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 sometimes called bumps. They typically develop over a number of weeks.
They current as lacy white patches, typically accompanied by painful sores – particularly in mouth and genital areas. This situation is extra widespread in center aged individuals. It could resolve in just a few months but in addition does recur.
Associated Studying – ‘Lichen Planus – causes, signs, prevention, therapy modalities’
Lichen Planus: Ayurveda Understanding
There isn’t a one explicit situation which could be immediately in contrast with lichen planus. However we are going to attempt to perceive this situation via the lens of Ayurveda.
1. Dosha Relation
Lichen Planus is a persistent inflammatory situation. Subsequently, involvement of pitta on this situation is inevitable. Extreme itching discovered on this situation is both as a result 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 situations / illnesses beneath its umbrella. All sorts 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 be concerned in inflammatory processes going down in any illness. Bumps could also be shaped as a result 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 elements 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 elements 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 be thought-about as dhatu as a result of its supportive position.
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 beneath ‘kushta’.
The beneath talked about sorts of kushta could 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 colour 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 seem like 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’s also a sort 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 colour. 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 sort of Maha Kushta. The patches / lesions resemble the petals of a pink number of lotus flower (pundareeka dala), white in colour 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 colour.
4. Locations of manifestation of lichen planus vs doshas and dhatus
Explicit 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 sorts of Kushta talked about above, although we will discover specification relating to website of manifestation in a single or two instances. However we will perceive these unrevealed and unexplained features via 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, muscle tissues and watery elements are the principle 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 the 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 could be understood as being brought on by vitiated / aggravated blood or an infection passing via blood – and could be a case of raktagata kushta or pittaja kushta.
5. From the angle of Causative Elements
The causative elements talked about for the beneath talked about could 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 element 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 best way 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 also can trigger stress and tensions in an individual – as a result of guilt or curse. Fashionable medication too has talked about that lichen planus is an idiopathic situation whereby the causes of the illness are clearly unknown and in addition that stress is a vital trigger or set off for lichen planus.
In line with fashionable medication, there’s a genetic element 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, notably sperms, and in addition when the artava / raja – ovum of the girl – is affected by kushta or doshas inflicting the illness, the kid born to those couple can even undergo from kushta.
Allergens defined within the fashionable medication as causal for lichen planus could 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 record 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 foul 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 result of kapha and in addition as a result of kushta lodged in muscle tissues. The firmness of the patches are additionally because of the similar causes.
Painful sores of lichen planus are as a result of vata, and partly as a result of pitta and rakta and the irritation it causes. It’s also because of the kushta positioned in mamsa – muscle tissues. Sores within the mouth are as a result 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 by kushta, the penis too will get affected. These sores are additionally brought about as a result of vitiated pitta or rakta.
Darkish traces on the nails and loss or scarring of nails is because of the asthi dhatu – bones being affected by kushta or when the illness is rooted within the bones. It’s 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. muscle tissues’. When these happen on the scalp, they might harm the hairs, skinny them out and in addition 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 colour in vataja kushta or raga – reddish coloration in pittaja kushta.
Additionally
Something resembling lacy white patches on the tongue or inside cheeks has not been talked about within the context of kushta and its subtypes. However vipuya – which really means pus assortment, could be taken as white patches (which seem like pus), karkashyam – which suggests roughness – lacy patches of lichen planus and vaktra shosha which really means dryness within the oral cavity – involvement of mouth and tongue have been talked about within the context of raktagata kushta. The identical may additionally be brought about because of the involvement of vitiated kapha – kapha predominance in lichen planus. Tongue and oral cavity is among the fundamental seats of bodhaka kapha.
Itching in lichen planus factors in the direction of kapha predominant kushta or kapha predominance within the illness. Affiliation of pitta and vata will not be dominated out. Itching can be one of many signs of raktagata kushta. This factors in the direction of the vitiation of blood, unfold of an infection and position of vitiated blood in inflicting the inflammatory reactions in lichen planus.
Lichen Planus: Ayurveda therapy rules
Nidana Parivarjana – Avoidance of causative elements is the principle precept to stop the illness from manifesting, for treatment of current illness and to stop triggering of the prevailing 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.Â
Kushta Chikitsa – Lichen planus shall be handled on the traces of ‘Kushta Chiktsa’ – therapy rules of treating pores and skin problems 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 supreme therapies. They aren’t solely healing but in addition are preventive. They successfully treatment the situation and relieve the signs and in addition would stop the recurrence of the illness.
Exterior therapies – must be completed 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 must be deliberate for enhancing the general and pores and skin immunity and in addition to stop the recurrences of the illness.
Sattvavajaya Chikitsa – Psychotherapy and counseling are essential components of interventions.
Daiva Vyapashraya Chikitsa – Divine and perception therapies are additionally essential inclusions within the therapy of Lichen Planus due to the idiopathic element concerned within the causation of the illness.
Different rules
–    Krimi Chikitsa – to seek out out if microorganisms are concerned and handle them
–    Doshika Chikitsa – to seek out out the principle concerned dosha and administering dosha particular medicines and interventions, particularly if the illness can’t be recognized or the illness named
–    Visha Chikitsa – treating the situation contemplating that toxins are gathered within the physique, although shodhana / panchakarma additionally helps in reaching this purpose
Additionally,
Each aspiring dad and mom must be administered with shodhana therapies adopted by Rasayana in order that they’ll get ready to convey 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
