
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https://jaims.in/jaims/article/view/4577/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-06-15 2025-06-27 2025-07-07 2025-07-17 2025-07-27
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© 2025 by Benakanahalli B, Chandrika Urs P, Prasad M, Patil AK and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2025;10(8)306
Download PDFBack To ArticleIntroductionCase ReportObservations and ResultsDiscussionConclusionReferences
Bhuvaneshwari B et al. Long Standing Adversely Affected Corticosteroid Resistant Urticaria

Introduction

Urticaria is skin disease that is caused by exposure to dust, allergens, cold climate & wind. People with Urticaria may develop Erythematous skin rashes. Though Urticaria is not life threatening, it causes significant concern for patients due to its appearance, severe itching that disrupts daily routines & its potential to become chronic. It affects 20% of People at some point in their lives & in some cases, condition can be mild or recurrent, frustrating for both Patient & Physician.[1]

Case Report

History of present illness

An Auto driver aged about 37 years visited OPD with history of Erythematous reddish wheals all over body, itching, burning sensation, lethargy, heaviness of whole body associated with disturbed sleep, pain in heel region, unable to stand for longer period since 9 months. He was very anxious about his health condition which has affecting his work efficiency severely. Symptoms used to aggravate during evening, night hours and exposure to cold climate.

Approached nearby Dermatologist, was advised with anti-allergic and steroidal medications. Patient started noticing increase in body of about 10kgs in span of 9months along with disturbed sleep, excessive sweating, bloating of abdomen, altered digestion patterns. Later he himself discontinued medications and approached Ayurveda line of treatment.

Family History - no any family member is suffered with same illness

Personal History - The registered patient is non-vegetarian, reported a decreased appetite, regular bowel movements, normal micturition, and disturbed sleep.

General examination

Ahara - Mixed diet
Vihara - Shram Jeevi
Vyasana - Tea 2 time / day
Nidra - Disturbed
Appetite - Anorexia
Bowel - Regular (once a day)
Micturition - Normal (3-4 times a day)

Samprapti Ghataka

Dosha - Vata, Kapha
Dushya - Twak, Rakta
Agni - Jatharagni
Aama - Jatharagni Mandya Janya Aama
Srotas - Rasavaha, Rakthavaha
Srotodusti - Vimargagamana
Udhbava Sthana - Amashaya
Vyaktha Sthana - Twak
Vyadhi Swabhava – Ashukari

Asthavidha Pariksha[2]

Nadi - 78/Min
Mala - Prakruta
Mutra - Prakruta
Jivha - Lipta
Shabda - Prakruta
Sparsha - Alpa ushna
Druk - Prakruta
Akruti – Madhyam

Dashavidha Pariksha[3]

Prakruthi - Vata-Kapha
Vikruthi - Vata-Kapha
Sara - Madhyama
Samhanana - Madhyama
Satmya - Sarvarasa Satmya
Satva - Madhyama
Ahara Shakti -

  Abhyavaranashakti - Madhyama
  Jaranashakti - Madhyama

Vyayama Shakti - Madhyama
Vaya - Madhyama
Bala - Madhyama

Treatment Schedule

TreatmentDrug of choiceDurationDate
Amapachana1. Avipattikara Churna (5gms at night B/F)
2. Patola Katurohinyadhi Kashaya (15ml - 0 - 15ml with equal quantity of water B/F)
3. Dooshivishari Gulika (2-0-2 A/F)		15 days15/4/2024 -30/4/2024
SnehapanaGuggulu Tiktaka Ghrita (started with dose of 50 ml & increased to 200 ml)3days30/04/24 - 2/05/24
Sarvanga Abhyanga f/b Bhaspa SwedaMarichadi Taila2days3/05/24 - 4/05/24
Vamana KarmaSnigdha Yavagu
Akantapana Milk
Yastimadhu Phanta
Saindhava Jala		1day4/05/2024

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Bhuvaneshwari B et al. Long Standing Adversely Affected Corticosteroid Resistant Urticaria

Advice on discharge

1. Potalakaturohinyadi Kashaya 15ml-0-15ml
2. Dooshivishadi Gulika 1-0-1
3. Valiya Madhusnuhi Rasayana 5gm-0-5gm

Methods 

Centre of study - Private sector
Type of study - Single case study

Assessment Criteria

Urticaria Activity Score (UAS) as per Indian Journal of Dermatology

Objective criteria[4]

ScoreWheals/24hrsPruritus
0NoneNone
1Mild: < 20 wheals over 24 hrsMild present but not Troublesome
2Moderate: 20-50 wheals over 24 hrsModerate: Troublesome but doesn’t interfere with daily routine or sleep
3Severe: > 50 wheals over 24 hrs or large area of whealsSevere pruritus which is sufficiently troublesome to interfere with daily activity or sleep

Subjective Assessment

SymptomsMildModerateSevere
Kotha (Raised Erythamatous wheals of pink red colour)123
Kandu (itching)123
Toda (pricking sensation)123
Daha (burning sensation)123

UAS7 is a simple scoring system for to evaluate urticaria signs and symptoms. It is based on scoring the wheals and itch separately on a scale of 0 to 3 over 7 days. Score both the wheals and itch according to the following criteria on a daily basis.

Observations and Results

During 15 days of Amapachana, sign & symptoms like Kotha, Kandu, Toda, Daha got reduced. Patient visited Hospital for Shodhana Therapy. After Vamana Karma completely symptoms eradicated & there is no reoccurrence is seen.

SNSymptomsObserved score
Before treatmentAfter treatment
1.Kotha (Raised Erythamatous wheals of pink red colour)31
2.Kandu (itching)30
3.Toda (pricking sensation)20
4.Daha (burning sensation)20

UAS7 SCOREBefore AmapachanaAfter Amapachana (15days duration)
50

UAS7 disease activity score bands

UAS7 bandRationale
0Itch and hive free - indicative of no symptoms of CSU and considered a full treatment response
1 - 6Well-controlled urticaria - indicates a good response to treatment
7 - 15Mild urticaria - indicates also a lower response level
16 - 27Moderate activity urticaria - entry criteria for clinical trials in CSU
28 - 42Severe activity urticaria

Sign and Symptom wise Result

SymptomsBefore TreatmentAfter Treatment
Indigestion85%2%
Body weight and BMI87%
BMI - 29.8%
(overweight)		78%
BMI - 26.7%
(overweight)
Lethargy90%35%
Sleep disturbance80%5%

jaims_4577_01.JPG

Mode of Action of Drugs

Name of DrugsIngredientsProperties and Mode of Action of Drugs
Patola Katurohinyadi Kashaya [5]Patola, katurohini, Chandana, Madhusrava, Guduchi, PathaKapha Pitta Kushtha, Jwara, Vishama jwara, Arochaka, Kamala
Dooshivishari Gulika [6]Pippali, Dhyamaka, Mamsi, Lodhra, Ela, Kutannata, Nalanda, Kushtha, Yashti, Chandana, Gairika
Avipattikara Churna[7]Trikatu, Triphala, Musta, Vida Lavana, Vidanga, Ela, Patra, Lavanga, Trivrit, Sharkara
Bhai. Ratnavali 53/25-29		Amlapitta, Vibhanda, Agnimandya, Prameha
Valiya Madhusnuhi Rasayanam[8]Phalatraya, Katutraya, Trijataka, Yavani, Saindhav, Vidanga, Rasna, Bhargi, Chavya, Granthi, Dhanya, Yugma Jeeraka, Kustha, Chitraka, Ashwagandha, Madhusnuhi, Sharkara, Gogritha, Makshika, GandhakaDeepan, Ruchipradham, Vatapittaruksha, Shleshmakshaya, Pramehari, Gulmahara, Shoolahara, Sarvadhatuvardhan, Bala and Sukhpradham

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Discussion

Ama refers to the accumulation of toxins and impurities in the body causssed due to improper digestion of food. Mandagni is the root cause of reduced digestion and metabolism is understood under terms such as Jatharagni Mandya, Dhatwgni Mandya and Bhutagni Mandya.[9] Ama can manifest in various forms, including physical, mental, and emotional realms. It is often associated with feelings of Gouravata (heaviness), Alasya (lethargy), and Mandata (dullness) and can lead to a range of health problems from digestive issues to skin problems and to Chronic Diseases like Diabetes and Arthritis. Due to consumption of steroids for longer period it leads to body resistance towards that medicine and produces wide range of adverse effects like weight gain, GERD, heel pain. Mental conditions like lack of concentration in work, overthinking, over sleep etc are usually found symptoms. All these adverse effects are considered under Ama (The unresolved toxins).

Nidana Parivarjanameva Chikitsa is the main treatment focus in Ayurveda.[10] It focuses on identifying and treating the root cause, thereby reducing symptoms and preventing reoccurrence is the ideal holistic approach implemented in the present case. Under Nidana Assessment of this case, Aharaja Hetu were found to be Santarpana, Viruddha Ahara Sevana, Adhyashana, Dadhi Sevana and Viharaja Hetu found to be exposure to dust, cold wind and cold climate are strictly advised to avoid.[11]

Nidana Sevana led to Tridosha vitiation predominantly of Vata and Kapha combines with Pitta (Ushna Mandata). Prasara happened in Twacha and Raktadi Dhatu lead to symptomatology of Sheetapitta involving Shotha, Mandoltpatti.[12]

Amapachana, a fundamental concept in Ayurveda, offers a promising solution for above said condition by targeting the root cause of the condition, it involves the breakdown and elimination of Ama, which are accumulated in the body. It is done by both Shamana and Shodhana therapy followed by Pathya Sevana.[13]

Shamanoushadi are administered for duration of 15 days. In this duration the patient got nearly 85% relief in symptoms like Kandu, Kotha, Daha and some metabolism related symptoms.

After Niraama Lakshana, planned for Vamana Karma. Snehapana with Guggulu Tiktaka Grita and Shunti Jala (3 days); In Vishrama Kala, Sarvanga Abhyanga with Marichadi Taila followed by Bhaspa Sweda for a day; followed by Kaphotkleshakara Ahara Sevana. Vamana Karma done with above said medications Madhyam Shuddhi attained.

Conclusion

The relentless itching, painful lesions, and unpredictable outbreaks can lead to sleep disturbances, anxiety, depression, and social isolation. Prolonged steroid treatment, often employed to manage symptoms, can lead to a vicious cycle of dependency, resistance and adverse effects. For patients with refractory Urticaria, who have experienced little to no relief from conventional treatments, the situation can seem bleak. However, Amapachana, a fundamental concept in Ayurveda, offers a promising solution. By targeting the root cause of the condition, Amapachana has shown remarkable efficacy in alleviating symptoms, reducing steroid dependency, and restoring overall well-being. All these basic ideal theories are judiciously applied from the health professionals and followed by the health seeker in the humblest manner. Both helped to achieve good result. This ancient wisdom, backed by modern research, provides new hope for individuals struggling with corticosteroid resistant Urticaria.

References

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