Urticaria Treatment (Shitapitta) in Ayurveda

Urticaria Treatment (Shitapitta)

Acharya Madhava has explained Shitapitta as an allergic skin condition with eruptions and itching all over the body. It can be correlated with urticaria / hives. Shitapitta is formed of two words – Shita and Pitta, Shita meaning cold and Pitta meaning the Dosha.  

It simply means two words exactly opposite to each other, because Shita means cold and Pitta is hot. So, it has to be understood that Pitta Dosha is influenced by cold leading to the condition Shitapitta.  

Nidana: Causative factors 

1. Aharaja Nidana (Dietary factors) 

Food that increases all three Doshas and vitiates Rakta Dhatu (blood tissue) and food that causes clogging of the circulatory channels are the main causative factors of Shitapitta.  

• Santarpana bhojana: Overnourishing food items such as deep fried food, excess intake of sugar or sweets, dairy products.  

• Atilavana sevana: Excess intake of salt in diet  

• Atiamla sevana: Too much indulgence in sour tastes such as excess consumption of citric fruits and their juices, tomatoes, tamarind, etc. and fermented food such as yoghurt, vinegar, etc.  

• Viruddha Aahara sevana: Indulgence in incompatible food such eating fish with milk, eating milk with citric fruits or salted food, etc.  

• Tikshna madya sevana: Indulgence in strong alcoholic drinks.  

• Katu Rasa sevana: Intake of spicy foods such as too much of chilies, garlic in diet.  

• Adhyasana: Over eating 

• Guru Dravya sevana: Consumption of heavy to digest food items in excess  

• Snigdha Bhojana sevana: Intake of excess amounts of unctuous food such as cheese, yoghurt, oils in diet. 

• Dadhi sevana: Regular intake of yoghurt. 

• Visha Yukta Annapanasevan: Food poisoning 

2. Viharaja Nidana (Lifestyle factors) 

All the lifestyle factors that increase the three Doshas, vitiate the blood tissue and skin cause pathogenesis of Shitapitta.  

• Sheeta Marut Sparsha: Too much exposure to cold breeze 

• Shita Paniya Sparsha:  Contact of cold substances and cold weather. 

• Vishayuktajal snana: Taking shower in contaminated water  

• Mlana Vastra: Use of unclean / unwashed clothes 

• Keeta Damsha: Insect bites 

• Bahya krimi: Contact with bugs, poisonous insects, etc. 

• Chhardi Nigraha: Suppression of vomiting 

• Divaswapna: Regular day sleep 

• Shishir Ritu viparyaya: Altered effects of climate in winters 

• Varsha kala: Rainy season 

• Ritusandhi: Seasonal transition 

3. Chikitsa Mithya Yoga (Improper Detox procedures) 

Sometimes improper detoxification of the body through improper administration of the Shodhana procedures (bio purificatory procedures) such as Vamana (Therapeutic emesis), Virechana (Therapeutic purgation), Swedana (Sweating therapy) explained in Ayurveda texts or not following the diet and lifestyle that is recommended after the Shodhana procedures can lead to weakening of immunity and vitiation of Doshas, especially Vata. 

Samprapti: Pathogenesis 

All three Doshas are involved in Shitapitta. Indulgence in causative factors such as exposure to cold wind and cold comforts increases the Vata Doshas in the body which then get associated with Pitta Dosha which has already undergone vitiation independently due to its own causative factors (like excess intake of spicy food, hot food, too much exposure to sunlight, etc). This interacts with the Kapha Dosha which introduces coldness and moistness properties. Thus, abnormal interaction of different Doshas results in hypersensitivity of the immune system causing allergic / inflammatory reactions in the blood and skin.  The cold property of Kapha and Vata together dominate the heating quality of the single Dosha Pitta. So, Pitta although aggravated in this condition is masked by the coldness of the other two Doshas, hence the disease is named Shitapitta, Shita represents coldness qualities of Kapha and Vata prevailing over the heat of Pitta.  

Pitta aggravation in this disease condition is dormant; hence we find most symptoms predominant to Kapha and Vata and not of Pitta. Some symptoms like feverish feeling and burning sensation are attributed to aggravated Pitta, however the Pitta Dosha that is trying to express itself is subdued by Kapha and Vata. Even from treatment perspective, Ayurveda has explained the use of warm comforts for treatment of Shitapitta (urticaria treatment).  

Prolonged indulgence in causative factors like consumption of incompatible food items and over-nourishing diet leads to impairment in the functioning of Jataragni (digestive fire) which contributes to the formation of Ama (micro toxins). Ama is nothing but accumulation of waste products in the body because the body is unable to eliminate them. Rasa Dhatu (Plasma) gets contaminated with Ama because it is the first tissue which also circulates the nutrients after digestion of food. So along with the nutrients, it also carries the allergens and transports it to the next tissue, blood. Hence Rakta Dhatu (blood) is subsequently affected leading to hypersensitivity and inflammatory reactions which manifests in the skin as redness, rashes, itching, swelling, etc. Ama also disturbs the already vitiated Doshas leading to hypersensitivity. These aggravated Doshas spread to different parts of the body along with the Ama, causing inflammatory reactions in blood and localize in the skin.  

• Blood that is vitiated by Ama along with the heat of Pitta causes inflammation of the skin leading to the appearance of welts seen in Shitapitta.  

• Vata aggravation causes dryness and itching on the skin. 

• Kapha vitiation leads to swelling / elevated eruptions on skin.  

Samprapti Ghataka: Factors involved in pathogenesis 

• Vata Dosha initiates the pathogenesis by disturbing the normalcy of Pitta as Vata is the controller of other two Doshas.  

• Pitta Dosha is the main Dosha aggravated leading to increase of heat and inflammation in the body.  

• Kapha Dosha is also a contributor to Shitapitta through its coldness property leading to allergic reactions.  

Purvarupa: Premonitory symptoms 

• Pipasa: Excess thirst 

• Aruchi: Loss of appetite 

• Hrillasa: Nausea 

• Dehasada: Weakness of the body parts 

• Angagaurava: Heaviness of the body 

• Raktalochanata: Redness of the eyes 

Rupa: Symptoms 

• Varti Dashta Samsthana Shotha Manadalotpatti: Eruptions of elevated patches / rashes or swelling on the skin resembling the wasp sting 

• Vidaha: Burning sensation 

• Toda bahulya: Excessive pricking type of pain 

• Kandu: Itching  

• Jwara: Feverish feeling 

Chikitsa: Treatment 

Ayurveda approach to treatment involves the avoidance of causative factors, intake of Ayurveda herbs, following of dietary and lifestyle recommendations, daily and seasonal routines. Approach to treatment of Shitapitta (urticaria treatment) as explained by Acharya Bhavaprakasha involves 3 steps – Shodhana (Purification therapy), Shamana (Pacification therapy) and Bahirparimarjana (External treatment).  

• Vamana, Virechana and Raktamokshana help in achieving Shodhana benefits. These are recommended when the Doshas and Dhatus are greatly vitiated and cannot be brought back to normalcy just with pacification treatments alone. Also, Shodhana therapies are very effective and helps prevent recurrence of the disease as well. The toxins along with the vitiated Doshas especially Kapha and Pitta from all over the body are brought to the stomach through proper preparatory procedures such as Dipana-Pachana (Appetisers and digestives), Abhyanga (oil massage), Vashpa Swedana (Steam bath) and Ghritapana (Oral administration of medicated ghee prepared by processing ghee with bitter herbs). From there it is eliminated through the upward channels (mouth) as in Vamana and through the downward channels (rectum) as in Virechana. In Raktamokshana, the vitiated blood is removed from the body through application of leech or venesection at a certain part of the body after a gentle massage.  

Importance of preparatory procedures before Shodhana – just like you cannot extract juice properly from an unripe fruit, in the same way, if the Doshas and Ama are not detached from the cells, it will be difficult to eliminate them from the body. Hence to make the Doshas and Ama soft and detached from the cells, preparatory procedures are done before the administration of purificatory procedures.  

A.) Dipana – Pachana which are administered orally help to improve Agni, thereby eliminating Ama and enabling proper digestion of medicated ghee. Medicines like Chitrakadi vati, Trikatu churna are used for this purpose along with intake of hot water and dry ginger infusion.  

B.) Abhyanga with warm medicated oils help to soften the toxins from the skin.  

C.) Swedana will liquefy the vitiated Doshas and help in easy elimination of toxins through the sweat.  

• Shamana treatment involves the administration of suitable herbs, diet and lifestyle. They are recommended when the vitiation of the Doshas is mild to moderate. 

• Lepa, Udvartana and Abhyanga come under Bahiparimarjana chikitsa. They help treat skin inflammation and itching through local action.  

1. Vamana: Therapeutic vomiting is induced using leaves of Nimba, Patola and fruits of Madanaphala helps to remove the Ama (micro toxins) from the body along with the vitiated Doshas, especially Kapha. This procedure is done following the administration of ghee medicated with bitter herbs for 5 to 6 days. This will help bring balance of the other two Doshas.  

2. Virechana: Therapeutic purgation using Triphala and Pippali helps to remove excess of Pitta along with Ama from the body thereby restoring Agni and normalcy of the Doshas and blood tissue. Virechana therapy also follows oral administration of medicated ghee for recommended period of time.  

3. Raktamokshana: Bloodletting therapy helps remove vitiated blood from the body which is the main vitiated body tissue involved in the pathogenesis of Shitapitta thus preventing further progression of Shitapitta.  It is the best Shodhana / Detoxification therapy in Shitapitta.  

4. Lepa: Application of herbal paste of Durva and Haridra or paste prepared by mixing salt, ghee and Kushta on the body, especially on the skin lesions. This is left on the skin for a period of 30 minutes and then washed off with water. It helps reduce skin inflammation, pain and itching.  

5. Udvartana: Scrubbing of the body using herbal powder mix prepared from mustard seeds, morning, neem, curcuma and yoghurt will help reduce inflammation and restore the skin microbiome. Udvartana helps to eliminate Ama from the circulatory channels because of its drying and heating property.  

6. Abhyanga: Oil massage using warm mustard oil with or without the addition of salt helps to increase the heat over the skin, thereby eliminating the coldness quality and reduce excess Kapha and Vata from the body. Abhyanga also helps improve circulation of nutrients to the skin.  

Two therapies that are recommended regularly at periodic intervals are Jala Dhauti and Nitya Virechana. As there is tendency of Ama formation, vitiation of all Doshas and blood during seasonal changes, Ayurveda suggests Jala Dhauti and Nitya Virechana that will help remove and prevent Ama formation, thus preventing recurrence of Shitapiita.  

1. Jala Dhauti: Voluntary inducement of vomiting explained as one among the six cleansing techniques in the ancient Yoga scripture, Hathayoga Pradipika is beneficial in Shitapitta. One should drink warm water as much as possible until the vomiting process is induced by a gag reflex. For a beginner, Jala Dhauti should be done strictly under the supervision of an Ayurveda physician or an expert Yoga faculty.  

2. Nitya Virechana: Virechana is a Shodhana procedure done under strict supervision of Ayurveda physician. However, Nitya Virechana is a simple cleansing procedure which can be done by oneself at home. During seasonal changes, the person who is prone to Shitapitta has to take 1 tsp of Avipathikar powder or Triphala churna at bedtime with warm water for a period of 7 to 10 days. This helps cleanse the gastrointestinal tract of micro-toxins and help maintain healthy digestive fire. It also helps to prevent excess increase of heat in the body thus preventing Shitapitta.   

As Kapha Dosha blocks the channels of circulation and prevents vitiated Pitta Dosha from expressing itself, the administration of hot potency herbs and diet having lightness property and predominant bitter taste will help normalize the vitiated Kapha Dosha and remove the obstruction simultaneously enabling Pitta to achieve a normal state as the obstruction is gone.  

Charaka has recommended the use of Udarda Prashamana Mahakashaya to treat Shitapitta. These are a group of 10 herbs which consists of the following – Tinduka (Diospyos peregrine), Priyala (Buchanania lanzan), Badara (Zizyphus jujube), Khadira (Acacia catechu), Kadara (variety of Khadira), Saptaparna (Alstonia scholaris), Ashvakarna (Dipterocarpus alatus), Arjuna (Terminalia arjuna), Asana (Pterocarpus marsupium), Arimeda (Acacia farnesiana). Most of the herbs in this group are bitter or astringent in taste and hot in potency thus help balance Kapha Dosha. Also, they improve metabolism and are good blood purifiers. They also possess micro toxin scraping, anti-histaminic, anti-inflammatory, tissue replenishing, rejuvenating and immune modulatory effects. So Charaka says one can use these herbs individually or in combination for Shitapitta.  

A.) Single herbs used in treatment 

1. Nimba (Neem leaves): Has a cooling and detoxifying effect on the skin.      

• Boil neem leaves in water and use for bathing in Shitapitta.  

• Alternatively paste of neem leaves can be applied on affected part of the skin.  

• Drink 15 ml of Neem juice everyday in empty stomach.  

2. Haridra (Curcuma): Its anti-allergic properties help to reduce inflammation and itching.  

• Consume ¼ tsp of curcuma with a cup of warm water daily before going to bed.  

• Mix curcuma with warm water and apply as a paste on the itchy area of your skin.  

3. Yashtimadhu (Licorice): Exerts a healing effect on the skin.  

• Drink a cup of licorice tea daily.  

4. Amalaki (Indian gooseberry): Powerful antioxidant and rich in Vitamin C.  

• Consume one or two Amla fruits daily. Or drink 20 ml of Amalaki juice daily.  

5. Ajamoda (Carom seeds): Helps eliminate Ama and correct Agni imbalance.  

• Add ¼ tsp of Ajamoda to a cup of hot water and drink it once daily.  

6. Pippali (Long pepper): Has potent antimicrobial property.  

• Mix ¼ tsp of Pippali with honey and consume every day.  

7. Ghritakumari (Aloe vera): Has a cooling and soothing effect on the skin when applied locally.  

• Apply fresh aloe vera gel on the affected parts of the skin for a quick relief from itching and discomfort.  

8. Tulsi (Basil leaves): Treats infections and has antimicrobial and wound healing properties.  

• Drink a cup of Tulsi tea daily. Or chew 5 to 6 fresh leaves of Tulsi every day.  

B.) Compound formulations  

1. Kashaya (Decoctions) - Amritadi Kashayam, Patolakaturohinyadi Kashaya, Mahamanjishtadi Kashayam, Guggulu tiktakam Kashayam, Guduchyadi Kashayam 

2. Arishtam / Asavam (Fermented preparations) – Aragwadharishtam, Khadirarishtam, Saribadyasavam 

3. Churna (Herbal compound powders) - Triphala churna, Avipathikar churna, Eladi churna, Nisha Amalaki churna, Mustadi churna 

4. Khandam (Granules) - Haridra khandam, Ardraka khandam 

5. Vati (Herbal tablets) - Arogyavardhini vati, Triphala guggulu, Navakarshika guggulu 

6. Rasa Aushadhi (Metallic and mineral preparations) - Manikya rasa, Sootasekhara ras, Gandhaka rasayana, Rasadi gutika 

7. Bhasma (Herbo-mineral preparations / Nanoparticles) – Praval Bhasma, Swarna Bhasma 

8. Ghrita (Medicated ghee) – Mahatiktaka ghrita, Panchatiktaka ghrita, Indukanta ghrita 

9. Taila (Oils) – Chandanadi taila, Katu taila, Himsagara taila, Marichadi taila, Eladi taila, Karpooradi taila 

10. Lepa (Topical medicinal paste) – Siddhartaka Snana, Kushtadi lepa  

C) Rasayana Prayoga (Use of rejuvenative herbs) –

Rasayana in Ayurveda is explained as rejuvenation of the body through correction of disturbances in Doshas, enhancement of Agni and nourishment of Dhatu. Thus, Rasayana improves overall health, immunity and body strength. They have health promotive, disease preventive and curative benefits. Rasayana is generally recommended after Shodhana procedures for enhanced results.  

Vardhamana Pippali and Vardhamana Lashuna prayoga are explained in Yogaratnakara. They are two Rasayana preparations which involves increasing and decreasing the doses of Pippali (long pepper) and Lashuna (garlic) respectively. They are administered for a specific period of 20 days, where the dose is increased gradually over the first 10 days and decreased gradually during the next 10 days coupled with diet and lifestyle modifications to alleviate the symptoms as well as address the underlying cause of Shitapitta. As these two herbs possess potent anti-inflammatory and antimicrobial properties they are used as Rasayana in the treatment and prevention of Shitapitta. It has enhanced absorption owing to the higher dose and reduced discomfort as the dose is decreased after increasing. Research studies suggest that these two Rasayana preparations provide long-lasting therapeutic benefits as they aim at enriching the quality of blood tissue because of the active components of the herbs in these preparations. 

The three phases of treatment of Shitapitta are as follows: 

1. Alpa Dosha Avastha: Mild increase of Doshas – Here, Langhana chikitsa, that is fasting or intake of light to digest food is recommended.  

2. Madhya Dosha Avastha: Moderate vitiation of Doshas – In this stage, Langhana chikitsa along with Pachana, that is digestives are ideal.   

3. Prabhoota Dosha Avastha: Excess aggravation of Doshas – Shodhana or purificatory therapies will be effective.  

Diet and lifestyle recommendations 

Pathya Ahara: Wholesome diet  

• Laghu bhojana: Light to digest food such as soups, porridges, etc.  

• Tikta rasa pradhana ahara: Food articles with predominant bitter taste such as spinach, fenugreek, etc.  

• Ushnodaka: Hot water 

• Mudga: Green gram 

• Kulattha: Horse gram 

• Karvellaka: Bitter gourd 

• Shigru: Moringa  

• Dadima: Pomegranate 

• Haridra: Curcuma 

• Shali Anna: Special red variety of rice that is harvested in 60 days.  

• Purana Shali: Rice which is older than a year. 

Apathya Ahara: Unwholesome food 

• Virudha Ahara: Incompatible foods such as eating fish with milk, eating milk with citric fruits or salted food, etc.  

• Dadhi: Yoghurt 

• Matsya: Fish 

• Ati lavana: Excess intake of salt 

• Ikshu vikara: Sugarcane products 

• Ati Amla rasa: Excess intake of sour food items 

• Ati Katu rasa: Excess spicy foods 

• Kshira vikara: Milk and its products 

• Madya sevana: Intake of alcohol 

Pathya Vihara: Wholesome practices 

• Langhana: Light to digest food.  

• Abhyanga: Oil massage 

Apathya Vihara: Unwholesome practices 

• Divaswapna: Day nap 

• Chardi vega dharana: Suppression of vomiting 

• Vayu sevana: Exposure to cold breeze 

• Atapa sevana: Exposure to hot sun 

Along with the above, Ayurveda also emphasizes on stress management, regular exercise and use of natural clothing.  

• As stress exacerbates the condition of Shitapitta, one has to practice meditation and deep breathing regularly to balance stress.  

• Exercise improves circulation and helps to eliminate toxins through sweat and keeps the skin supple and healthy.  

• Also, one is recommended to wear loose fitted clothing made of natural fibers such as cotton and linen which are soft, skin-friendly and hypoallergenic so as to allow your skin to breathe by absorbing sweat and moisture. This helps keep your skin cool and heal faster.  

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