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, generally accompanied by painful sores – particularly in mouth and genital areas. This situation is extra frequent in center aged individuals. It might resolve in a couple of months but additionally does recur.
Associated Studying – ‘Lichen Planus – causes, signs, prevention, remedy modalities’
Lichen Planus: Ayurveda Understanding
There is no such thing as a one specific situation which might be straight in contrast with lichen planus. However we are going to attempt to perceive this situation by way of 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 attributable to vitiation of kapha or mixed vitiation of kapha and vata. Ache related to lichen planus is attributable to vitiated vata.
Kushta is a situation which encompasses many pores and skin circumstances / ailments beneath its umbrella. All sorts of Kushtas are mentioned to be ‘tridoshaja’ i.e. attributable to vitiation of all three doshas, with predominance of a number of doshas.
Being an inflammatory situation, lichen situation is initially attributable to 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 going down in any illness. Bumps could also be fashioned attributable to involvement of all three doshas, with vata inflicting dryness of kapha on the backdrop of irritation attributable to pitta.
2. Dhatu Relation
4 different elements aside 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 also be thought of as dhatu attributable to 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 beneath ‘kushta’.
The under talked about sorts of kushta might be thought of in shut correlation with lichen planus.
a. Alasaka Kushta
It’s a kind of kshudra kushta – minor pores and skin illness which presents with boils or eruptions (patches) that are itchy and with reddish coloration across the boils. It’s attributable to joint vitiation of vata and kapha.
b. Udumbara or Audumbara Kushta
It’s a kind of Maha Kushta – higher 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 attributable to predominant vitiation of pitta.
c. Mandala Kushta
It is usually a sort of Maha Kushta – higher pores and skin illness. The patche / lesions are within the type of a round raised patch that are white or pink in coloration. 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 coloration within the periphery and pink within the middle, elevated from the floor of the pores and skin and related to burning sensation. It’s attributable to mixed vitiation of kapha and pitta.
e. Pama Kushta
It’s a kind of Kshudra Kushta – minor pores and skin illness attributable to predominant vitiation of pitta and kapha. It’s offered with itchy boils of white, golden yellow or blackish brown coloration.
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 web site of manifestation in a single or two circumstances. However we will perceive these unrevealed and unexplained elements by way of 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 mass and watery elements 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 might be understood as being attributable to vitiated / aggravated blood or an infection passing by way of 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 under talked about might be thought of 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 way in which for manifestation of this situation. Other than meals and actions which may 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 also trigger stress and tensions in an individual – attributable to 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 in addition that stress is a crucial trigger or set off for lichen planus.
In accordance 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 ailments affecting the semen and male reproductive system, significantly sperms, and in addition when the artava / raja – ovum of the lady – is affected by kushta or doshas inflicting the illness, the kid born to those couple may also endure from kushta.
Allergens defined within the fashionable medication as causal for lichen planus might be thought of 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 attributable to 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 attributable to kapha and in addition attributable to kushta lodged in muscle mass. The firmness of the patches are additionally as a result of identical causes.
Painful sores of lichen planus are attributable to vata, and partly attributable to pitta and rakta and the irritation it causes. It is usually as a result of kushta situated in mamsa – muscle mass. Sores within the mouth are attributable to 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 prompted attributable to vitiated pitta or rakta.
Darkish traces 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 mentioned 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 mass’. When these happen on the scalp, they could injury 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 coloration 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, might be taken as white patches (which appear to be pus), karkashyam – which implies 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 additionally be prompted as a result of involvement of vitiated kapha – kapha predominance in lichen planus. Tongue and oral cavity is among the important 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 will not be 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 remedy ideas
Nidana Parivarjana – Avoidance of causative elements is the primary 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 averted.Â
Kushta Chikitsa – Lichen planus shall be handled on the traces of ‘Kushta Chiktsa’ – remedy ideas of treating pores and skin problems together with medicines, therapies, dietary and life-style modifications.
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 don’t seem to be solely healing but additionally are preventive. They successfully treatment the situation and relieve the signs and in addition would stop the recurrence of the illness.
Exterior therapies – ought to be completed on the ideas laid in kushta and vatarakta remedy. 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 ought to 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 necessary components of interventions.
Daiva Vyapashraya Chikitsa – Divine and perception therapies are additionally necessary inclusions within the remedy of Lichen Planus due to the idiopathic element concerned within the causation of the illness.
Different ideas
–    Krimi Chikitsa – to search out out if microorganisms are concerned and deal with them
–    Doshika Chikitsa – to search out out the primary 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 aim
Additionally,
Each aspiring mother and father ought to 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
