Article by Dr Manasa S, B.A.M.S & Dr Raghuram Y.S. MD (Ay)
Kushta is a disease which covers many skin diseases of major and minor ones under its umbrella.
Kushta is classified broadly into two groups, Maha Kushta – greater skin disorders which are 7 in number and Kshudra Kushta – minor skin disorders which are 11 in number.
Vaipadika is a type of Kshudra Kushta. Except in the verse which describes this condition, the word Vipadika is used everywhere instead of Vaipadika. I have used the word ‘Vaipadika’ in this article against the mostly used Vipadika just to differentiate it from another ‘Vipadika’ explained in the context of Vata Vyadhi.
Causative factors of Vipadika / Vaipadika
Specific causative factors have not been enumerated in the texts for vaipadika or in fact for any of the eighteen types of kushta. Therefore the general causative factors which have been enlisted amongst ‘kushta nidana’ i.e. etiological factors for kushta shall be considered as the causative factors for vaipadika as well.
Related Reading – General causes for skin diseases as per Ayurveda
Dosha Predominance in Vaipadika Kushta
Though kushta is a tridoshaja roga i.e. it is caused by simultaneous aggravation of all the three doshas, involving skin, blood, muscles and fluids of the body, Vaipadika is Vata-Kaphaja Kushta i.e. is caused by combined vitiation of vata and kapha. Here pitta may be a dormant dosha.
Pathogenesis of Vaipadika Kushta
Just like nidana – etiological factors, the samprapti i.e. pathogenesis of individual kushtas too has not been described in the treatises. So we need to understand the pathogenesis of Vaipadika on the lines of general pathogenesis of Kushta.
When a person excessively consumes or gets exposed to the etiological factors of kushta, vata and kapha gets jointly vitiated with pitta as a dormant dosha. These doshas move towards the feet and hands of the person and contaminate the skin, blood, muscles and fluids therein. This leads to excessive dryness in the skin of the feet. This happens due to the drying up of kapha, rasa dhatu (skin is the abode of rasa dhatu), muscles and liquids in the feet by extremely vitiated vata. The skin gives way leading to development of cracks and fissures in the skin of the plantar aspect of the feet and palmar aspect of the hands. The person also experiences severe pain in the region of the skin where cracks / fissures occur. This condition is called Vaipadika Kushta.
This condition shall be called as Vaipadika Kushta because there is yet another condition called Vipadika explained in the context of Vata Nanatmaja Rogas i.e. specific diseases caused by aggravation of only vata. Vaipadika is also called as Vipadika by some authors. To avoid confusion it is better to call Vaipadika as Vaipadika Kushta or Vipadika Kushta.
Note – Vata and kapha are antagonistic to each other. When vata increases it dries up the kapha and kapha category of tissues – rasa, mamsa and ambu in this context, owing to its dry and rough qualities. This is the reason for cracks and fissures to occur. Dryness caused by vata gives a backdrop on which the symptoms of vaipadika develop.
Though both vata and kapha are involved in the causation of vaipadika, the clinical picture is dominated by vata as evident by cracks and fissures in hands and feet along with severe pain, all of which can be caused only by an extremely aggravated vata.
Symptoms of Vaipadika Kushta
वैपादिकं पाणिपादस्फुटनं तीव्रवेदनम्॥च.चि.७/२२॥
vaipādikaṃ pāṇipādasphuṭanaṃ tīvravedanam||ca.ci.7/22||
The predominant symptoms of Vaipadika Kushta are –
– pani pada sphutana – cracks and fissures in hands and feet
– teevra vedana – severe pain in the regions of fissures
Sadhya Asadhyata
Vaipadika is a sadhya type of kushta i.e. it is curable.
Treatment Principles of Vaipadika
Nidana Parivarjana
All etiological factors of kushta need to be kept away. Skin hygiene should be given utmost importance. Hand and food care are important especially if the person has any type of skin disorders anywhere in the body. One should be careful while handling corrosive and toxic things, chemicals or plants. At the same time, feet shall always be protected by using footwear. Skin care in vata aggravating seasons – summer and rainy seasons is very essential.
Samanya Kushta Chikitsa
General line of treatment of Kushta vis-à-vis skin diseases should be considered.
Panchakarma
– In vata predominant conditions snigdha virechana – purgation using unctuous purgatives like Nimbamritadi Eranda Taila in daily metered small doses can be given if the dosha aggravation and lesions are not very much.
– If there are signs of severe vata aggravation along with kapha, classical virechana may be planned following snehana and swedana. Ghee prepared with bitter herbs like – tikta ghrtas like Guggulutiktaka Ghrta and Tiktaka Ghrta shall be used for snehana.
– If kapha signs are seen, like itching, discharges etc Vamana may be considered following which Virechana may be administered.
– In excessive aggravation of vata, vasti – medicated enemas too shall be considered following a course of virechana.
– Panchakarma therapies blended with external therapies and disease modifying formulations and diet and lifestyle changes will be a comprehensive package to treat vaipadika.
External Therapies
Dhara – showering of medicinal liquids over the affected parts
Sneha Dhara – Nalpamaradi Taila, Pinda Taila, Ayyapaladi Kera Tailam, Shatadhauta Ghrta – can be used
Ksheera Dhara – milk prepared with Nalpamaradi Kashaya is highly beneficial
Kashaya Dhara – Only Nalpamaradi Kashaya can be used for showering if there are signs of kapha aggravation without much pain
Avagaha – affected foot and hand shall be placed in the warm medicated milk like Nalpamaradi Kashaya siddha Ksheera following application of one of the above mentioned medicated oils.
Vishesha Chikitsa – specific line of treatment
Vipadikahara Ghrta Taila
जीवन्ती मञ्जिष्ठा दार्वी कम्पिल्लकः पयस्तुल्यम्।
एष घृततैलपाकः सिद्धः सिद्धे च सर्जरसः॥
देयः समधूच्छिष्टो विपादिका तेन शाम्यतेऽभ्यक्ता।
चर्मैककुष्ठकिटिभं कुष्ठं शाम्यत्यलसकं च॥ इति विपादिकाहरघृततैले ॥च.चि.७/१२०, १२१॥
jīvantī mañjiṣṭhā dārvī kampillakaḥ payastulyam|
eṣa ghṛtatailapākaḥ siddhaḥ siddhe ca sarjarasaḥ||
deyaḥ samadhūcchiṣṭo vipādikā tena śāmyate’bhyaktā|
carmaikakuṣṭhakiṭibhaṃ kuṣṭhaṃ śāmyatyalasakaṃ ca|| iti vipādikāharaghṛtataile ||ca.ci.7/120, 121||
Ghee and mustard oil should be processed with the decoction of Jivanti – Leptadenia reticulata, Manjishta – Rubia cordifolia, Darvi – Berberis aristata and Kampillaka – Mallotus philippensis and paste of Tuttha – purified copper sulfate. When the medicated fat is ready it should be filtered and added with Sarjarasa – Gum resin of Vateria indica and Madhuchista – beeswax. This Yamaka (mixture of two fats) or Ghrta-Taila when applied destroys Vipadika / Vaipadika. It is also a one shot remedy for other skin conditions like Charma Kushta, Eka Kushta, Kitibha and Alasaka.
Best medicines for Vipadika Kushta
– Kaishora Guggulu
– Guggulutiktaka Ghrta
– Mahatiktaka Ghrta
– Tiktaka Ghrta
– Aragwadhadi Ghrta
– Gandhaka Rasayana
– Nimbamritadi Eranda Taila
Modern Correlation
Vipadika or Vaipadika Kushta can be closely correlated with cracks and fissures occurring in the skin or ‘skin fissures of hand and foot’. They generally occur in the heels, fingertips and in between the toes or fingers and are caused mainly on the backdrop of dryness of skin.
Some people have correlated it to a condition called ‘rhagades’. Though rhagades are also cracks and fissures, they commonly occur at the angles of the mouth and nose.
The ‘Vipadika’ explained in Vata Roga (Vata Nanatmaja Roga) is also correlated with the same condition though they differ from each other from the perspective of Ayurveda description with certain similarities in presentation.
Related Reading – Skin fissures of hand and foot – causes, symptoms, prevention, treatment and Ayurveda Understanding
