A Case Study on Management of Tinea Cruris with Classical Vaman Karma

Tinea Cruris is the disease of fungal infection of groin by dermatophyte fungi. It is commonly seen in men, and also called as Jock Itch as the other name. It is the condition which shows characteristics of disease as erythema, itching, burning sensation, cracked skin, skin rashes which worsen by exercise, skin discoloration and important symptom like rashes does not clears but increases due to antifungal creams. The management of the condition can be done in Ayurvedic perspective. According to Ayurveda all the classified disease of skin are considered as in Kushta Roga (skin disease), where the conditions of fungal infections are correlated with the Dadru Kshudra Kushta (Tinea). Due the clinical features of itch, redness, circular patches. The disease having exaggerated state of Pitta and Kapha Dosha, moreover Kapha. The treatment principle in such conditions is Shodhan Purificaton therapy along with Shaman (Pacificatory) therapy, as both therapies are considered best in Kushta Roga according to Acharyas. This case report is of the female patient suffered from itching over left thigh region along with redness, pimples, and round patches since 3 months, the patient finds the relief after following the Ayurvedic treatment as Case Study Deshmukh et al.; JPRI, 33(33B): 195-202, 2021; Article no.JPRI.70537 196 Shodhan Karma and Shaman Karma with lifestyle changes. The symptoms were diminished by Vaman Karma (emesis). She got 80-90% relief after Shodhan Karma as if one can consider the best treatment for tinea cruris.


INTRODUCTION
Tinea Cruris is a fungal infection caused by fungi. These fungi are present in atmosphere, plants and over human skin. There have been numbers of fungus species explained in the modern which are capable to make one ill also causing different clinical appearance in the skin in different parts of body, out of which one of the infection is Tinea Cruris causing symptoms like redness, itching, patches over the thigh region and can be unilateral or bilateral. Tinea Cruris is a fungal infection caused due to dermatophyte type of fungus affecting thigh region and synonymic as Jock-Itch. It has raised red bordered ring like appearance which spread in inner thigh and mostly itchy. It has been also mentioned that different country of world have differs in causative species of fungus causing Tinea Cruris, likewise as Trichophyton rubrum and Epidermophyton floccosum in New Zealand as a common cause. The infection is not sexually transmitted disease but can be spread through skin to skin contact.

CASE REPORT
A 25yr female patient came to clinic on (16/01/2020) with the complaints of erythema, boils, itching, discolouration and round patches over left inner thigh. The patient also suffered from frequent bowel movements. The complaints appear progressively one after another and aggravated even by medication. After examination she diagnosed with Tinea Cruris.
On examination, it was seen erythema, skin rashes, and circular patches over left inner thigh region.

Past History
The patient has the history of itching, redness, and pimples, over the left inner thigh. She took allopathic treatment by using antifungal medications like cream but complaint increased over site even after having medications, even though she does not found relief and she planned for taking Ayurvedic treatment.

Shodhan Karma
By assessing the Koshta (abdomen) of patient, dominant Dosha of disease, and the bowel habits of patient Vaman was planned. The patient was acknowledged about the procedure, medicaments, diet, and also about Snehapana (oleation) and Swedan Karma (sudation therapy) as in Purvakarma (pre-treatment).
The following medications were used for the whole Vaman planned For, The procedure is performed in mainly 3 divisions such as, Purvakarma (before procedure), Pradhan Karma (at the time of procedure), and Pashchat Karma (after procedure).

 Purvakarma
The

RESULTS
The patient's Vaman result to Avara Shuddhi followed by Shaman Chikitsa, the symptoms like erythema, cracks, itching etc. were relieved. The patient got adequate treatment. Result shown in Table 8.

DISCUSSION
According to classical literature, Tinea/Ringworm is related with the Dadru Kshudra Kushta. Tinea Cruris, and fungal infection of groin region in any gender, more often occurs in males it cause itching and burning sensation in the groin area, thigh area skin folds, and anus. It also involves the inner thighs and genital areas, and also extends towards back to the perineal and perianal areas. The Affected areas appear red, or brown, with cracking skin in text by Acharya Ghanekar, and Acharya Sushruta it is mentioned about the 7 layers of skin [9,10] out of 7 layers , 4 th layer named Tamra is the site of Dadru Kushta formation, the same was also described by Acharya Charak [11]. Kshudrakusta is the type of Kushta Roga, Kushta has the predominance of all three Doshas along with Dushya like Rasa, Rakta, Mamsa Dhatu [12,13]. By Acharya Chakrapani, he has mentioned the Pacification of Doshas in Kustha Roga is done by Shodhana purposely and repeatedly [14].
In present study, after taking proper history and examination as shown in Table 1 the patient was prior undergone for Deepen-Pachan karma by Sunti Churna. A Sunthi (zingiber officinale) dry ginger is Ushna Viryatmak (potency) it minimise the Vata-Kapha due to their Sheet Guna and increase Pitta due to similar Ushna Guna . Due to its hot potency it act as digestive and carminative, it helps in for Aam pachana. After that the patient was advised for Snehapana with Panchatikta Ghrita in increasing dose as given in Table 2. It is an herbal Ghruta used most often in skin disorders and has a best result in skin diseases. It contains five Tikta Rasa Dravya as shown in Table 6. This improves digestion by its sharp and penetrates action which clarifies perception of skin. It moreover reduces Kapha and aggravates Pitta. It is considered as best for all skin diseases as mentioned in Bhaisajya Ratnavali Kushta Adhikara. The senhapana is then followed by Snehana i.e. Abhyanga and Swedan with Nadi Sweda by Dashmula Taila & Kwath respectively, as it is best in reduction of Vata Dosha and treats nervous system related disorders.
The Kushta of Kapha-Pitta predominant are Krucchasadya (difficult to cure) [15] after this, Panchakarma procedure [16] the planned Vaman Karma [17,18] was performed. In Shaman Chikitsa as described in Table 3, the patient was advised capsule Finbid which is effective in fungal infections by increasing immune response, ingredients in capsule are mostly anti-inflammatory & anti-allergic as shown in Table 4 which controls itching, skin scaling, and skin infections and also helps to rejuvenate the skin cells, which replaces the infected destroyed cells with the healthy on which helps in deduction of the skin disorder symptoms. Another medication is Marichyadi Taila contains Maricha and other drugs as given in Table 5 is used for local application over the infected site. It has the anti-fungal and anti-septic properties used widely in reliving skin diseases. It has the Disclouration +++ +

Fig. 1. Pictures of tinea cruris before and after treatment
property of pacifying pitta and Kapha-Kleda reduction action, it is commonly used in conditions like itching, and redness likewise Trichoderma cream, containing drugs as shown in Table 7 having anti-fungal effect of ingredients. It helps in reducing cell wall permeability of membrane in fungi which helps in decreasing the symptoms of fungal infection and suggest a satisfactory relief from symptoms.

CONCLUSION
After Acknowledge the fact about the satisfactory relief from Vaman Karma in Tinea Cruris patient, followed by Shaman Chikitsa. The disorder is of Tridosha and can be treated by balancing the Doshas by Shodhan Karma and Shaman Chikitsa. The present study is about the management of Tinea Cruris by classical Vaman mentioned in Ayurevda text followed by Oral administration of some polyherbal medication which gives better result in decreasing symptoms of disease as shown in Table 8. So, it can be said that by following Panchakarma one can have a healthy life.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.