Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Lichen Planus
It is a chronic inflammatory condition which affects the skin. It also affects the arms, legs, scalp, oral mucosa, nails and genitals. It presents as purple and flat elevated lesions on the skin which are intensely itchy. The lesions are often referred to as bumps. They often develop over several weeks.
They present as lacy white patches, sometimes accompanied by painful sores – especially in mouth and genital regions. This condition is more common in middle aged persons. It may resolve in a few months but also does recur.
Related Reading – ‘Lichen Planus – causes, symptoms, prevention, treatment modalities’
Lichen Planus: Ayurveda Understanding
There is no one particular condition which can be directly compared with lichen planus. But we will try to understand this condition through the lens of Ayurveda.
1. Dosha Relation
Lichen Planus is a chronic inflammatory condition. Therefore, involvement of pitta in this condition is inevitable. Severe itching found in this condition is either due to vitiation of kapha or combined vitiation of kapha and vata. Pain associated with lichen planus is caused by vitiated vata.
Kushta is a condition which encompasses many skin conditions / diseases under its umbrella. All types of Kushtas are said to be ‘tridoshaja’ i.e. caused by vitiation of all three doshas, with predominance of one or more doshas.
Being an inflammatory condition, lichen condition is initially caused by pitta. Itching is severe in this condition and hence kapha gets associated and established in later time. Pitta also can cause itching associated with ama or kapha. Ama is also involved in inflammatory processes taking place in any disease. Bumps may be formed due to involvement of all three doshas, with vata causing dryness of kapha on the backdrop of inflammation caused by pitta.
2. Dhatu Relation
Four other components other than the three doshas have been mentioned in the pathogenesis of kushta. They are twak – skin, rakta – blood, mamsa – muscle and ambu – watery components of the body.
Among these, the skin is an abode of rasa dhatu. Rakta and mamsa are also dhatus. So, these three are the dhatus involved. Ambu or Ap is also considered as dhatu due to its supportive role.
3. Kushta and Lichen Planus
Since lichen planus is manifested on the skin and is a skin condition, it can be grossly included under ‘kushta’.
The below mentioned types of kushta can be considered in close correlation with lichen planus.
a. Alasaka Kushta
It is a type of kshudra kushta – minor skin disease which presents with boils or eruptions (patches) which are itchy and with reddish color around the boils. It is caused by joint vitiation of vata and kapha.
b. Udumbara or Audumbara Kushta
It is a type of Maha Kushta – greater skin disease. The patches / lesions in this condition appear like a ripe fruit of Udumbara (Ficus racemosa). There are golden yellow-colored hairs around the patch. There is reddish discoloration and this condition is associated with itching, pain and burning sensation. It is caused by predominant vitiation of pitta.
c. Mandala Kushta
It is also a type of Maha Kushta – greater skin disease. The patche / lesions are in the form of a circular raised patch which are white or red in color. They are stiff, elevated and unmovable, circular in shape and mingled with one another. There is a feeling of heaviness around the patches.
d. Pundareeka Kushta
This is also a type of Maha Kushta. The patches / lesions resemble the petals of a red variety of lotus flower (pundareeka dala), white in color in the periphery and red in the center, elevated from the surface of the skin and associated with burning sensation. It is caused by combined vitiation of kapha and pitta.
e. Pama Kushta
It is a type of Kshudra Kushta – minor skin disease caused by predominant vitiation of pitta and kapha. It is presented with itchy boils of white, golden yellow or blackish brown color.
4. Places of manifestation of lichen planus vs doshas and dhatus
Particular regions of manifestation of lichen planus have been mentioned as occurring in the arms, legs, genitals etc. the same has not been mentioned in case of types of Kushta mentioned above, though we can find specification regarding site of manifestation in one or two cases. But we can understand these unrevealed and unexplained aspects through inference.
The three doshas are involved in the causation of kushta. So, it is obvious that kushta can occur in any place where these three doshas lodge when vitiated. Skin, blood, muscles and watery components are the main tissues involved. So, these tissues are invariably involved, which includes the skin of arms, legs, scalp, around nails and genitalia.
The explanation of dhatugata kushta points out towards all the tissues of the body involved in the disease, when the disease goes deeper into the tissues. Inflammation of skin of limbs, oral mucosa, genitals and nails in lichen planus can be understood as being caused by vitiated / aggravated blood or infection passing through blood – and can be a case of raktagata kushta or pittaja kushta.
5. From the perspective of Causative Factors
The causative factors mentioned for the below mentioned can be considered as causative for lichen planus also –
– Causes mentioned for Kushta
– Causes mentioned for contamination / vitiation of Rasavaha, Raktavaha and Mamsavaha Srotas
– Causes mentioned for collective dosha imbalance
Immune component is said to be involved in causation of Lichen Planus. When the etiological factors mentioned for Kushta are collectively consumed or exposed to, the immunity will definitely be compromised and will pave the way for manifestation of this condition. Apart from foods and activities which might be causal or triggers for kushta, Ayurveda has also mentioned some unseen factors like papa karma – doing sins, insulting Brahmins, teachers etc. The same can also cause stress and tensions in a person – due to guilt or curse. Modern medicine too has mentioned that lichen planus is an idiopathic condition wherein the causes of the disease are clearly unknown and also that stress is an important cause or trigger for lichen planus.
According to modern medicine, there is a genetic component to this disease. In Shukragata Kushta i.e. when the skin disease or doshas causing skin diseases affecting the semen and male reproductive system, particularly sperms, and also when the artava / raja – ovum of the woman – is affected by kushta or doshas causing the disease, the child born to these couple will also suffer from kushta.
Allergens explained in the modern medicine as causal for lichen planus can be considered similar to the explanation of virodhini anna panani i.e. mutually incompatible and antagonistic foods, and excessive consumption of foods like navanna – new paddy, dadhi – curds, Matsya – fish, lavana – salt, amla – sour foods, masha – black gram, mulaka – radish, pishtanna – dishes prepared with flour, tila – sesame, kshira – milk products and guda – jaggery mentioned amongst the list of etiological factors of kushta.
Viral infections are mentioned as causal of lichen planus. Though not exactly a virus, the involvement of microorganisms has been highlighted in Kushta. Kshateshu krimi sambhavaha – formation of microorganisms in the wounds or lesions has been mentioned amongst the symptoms of asthi majjagata kushta – kushta lodged in deeper tissues like bones and bone marrow. Kushta wherein krimi have developed, is caused by tridoshas and associated with other complications is said to have a bad prognosis and is incurable.
6. Analysis of symptoms of lichen planus in relation to doshas and dhatus
Elevated lesions or bumps of lichen planus are due to kapha and also due to kushta lodged in muscles. The firmness of the patches are also due to the same causes.
Painful sores of lichen planus are due to vata, and partly due to pitta and rakta and the inflammation it causes. It is also due to the kushta located in mamsa – muscles. Sores in the mouth are due to vitiated pitta or rakta.
Redness and painful sores occurring in genitals is due to contamination of shukra dhatu by doshas or lodgment of kushta in shukra dhatu (shukragata kushta). Shepha – penis is one of the roots of channels conveying shukra dhatu in the body. So, when shukra gets contaminated by doshas or afflicted by kushta, the penis too will get affected. These sores are also caused due to vitiated pitta or rakta.
Dark lines on the nails and loss or scarring of nails is due to the asthi dhatu – bones being affected by kushta or when the disease is rooted in the bones. This is because nakha i.e. nails are said 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 mentioned among the symptoms of ‘kushta lodged in mamsa dhatu – i.e. muscles’. When these occur on the scalp, they may damage the hairs, thin them out and also cause their fall or loss, as they characteristically occur in lichen planus.
Residual hyperpigmentation which is a symptom or complication of lichen planus appears similar to Vaivarnya mentioned in Twak gata kushta – kushta lodged in the skin (rasa tissue) and Shyava Aruna Varna – blackish brown or yellowish brown / crimson color in vataja kushta or raga – reddish coloration in pittaja kushta.
Also
Anything resembling lacy white patches on the tongue or inside of cheeks has not been mentioned in the context of kushta and its subtypes. But vipuya – which actually means pus collection, can be taken as white patches (which look like pus), karkashyam – which means roughness – lacy patches of lichen planus and vaktra shosha which actually means dryness in the oral cavity – involvement of mouth and tongue have been mentioned in the context of raktagata kushta. The same may also be caused due to the involvement of vitiated kapha – kapha predominance in lichen planus. Tongue and oral cavity is one of the main seats of bodhaka kapha.
Itching in lichen planus points towards kapha predominant kushta or kapha predominance in the disease. Association of pitta and vata is not ruled out. Itching is also one of the symptoms of raktagata kushta. This points towards the vitiation of blood, spread of infection and role of vitiated blood in causing the inflammatory reactions in lichen planus.
Lichen Planus: Ayurveda treatment principles
Nidana Parivarjana – Avoidance of causative factors is the main principle to prevent the disease from manifesting, for cure of existing disease and to prevent triggering of the existing symptoms. All the etiological factors mentioned in the context of ‘Kushta Nidana’ shall be kept away. Similarly, the causative factors of tridosha aggravation, vitiation of rasavaha, raktavaha, mamsavaha srotas shall be avoided.
Kushta Chikitsa – Lichen planus shall be treated on the lines of ‘Kushta Chiktsa’ – treatment principles of treating skin disorders including medicines, therapies, dietary and lifestyle changes.
Panchakarma Therapies – Depending on the dosha predominance in Lichen Planus, Vamana in kapha / kapha-pitta predominance and Virechana in pitta / pitta-vata predominance are ideal therapies. They are not only curative but also are preventive. They effectively cure the condition and relieve the symptoms and also would prevent the recurrence of the disease.
External therapies – should be done on the principles laid in kushta and vatarakta treatment. This mainly includes lepa – application of medicinal pastes and parisheka / dhara – showering or sprinkling medicated liquids like Taila (oils), Kashaya (decoctions) and Ksheera (medicated milk).
Rasayana – Rasayana therapy should be planned for enhancing the overall and skin immunity and also to prevent the recurrences of the disease.
Sattvavajaya Chikitsa – Psychotherapy and counseling are important parts of interventions.
Daiva Vyapashraya Chikitsa – Divine and belief therapies are also important inclusions in the treatment of Lichen Planus because of the idiopathic component involved in the causation of the disease.
Other principles
– Krimi Chikitsa – to find out if microorganisms are involved and address them
– Doshika Chikitsa – to find out the main involved dosha and administering dosha specific medicines and interventions, especially if the disease cannot be diagnosed or the disease named
– Visha Chikitsa – treating the condition considering that toxins are accumulated in the body, though shodhana / panchakarma also helps in achieving this goal
Also,
Both aspiring parents should be administered with shodhana therapies followed by Rasayana so that they can get prepared to bring a healthy baby into the world, especially if there is a family history of lichen planus in either side of the families.
Beneficial 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
