Efficacy of virechana karma in the management of sheetapitta (urticaria) – a case report

Background : Chronic urticaria, an inflammatory disease of the skin characterized as a recurrent disease, is a closely related Tridoshaja vyadhi described in Ayurveda, with erythematous wheals, pruritus and loss of quality of life. Typical treatment is symptomatic and will have a tendency to recur. There is a limited clinical evidence for Virechana Karma, although the principle therapy for the pitta-predominant disorders as suggested by ayurveda. Case Presentation : A 21 year old male with recurrent erythematous on face, hands, and thighs for 4 years and fever, cough with expectoration, vomiting, and constipation. Allopathic/ayurvedic therapies were providing only temporary relief and recurrent attacks. Clinical condition showed sheetapitta (urticaria) condition and it was planned for classical Virechana Karma. Management and Outcomes : The patient was given Deepana–Pachana with Amapachaka Vati and then Snehapana with Panchatikta Ghrita in increasing doses and then Vishrama Kala with Sarvanga Abhyanga & Mridu Swedana followed by Virechana Karma using Trivrit Avaleha in 40 g dose with Triphala Kwatha (150 mL) in increasing dose. Then, the Samsarjana Krama and an appropriate shamana medicine was given. The treatment was well tolerated with no adverse events. The clinical evaluation showed complete resolution of erythema, itching, fever, vomiting and related symptoms, with total scores of symptoms improving from 8 before treatment to 0 after treatment. There was no recurrence noted during follow up. Conclusions: This case illustrates how classical Virechana Karma, when applied based on the Ayurvedic principles could be a safe and effective management for recurrent Sheetapitta (urticaria) with sustained symptomatic remission. These findings are encouraging, but more controlled clinical studies are needed to confirm these results.