Itching And Pruritus: Ayurvedic Understanding

Article by Dr Raghuram Y.S. MD (Ay)
Itching is called Kandu in Ayurveda. It is not explained as as a separate disease entity. It is either a symptom or a purvarupa (premonitory symptom of an impending disease) or Upadrava (complication) or Asadhya Lakshana (symptom reflecting the bad prognosis) of one or the other systemic diseases. Thus kandu has a cause and effect relation with its parent disease. If the cause goes away, the effect too goes away. Thus, if the disease is treated effectively, the itching symptom also goes away.  

Causes, mechanism

Causes and mechanism of Kandu
The causes and types of Kandu have not been enlisted anywhere in the Ayurvedic texts. I have tried to compile material related to Kandu from different corners of the treatises.

Kapha type of kandu

Kapha type of Kandu –
Vitiation of Kapha is said to be the most important factor in the causation of itching. In fact, the pathological increase of kapha is often correlated with kandu and is said to be directly proportional to each other. Thus all the factors which lead to pathological increase of Kapha Dosha are regarded as causes of Kandu. They are as mentioned below.

• Guru ahara – excessive consumption of heavy to digest foods
• Madhura – excessive consumption of foods which have sweet taste
• Ati snigdha – excessive consumption of unctuous or oily foods (fried foods)
• Dugdha – excessive consumption of milk
• Ikshu – excessive consumption of sugarcane and its derivatives like sugar, jaggery (molasses) etc
• Bhakshya – high caloric foods
• Drava – consumption of liquid foods
• Dadhi – consumption of curds
• Ati nidra – excess sleeping
• Apupa – excessive consumption of stuffed foods
• Sarpi – consumption of ghee, ghee foods
• Divasa adau – early part of the day
• Bhukta matre – immediately after the consumption of the food
• Vasanta – spring season
• Avyayama – lack of exercise, sedentary lifestyle etc

What happens in high kapha? (Mechanism of kandu in kapha predominant itching) –
High kapha means more fluidity in the body. More fluidity is more stagnation of unwanted materials in the body. It causes decreased metabolism (agnimandhya) at the gut and cellular levels.

This leads to formation of ama or metabolic toxins (ama=immature essence and extract of digestion which is in circulation, by the virtue of its sticky nature tends to block the channels of transport in the body, deplete nutrition and essential elements to the tissues and organs, causes damages therein and causes many diseases).

Formation of ama at gut and cellular levels will lead to constipation at gut and cellular levels as the metabolites and toxins (ama-visha) are not flushed out in proper quantities and at proper time. This leads to less oxygenation and accumulation of fluids in the cells leading to local oedema.

All these causes lead to the lowering of cellular defence mechanism and an environment for frequent infections and stubborn disease processes. Availability of less fire and more water in the body reflects damp conditions which attract various types of bacteria, fungi and facilitate their growth. This leads to severe infections which do not respond to any treatments. This leads to Kandu.

Kapha related kandu includes the metabolic diseases like diabetes etc associated with itching as explained in modern texts.
Read related: Diet And Ayurvedic medicines For Itching

Pittaja type of kandu

Pitta Prakopa, Pitta type of pruritus –
Vitiation of Pitta will also cause itching. High pitta reflects concealed heat in the body which in turn points towards the ongoing inflammatory process in the body. Therefore all the causative factors of pitta vitiation are also the cause of Kandu. They are –

• Katu – excessive consumption of pungent foods
• Amla – excessive consumption of sour foods
• Ushna – excessive consumption of hot foods
• Vidahi – excessive consumption of corrosive foods
• Teekshna – excessive consumption of intense acting foods and medicines
• Lavana – excessive consumption of salt or salty foods
• Krodha – excessive anger
• Upavasa – excessive fasting, starvation
• Atapa – excessive exposure to heat of Sun
• Stree samparka – excessive indulgence in sexual intercourse
• Tila – excessive consumption of sesame and foods prepared with sesame
• Atasi – excessive consumption of flax seeds and foods prepared with flax
• Dadhi – excessive consumption of curds
• Sura – excessive consumption of fermented herbal drinks
• Shukta and Aranala – excessive consumption of sour and fermented medicated drinks
• Bhukte jeeryate – during the process of digestion of food
• Sharadi – in autumn season
• Greeshma – in summer season
• Madhyahna – during afternoon
• Ardha ratre – mid night etc.

How High Pitta leads to itching? –
High pitta means high fire content in the system. Basically the fire in the belly is a dry fire, means comparably the basic proportion of liquidity of pitta (dravatva) is less in comparison to the fiery component (agni, ushnata). The representative pitta’s located in other parts of the body and tissues are liquid or moist fire (water content more than heat content), in terms of hot water.

With respect to this perspective, 2 types of inflammation can take place depending upon whether pitta is a drava pitta (liquid pitta or liquid fire) or adrava pitta (dry pitta or dry fire). They are:

Wet inflammation – when water content of pitta is high. This again is similar to vitiated kapha. Here the water content of pitta will keep its own fire component in a lower level. Thus the heat of pitta will be less. The fire activities like digestion and other metabolic functions contributory to pitta are sluggish. Like vitiated kapha, this type of pitta provides a damp background and platform for many infections and diseases to take place. When water content of pitta has increased, the fire element or heat of the pitta decreases leading to agnimandhya and chain of events as explained in vitiation of kapha. The itching will also occur on this backdrop.

Dry inflammation: On the contrary, if the heat element of pitta is on a high, the water content of pitta will come down. This causes dry inflammation. Since the water cannot buffer the fire component, the inflammation gets outrageous. Inflammation leads to cellular damage and death and lot of debris, including the skin. This leads to excessive dryness and is not antagonized by Kapha, since the heat has evaporated all the water components and stores (kapha) of the body. The body doesn’t have a protective shield and buffering system.

High pitta is contributory to the pruritus explained in context of inflammatory skin conditions, autoimmune skin diseases and dry skin presenting with itching.
Read related: Pruritus (Kandu) : Ayurvedic Treatment Principles

Vata type of Kandu

Vitiation or aggravation of vata leads to extreme dryness in the body and also in the nerves. The irritability in skin and nerves will lead to itching like in pruritus. Thus all causes of Vata vitiation are the causes of Vata type of Kandu. They are as mentioned below –

• Vyayama – Excessive exercises
• Apatarpana – Fasting in excess
• Prapatana – Fall, injury
• Bhanga – Fractures
• Kshaya – Depletion of tissues
• Jaagarat – Excessive vigil (awakening all night)
• Veganam cha vidharanat – Suppression of natural body urges (reflexes)
• Ati shuchi – Excessive administration of cleansing procedures (Panchakarma)
• Shaityadi – Excessive consumption of cold foods and activities
• Traasaat – Fear
• Ruksha – Excessive consumption of dry foods
• Kshobha – Irritation
• Kashaya – Excessive consumption of astringent foods
• Tikta – Excessive consumption of bitter foods
• Katu – Excessive consumption of pungent foods
• Vari-ghanagame – cloudy and rainy season
• Parinate anne – After the digestion of food
• Aparahne – Evening

How high Vata leads to itching symptom?
Pathological increase or vitiation of Vata in the body means a pathological increase of Vayu (air component of Vata) and Akasha (ether or space component of Vata) elements in the body.

This leads to the manifestation of excessive dryness and roughness in the body owing to the increase in ruksha (dry) and khara (rough) components of the Vata.

The body will lose its water or fluid stores which reflect a diminution of kapha and its protective (buffer) functions.
The insulation to the body cells and nerves is hence lost. The natural moisture of the skin is lost.

Like any other tissue, vitiated Vayu also causes dryness in the nerves. The irritated nerves and skin will cause pruritus.

The Vata type of Kandu will cover all kinds of dry skin (caused due to various causative factors) including those associated with neurological and degenerative diseases and also the dry skin occurring due to low quality and quantity of nutrition.
Read related: 41 Natural Home Remedies For Itching And Pruritus

Other notable points

Other important notable points regarding Kandu –

• When 2 doshas are mixed up in vitiated proportions we can get symptoms of both doshas involved with respect to Kandu.
• When Vata and Pitta are involved the kandu may be associated with dryness and burning sensation
• When Vat and Kapha are involved, the kandu will be severe with dryness and oozing or secretions or swelling, forming of crusts and flakes will be more in this condition
• When pitta and kapha are involved, itching is associated with signs of inflammation like redness, burning sensation and also heaviness and associated discharges due to kapha
• In vata-Pitta and Pita-Kapha cases we may see skin conditions with blisters, sores, eruptions etc
• When all the 3 doshas are involved the symptoms of all the morbid doshas will be present in different proportions depending on the proportions of vitiation of each dosha in the combination.

Other causes

Other contributory causes for Kandu –
Agnimandhya – sluggish metabolism or weak digestion
Dhatwagnimandhya – sluggish tissue metabolism, depletes cell or tissue compliance to defend themselves
Formation of ama – toxins or intermediate products of digestion, immature essence of digestion in circulation, later formed at cellular level

Sroto-dushti (rasa-raktavaha, swedavaha) – means contamination of channels or transport system of the body, mainly those carrying rasa (nutrition, lymph, plasma) and rakta (blood tissue).

Rasa is directly related to Twak or skin. The wellness and health of skin is explained in terms of rasavaha sroto dushti (contamination of rasa vaha srotas). This means that if the contents in circulation (nutrition and essentials) are clean and sterile, the skin health is also good.

If the rasa contains contaminants and toxins, the skin is exposed to various diseases and also will lose its immunity.

Similarly, contaminated blood also leads to various skin diseases. Kandu or pruritus is one of the main symptoms of contaminated or diseased rasa or raktavaha srotas.

Skin also throws out the unwanted wastes in the form of sweat or sweda. Thus contamination of sweda vaha srotas (channels associated with throwing out the sweat) will prevent loss of sweat and the contaminants are held back. This also leads to many skin diseases which give rise to kandu or itching.
Read related: Itching, Pruritus: Causes, Mechanism, Diagnosis, Treatment, Research

Dinacharya apachara – Poor management of diurnal rituals, lifestyle protocol and diet schedules. For better maintenance of skin health some tips like daily Abhyanga and snana (massage and bath), udwarthana (daily powder massages) etc have been mentioned in the daily protocol of Ayurvedic lifestyle. Not following these and maintaining untidy and undisciplined approach towards skin health can lead to many skin diseases and associated itching.

Rutucharya – Seasonal incompatibility due to not following the rules and regulations of ‘seasonal health maintenance’

VegaDharana – Forcibly withholding the natural reflexes or impending urges of the body example, the urge to defecate, urinate, hunger, thirst etc will hold back the toxins and wastes in the body. Among a set of diseases and symptoms they cause, kandu also occupies the list. Withholding the urge for vomiting will cause kandu.

Improperly administered Panchakarma treatments – will cause Kandu due to insufficient elimination of toxins from the system.

Viruddha Ahara – mutually incompatible foods like hot and cold foods together, fish with milk, fried foods with chilled curds etc

Secondary causes

Secondary Causes of Kandu (Ayurvedic differential diagnosis of Kandu vis-à-vis itching or pruritus) –

Kandu can be an effect of many diseases. As explained earlier, Kandu can manifest as a symptom, premonitory symptom or a complication of some disease. Below mentioned are the list of diseases explained in Ayurveda in which Kandu is seen –

Kandu as Poorvarupa

Kandu as Purvarupa (premonitory symptom) –

• Kasa – Cough (Kanta kandu – itching in throat)
• Kushta – Skin disorders
• Masurika – Chicken pox
• Vatarakta – Gout (kandu sandhishu – itching in the joints)

Kandu as Lakshana

Kandu as Lakshana (Symptom) –

• Urdhwaga Amlapitta – Gastritis or GERD, presenting its symptoms like sour belching, heartburn etc in the upper part of the body (type of amlapitta having an upward course)
• Kaphadhika amlapitta – Gastritis or GERD caused due to kapha vitiation or associated with excess kapha
• Kaphaja arshas – piles or haemorrhoids caused by vitiated kapha (Guda kandu – itching in the anal region)
• Alasaka – is a kshudra roga (minor disease) which manifests with anguli antarau padau kandu (itching in the spaces between the fingers and in the foot)
• Ahiputanaka – is a kshudra roga (minor disease), napkin rashes in the anal region commonly seen in kids (guda kandu – itching in the anal region)
• Kaphadhika Amavata – Rheumatoid arthritis with kapha predominance
• Utkota – skin eruptions (mandalani kandu – itchy patches)
• Udarda – type of urticaria (kandumadbhischa mandalaihi – multiple itchy patches)
• Chardi nigrahaja Udavarta – disease in which there is upward movement of Vayu caused due to forcibly withholding the vomiting reflex
• Upajihwika – inflammation of epiglottis (jihwa kandu – itching in the tongue)
• Ekavrinda – disease of the throat (gala kandu – itching in throat)
• Kaphaja kasa – cough caused due to vitiated kapha (kanta kandu – itching in the throat)
• Kushta – leprosy or skin diseases including – Alasaka, Udumbara, Kaphaja, Kilasa, Charmadala, Dadru mandala, Pama, Raktagata, Vicharchika
• Krimija Chardi – vomiting caused by infection or worms
• Jwara mukti lakshana – symptom of remission from fever (shirasaha kandu – itching in the head)
• Darunaka – is a kshudra roga (minor disease), dandruff, (shirasaha kandu – itching in the head or scalp)
• Parivartika – is a kshudraroga affecting penis (minor disease), medhre kandu – itching in the penis
• Padminikantaka – is a kshudra roga (minor disease)
• Kaphaja pratishyaya – cold and stuffy nose caused by vitiated kapha (oshta talu kanta shiras kandu – itching in lips, palate, throat, head)
• Parisravi bhagandara – fistula in anus (guda kandu – itching in the anus)
• Kaphaja Masurika – chicken pox caused due to vitiation of kapha
• Mamsagata Masurika – chicken pox afflicting the flesh and muscles
• Kaphaja mukhapaka – stomatitis or ulcers (sores) in the mouth caused due to vitiated kapha (mukha kandu – itching in the oral cavity)
• Kaphaja Yoni kanda – Vaginal disorder caused by vitiated kapha (yoni kandu – itching in the vagina)
• Kaphadhika vatarakta – Gout caused by vitiated kapha
• Kaphaja Visarpa – herpes caused by vitiated kapha
• Vishphota – eruptions of skin caused by vitiated kapha, Kapha-Vata and Kapha-Pitta
• Vrana – ulcers and wounds
• Nadi Vrana – Sinus
• Jalauka damsha visha – poisoning due to leech bite
• Mashaka damsha – poisoning due to spider bite
• Sheetapitta – urticaria
• Shukara Damshtra – is a kshudra roga (minor disease)
• Krimija Hridroga – Heart disease caused by worms

Thus Kandu or Pruritus (itching) can be classified as –

Primary Kandu – Caused due to vitiated doshas (individually, in duals or all together), agnimandhya, ama, apachara of dinacharya and ritucharya, vegadharana, sroto dushti and viruddha ahara. These causes can further cause many diseases. In that case if kandu continues to be a part of those diseases, it becomes secondary.

Secondary Kandu – Kandu manifested as a part of premonitory symptom or symptom of some disease.
Consult Dr Raghuram MD (Ayu)