INTRODUCTION: In Today's world of beauty and glamour, it is a natural tendency that every one of us is highly conscious about our skin. Skin is the most visible part of the body that reects personality of a person. Skin is the rst organ of the body interacting with the environmental agents like physical, chemical & biological agents. Variations in the environmental stimuli & natural ability of body to deal with these factors result in spontaneous remissions & relapses. Interaction with these factors results in specic reaction pattern producing characteristic skin lesions in different parts of the body. Large community prevalence studies have demonstrated that between 20-30% of the population have various skin problems requiring attention. (Davidson 18th Ed.) Skin is a mirror that reects internal & external pathology & thus helps in diagnosis of diseases. Skin complaints affects all ages from the neonates to the elderly & cause harm in a number of ways, such as discomfort, disgurement, disability, etc. Skin disorders like urticaria create physical as well as mental stress to an individual. Excessive itching sometimes becomes intolerable. Shitapitta is disorder in which vata and kapha are two doshas which are primarily disturbed due to doshprakopak hetu and in combination with pitta dosha they create swellings, redness, itching, over the skin. Vata dosha is dominant in shitapitta. If one is constantly exposed to certain qualities, the doshic balance can become disturbed and this, in turn, may disturb the digestive re (Agni), leading to poor digestion, absorption and assimilation of nutrients, and creating ama as a result. Ama can affect the tissues and cells and can clog and Obstruct channels. In the case of allergies, ama can be viewed as an antigen. When certain qualities are already in excess and more of these qualities are forced upon the organism, the immune system creates more and more antibodies to contend with the invading qualitative ama. As a result, whenever there is even the slightest exposure to the specic allergen the body responds with all its protective forces. This is what is experienced as an allergic reaction. It is the system trying to rid itself of excess ama (antigens). Shitapitta can be co-related with urticaria. Urticaria or hives is truly not one disease but reaction pattern of skin. A vascular reaction usually transient involving the upper dermis representing localized edema caused by dilatation and increase permeability of the capillaries and marked by development of wheals. It manifests as pruritic erythmatous raised rash. About 20%of people have urticaria at the same time during their lives. This condition may be caused by contact with an external irritant such as the nettle, physical agents, food, insect bites, pollens, drugs or neurogenic factors. Though lot of research work has been done in ayurveda and other pathy, still there is not satisfactory result in current sciences for shitapitta. Hence many patient of shitapitta are reported in day to day practice. So emphasis were made to nd out easy method for lowering the incidence of shitapitta by using amrutadi kwath. AIMS AND OBJECTIVES 1. To study the aetiopathogenesis & symptomatology of shitapitta w. s. r. to urticaria. 2. To assess the efcacy of Amrutadi kwath in shitapitta w. s. r. to urticaria. REVIEW OF LITERATURE: Complete description about shitapitta is obtained in Laghutrayee. In Yogatnakar- Detailed description of disease and its treatment describe under title Shitapittadi Nidana Chikitsa in its Uttara Khanda. In Bhaishjya Ratnavali- Detailed description of Chikitsa for Udarda-Shitapitta -Kotha found in bhaishajyaratnavali in chapter 55. MATERIALS AND METHODS: Amrutadi kwath described in Bhaishajya Ratnavali. Guduchi consists of dried, matured pieces of stem of Tinospora cordifolia. Nimba- Melia azadirachta Linn. Haridra- Curcuma longa Linn. Dhanvay¡sah consists of dried whole plant of Fagonia cretica Linn. Honey. SELECTION CRITERIA OF PATIENT : Patient subjected to clinical trials were selected from OPD and IPD of Kayachikitsa department and also from Medical camp. CRITERIA FOR SELECTION OF PATIENT A.INCLUSION CRITERIA: 1. Patient with symptoms like Mandalotpatti, Kandu, Daha, THE EFFICACY OF AMRUTADIKWATH IN SHITAPITTA WITH SPECIAL REFERANCE TO URTICARIA Original Research Paper Dr. Nikhil Urunkar Lecturer, Kayachikitsa Dept. LRP Ayurved Medical College, Hospital, Pg Institute & Research Centre, Islampur Dist. Sangli Ayurveda Shitapitta is one of the disorder which caused by virudhahara sevan. Shitapitta is disorder in which vata and kapha are two doshas which are primarily disturbed due to doshprakopak hetu and in combination with pitta dosha they create swellings, redness, itching, over the skin. Vata dosha is dominant in shitapitta. Shitapitta can be co- related with urticaria. This condition may be caused by contact with an external irritant such as the nettle, physical agents, food, insect bites, pollens, drugs or neurogenic factors. Still today there is no satisfactory treatment for Shitapitta. So emphasis were made to nd out easy method for lowering the incidence of shitapitta by using Amrutadi kwath. ABSTRACT KEYWORDS : Shitapitta, Urticaria, Amrutadi Kwath. Dr. Dhairyashil P. Patil* Associate Prof, Kaumarbhritya Dept LRP Ayurved Medical College, Hospital, Pg Institute & Research Centre, Islampur Dist. Sangli *Corresponding Author Dr. Sanjy S. Patil Associate Prof., Kayachikitsa Dept. LRP Ayurved Medical College, Hospital, Pg Institute & Research Centre, Islampur Dist. Sangli VOLUME-8, ISSUE-12, DECEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 12 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Toda, Frequent of attacks 2. Patient in age group 16 to 60yrs. 3. Sex-both sexes. B. EXCLUSION CRITERIA: 1. Below 16 and above 60yrs patients. 2. Patients suffering from urticarial vasculitis, T.B., HIV, Viral infections, Diabetes, Carcinoma etc. A) SUBJECTIVE PARAMETERS 1. Mandalotpatti 2. Kandu 3. Daha 4. Toda 5. Frequent of attacks B) OBJECTIVE PARAMETERS: Investigations of all patients were done before and after treatment. 1. Haematological tests—CBC, Absolute Eosinophil count, ESR 2. How long does the condition been present? <6wks (acute) >6wks (chronic) 3. Measurement of mandal in mm_ cm. (length, bredth) 4. Part of skin occupied by mandal in percentage. By using rule of nine. PREPARATION OF KWATH 1 part of choorna +16part of water → 1/8part kwath Each drug- 5grms + 320ml water → 40ml kwath For preparation of Kwatha Kalpana the Aushadhi Dravyas in the form of bharad choorna were taken in given quantity and 16 times the aushadhi Dravya, water was taken. This mixture were boiled till 1/8th of the water quantity remains. Ratio of Ingredients- Aushadhadi dravya: Water 1: 16 Matra- 40ml. Sahanupan- Madhu. (1 tea spoon) Sevan Kala- vyanodan STANDARDISATION, AUTHENTIFICATION, ANALYSIS OF DRUGS: Drugs were purchased from GMP certied pharmacy. Drugs standardisation, authentication & analysis have been done. After complete examination and investigations all patients were randomly divided into 2 groups EXPERIMENTAL GROUP (GROUP A) – In this group 30 patients were kept on Amrutadi Kwath (40ml) twice a daily. CONTROL GROUP (GROUP B)— In this group 30 patients were kept on kwath like detoxifying edible colored water (40ml) twice a daily. DURATION OF TREATMENT- 60 days. FOLLOW UP- every week OBSERVATIONS AND RESULTS: OBSERVATIONS: 1. Maximum no. of patients i.e. 51.67% were from the age group of 26 – 40 years. 2. Maximum no. of patients registered i.e. 51.67% were male & 48.33% were female. 3. Maximum no. of patients i .e. 55% having H/O Vishamasana,38.33% had H/O Adhyashana followed by 6.67% having H/o Samashana. 4. Maximum no. of patients i.e. 41.67% were having visha magni, while 33.33% were having mandagni & 25% were having tikshnagni. VOLUME-8, ISSUE-12, DECEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra S. N. Symptom Group Diff. T P Value Remark Comparison 1 Mandalotpatti Group A 1.4 10.14 <0.001 signicant Gp A is better than Gp B Group B 0.1 1.97 >0.05 Insignicant 2 Kandu Itching Group A 1.13 8.49 <0.001 signicant Gp A is better than Gp B Group B 0.13 1.43 >0.05 Insignicant 3 TODA (Pricking pain) Group A 1.46 8.57 <0.001 signicant Gp A is better than Gp B Group B 0.26 1.64 >0.05 Insignicant 4 Daha Group A 1.16 6.99 <0.001 signicant Gp A is better than Gp B Group B 0.06 1 >0.05 Insignicant 5 Frequency of attack Group A 1.56 8.76 <0.001 signicant Gp A is better than Gp B Group B 0.13 1 >0.05 Insignicant 6 AEC Group A 85.5 7.65 <0.001 signicant Gp A is better than Gp B Group B -4.5 -1.53 >0.05 Insignicant S.N. Parameters Overall % mean improvement Group A Group B 1 Mandalotpatti 79.62 % 8.47 % 2 Kandu Itching 79.07 % 7.40 % 3 TODA (Pricking pain) 88 % 11.32 % 4 Daha 89.74 % 5.88 % 5 Frequency of attack 80.75 % 7.01 % 6 AEC 76.05 % -0.8% OVERALL IMPROVEMENT: In experimental group 13.33% patients got excellent improvement, 40% patients got good improvement, 33.33% patients got moderate improvement, while 13.33% patients got poor improvement. In control group 10% patients got moderate improvement & 90% patients got poor improvement. PROBABLE MODE OF ACTION OF TRIAL DRUG- AMRUTADI KWATH: It contains 4 drugs- Amruta, Nimba, Dhamasa, Haridra. These belong to Tikta varga. Guduchi & Haridra are Anti Allergic & improves Cellular Immune function. By rasa viraya & guna they act as tridoshaghna. Twak vaigunya relieved by vata- pittaghna property of drug. Most of drugs are kushtaghna, vayasthapaka, dahaprashaman, Shothahara, vedanast hapaka, varnya, kandughna, raktagata vikar shamak, jwaraghna, tridoshghna, chardighna. By Tikta rasa act as amapachak, raktaprasadak, By katu rasa agnidipak, By Tikta rasa & vaishadyakar guna of vayu mahabhut acts as rasa- raktashudhikar & relieves strotodushti by ruksha, ushna guna of drugs, at last vimargag dosha gets prakrut gati & sampraptibhang takes place. AMRUTA (GUDUCHI): Guduchi belongs to ganas like Vayasthapaka, dahapra X 13GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS VOLUME-8, ISSUE-12, DECEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra shamana, trushnanigrahan so it acts as Rasayan, dahas hamak & relieves trushna. DHATU: Guduchi causes stimulation to Dhatwagni by its Tikta rasa & nutrition of dhatu by its madhura vipaka, by its Tikta –katu kashaya rasa & dhatu & causes purication. Guduchi acts on 7 dhatu thus it is good rasayandravya. Guduchi by its Tikta- katu rasa & ushna virya act as dipan, pachan. It acts as pittasaraka & anuloman by its Tikta katu rasa. With Madhu it acts as kaphaghna. It puries rasa & rakta & eliminates kleda, kaphadushti by its Tikta, kashay, katu rasa & ruksha guna. NIMBA: By ruksha & laghu guna it causes wasting of Snigdha dhatu & absorbs kleda by Tikta rasa & shita virya & thus puries blood which eliminates kleda & Kandu from skin. Nimba act as amapachak when used in jwar. Nimba by its shita virya act as Pittaghna, jwaraghna & trushnashamak. Daha: It is dahashamak due to its Tikta & sheeta guna. It absorbs rasagata pitta & reduses daha. It absorbs kleda & puries dhatu by its Tikta & ruksha guna. DHAMASA: Pittashamaka due to madhura rasa & vipaka so useful in Pittaja chardi, trushna. Raktashodhana due to tikta & madhura rasa. Jwar: Useful in jwara & daha shamana due to its Tikta & shita guna & eliminates Pittaja lakshana such as chardi trushna, daha. MANSAVAHA: Eliminates kapha-pitta dushti lakshana such as Kandu, redness & daha. Dhamasa act as tridoshaghna. By madhura rasa, Snigdha guna act as Vataghna, by madhura rasa & shita virya act as Pittaghna so relieves pitta prakopak lakshana like sruti, daha, kleda. By Tikta, kashay rasa, laghu, Snigdha guna act as kaphanisarak. By kashay rasa it decreases porosity of vessels, so decreases vascular uid leakage. HARIDRA: It eliminates pathological coating of buccal mucus membrane due to Tikta katu rasa & Ushna virya & cleaness mouth due to ruksha guna hence used in aruchi. Rasa-raktavaha: It digest rasagata doshas by its tiktakatu rasa & causes rasagnidipan & thereby causes prakrut rasanirmiti. Because of this all dhatus are nourished well & they become healthy. It causes raktaprasadan by eliminating dushta kapha & pitta. Haridra by its Tikta rasa, katu vipak, ushna virya & laghu, ruksha guna acts as kaphaghna, shothaghna, deepan, pachan, Amapachan, absorbs kleda hence kandughna. MADHU: By its kashay, ruksha guna act as kaphaghna, kledaghna, yogavahi. By madhur rasa, shita guna act as Pittaghna. CONCLUSION: The treatment with Amrutadi kwath is more effective than Placebo kwath in Shitapitta. REFERENCES: 1. Charaka Samhita – (elaborated Vidyotini hindi commentary) Chaukhambha bharati academy, Varanasi. 2001 2. Sushruta Samhita –Kaviraja Ambikadutta Shastri- Chaukhambha Sanskrit Sansthan Varanasi. 2005 3. Vagbhat Samhita (Sarth Vagbhat) Anmol Prakashan Pune. 2004 4. Madhava Nidana – Madhukosha with Vidyotini, Hindi comm. by Sudarshna Shastri. 2005 5. Bhavprakash madhyamkhanda, chikitsaprakaranam shitapittodarda utkothadhikar 55/1 vd .Brahma sankara misra –choukhamba Sanskrit prakashan. 2005 6. Yogratnakar – shitapittodardakothadhikar31 vidyotinitika choukhamba Sanskrit sirji Varanasi 7. Bhaishajya-ratnawali- Udardashitapittakothchikitsaprakaran 55 Govinddas sen tika of Kaviraj Ambikadatta Shastri Choukhamba Sanskrit sansthan Varanasi. 8. Chakradatta- Athoudardakothshitpittaadhikar vd. Pandit jagannath Prasad sharma 9. Sharangdhar samhita dwitiya khanda a.2/1 10. Concise textbook of surgery, Dr. S. Das, Burn 11. Davidson‘s principles and practice of medicine 18th edition pg888 12. Harrison‘s principles of medicine. 13. Dr. Baghel M.S. �Researchers in ayurveda�2nd edition 2005 14. THE AYURVEDIC PHARMACOPOEIA OF INDIA 15. Jacobson KW, Branch LB, Nelson HS: Laboratory tests in chronic urticaria, JAMA 1980; 243:1644. 14 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS