Pruritus (Kandu) : Ayurvedic Treatment Principles

Article by Dr Raghuram Y.S. MD (Ay)
Principles of managing Primary Kandu:

Nidana Parivarjana

Keeping away the diet and lifestyle practices which cause vitiation of doshas (avoiding the vata vitiating, pitta vitiating and kapha vitiating foods and lifestyle practices as enlisted in the causes)

Keeping the agni under control, combating agnimandhya and ama by administering deepana and pachana medicines:
Agnimandhya and ama create ideal environment in the body so as to vitiate the doshas and channels of transportation, cause tissue and organ damage and cause many diseases which can present with kandu. Thus combating these causes is important step to sterilize the environment of the body and keep itching and the diseases causing itching at bay.

Deepana Pachana Chikitsa

Deepana medicines are those which kindle the agni, i.e. the metabolic fire and act like appetizers. They rectify and enhance the metabolic process which had gone weak.

Pachana medicines are those which help in digesting ama (digestants) and removing them from the cells. Ama is a metabolic toxin. It is an intermediate product (bi-product) of digestion which by all means is harmful due to its harmful nature. Ama is the improperly processed or immature essence of digestion in circulation. Due to its sticky nature, ama tends to block the channels of the body and deprive the cells and organs of nutrition leading to cell and organ damage which in turn is the causative factor of all the diseases.

Most of the medicines of deepana and pachana category will act on the virtue of one or more of the katu (pungent), tikta (biter) or kashaya (astringent) tastes, ushna guna or veerya (hot nature or potency) and katu vipaka (post digestion effect). Many medicines act on the virtue of prabhava (disease modifying effect). All these taste and qualities mentioned above are best in destroying and eradicating krimis (pathogens, bacteria), digest and expel ama and to set right the agnimandhya, all of which are causative factors of kandu.

The best drugs used for Deepana are –

• Pippali – Piper longum
• Pippalimula – Root of Piper longum
• Chavya – Piper retrofractum
• Chitraka – Plumbago zeylanica
• Shunti – Zingiber officinale
• Amlavetasa – Garcinia pedunculata
• Maricha – Piper nigrum
• Ajamoda – Trachyspermum ammi
• Bhallataka – Semecarpus anacardium
• Hingu – Ferula foetida
• Ativisha – Aconitum heterophyllum
• Kiratatikta – Swertia chirata
• Hingu – Ferula foetida
• Triphala – fruits of Terminalia chebula, Terminalia bellirica and Emblica officinalis
• Mishreya – Bishop’s weed
• Shatapushpa – Anethum sowa
• Jeeraka – Cumin seeds
• Krishna Jeeraka – Black caraway etc

The first 5 herbs are called Panchakola
Read related: Diet And Ayurvedic medicines For Itching

Ama Pachana

Ama-pachana – The best medicines which can get rid of ama are –

• Dhanyaka – Coriander
• Musta – Cyperus rotundus
• Pippalimula – Roots of Piper longum
• Maricha – Piper nigrum
• Shunti – Zingiber officinale
• Lavanga – Syzygium aramaticum
• Mulaka – Raphenus sativus
• Nagakeshara – Mesua ferrea
• Haridra – Turmeric
• Daruharidra – Berberis aristata
• Haritaki – Terminalia chebula
• Amalaki – Emblica officinalis
• Bibhitaki – Terminalia bellirica
• Kushta – Saussurea lappa
• Vacha – Acorus calamus
• Patha – Cissampelos pareira, Cyclea peltata
• Katuki – Picrorrhiza kurroa
• Ativisha – Aconitum heterophyllum
• Ela – Cardamom
• Bhallataka – Semecarpus anacardium
• Chitraka – Plumbago zeylanica
• Kiratatikta – Swertia chirata
• Patola – Trichosanthes dioica
• Chandana – Santalum album
• Guduchi – Tinospora cordifolia
• Karavellaka – Bitter gourd
• Shigru – Drumstick
• Tila – Sesame
• Sarshapa – Mustard
• Atasi – Flax
• Tikta skanda – bitter group of herbs
• Pippalyadi gana – herbs belonging to Pippalyadi group
• Dashamula – 10 roots
• Haridradi – Herbs belonging to Haridradi group
• Vachadi – Herbs of Vachadi group

Read related: Itching And Pruritus: Ayurvedic Understanding

Managing vitiated kapha

Managing vitiated Kapha in Kapha induced kandu –
Below said are the measures to combat vitiation of kapha:

• Nidana Parivarjana – keeping away the causative factors of kapha vitiation (mentioned in the causes)
• Teekshna Vamana – strong emesis (therapeutic)
• Virechana – therapeutic purgation
• Ruksha anna – foods that are dry in nature
• Alpa anna – intake of less food and light food (light to digest)
• Teekshna – intense acting foods and medicines
• Ushna – hot and fresh foods
• Katu – pungent foods and medicines
• Tikta – bitter medicines and foods
• Kashaya – astringent foods and medicines
• Deergha kala sthitam madhyam – old fermented medicinal alcoholic drinks
• Rati preeti – indulgence in sexual activities
• Prajagarana – awakening late nights
• Aneka roopa vyayama – various types of physical exercises
• Chinta, excessive thinking, worrying
• Ruksha vimardana – dry massages
• Yusha – soups
• Kshoudra – honey
• Medaghnam aushadham – fat depleting medicines (medicines for obesity and weight gain)
• Dhuma – medicated smoking
• Upavasa – fasting, starving
• Gandusha – herbal gargles
• Nisukhatwam – rejecting all sorts of comforts

Managing vitiated pitta

Managing vitiated Pitta in Pitta induced kandu –
Below said are the measures to combat vitiation of pitta:

• Nidana Parivarjana – keeping away the causative factors of pitta vitiation (mentioned in the causes)
• Sarpi Panam – intake of medicated ghee
• Swadu bhojana aushadani – foods and medicines which have sweet taste
• Tikta bhojana aushadani – foods and medicines which have bitter taste
• Kashaya bhojana aushadhani – foods and medicines which have astringent taste
• Sugandha – fragrances
• Sheeta – intake of cold foods and exposure to cold comforts
• Hridhya – indulging in likable and lovable activities, taking similar foods
• Gandha – scents, perfumes
• Haara – garlands of flowers etc
• Maninam hara – necklaces made up of pearls
• Anulepa – regular and frequent application of pastes of karpoora (camphor), chandana (sandalwood) etc coolant herbs
• Chandrama – getting exposed to moonlight
• Geetam – hearing pleasant music
• Hima anila – exposure to cool breeze
• Mitram putram – wholesome and friendly talks with friends, relatives and kids
• Chandanuvartini daara – company of loving wife who has adorned herself with coolant pastes of herbs, garlands and wet clothes
• Sheetaambu dhaaraa – spending time near sprinklers or fountains
• Garbha gruha – staying in underground homes or rooms
• Udhyaana deerghikaaha – walking in the gardens
• Salilaashaya saikate – walking on the sand on the banks of water
• Sarpi – consumption of ghee
• Payaha – consumption of milk
• Vireka – regularly taking therapeutic purgation etc

Read related: 41 Natural Home Remedies For Itching And Pruritus

Managing vitiated Vata

Managing vitiated Vata in Vata induced kandu –
Below said are the measures to combat vitiation of Vata:

• Nidana Parivarjana – keeping away the causative factors of Vata vitiation (mentioned in the causes)
• Sneha – Administration of medicated oils / ghee, Massage, oil pouring etc
• Sweda – Steaming / sudation / sweating therapy
• Mridu shodanam – Evacuation treatment (mild cleansing treatments like Virechana etc)
• Svadu bhojana – Consuming sweet foods
• Amla bhojana – consuming sour foods
• Lavana bhojana – consuming salt foods
• Ushna bhojana – Hot and fresh foods
• Abhyangam – Massage with herbal oils
• Mardana – Tapping the body with closed fists after application of vata alleviating oils
• Seka – Pouring of medicated oils over the body in streams
• Paishtika Madhya – Alcohol or fermented products prepared with flours
• Goudika Madhya – Alcohol or fermented products prepared with jaggery
• Snigdhoshna Vasti – Medicated enemas with oils and ghee, given luke warm
• Deepana pachana sneha – Oils and ghee processed with deepana (appetizer) and pachana (digestant) drugs

Managing Rasavaha Srotodushti

Managing Rasavaha Sroto Dushti –
Keeping away the causes of vitiation of Rasavaha srotas namely –

• Guru aahara – heavy foods
• Sheeta aahara – cold foods
• Ati snigdha – excessive consumption of oily foods
• Ati maatram – eating in excess
• Ati chintanaat – excessive thinking (stress)

Management of vitiation of Rasavaha srotas –
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Rasajaanaam vikaaraanaam sarva langanam aushadham (Ref – Charaka sutra 28/25)
In the management of vitiation of Rasavaha srotas and the disorders of their origin, all types of Langhana should be followed.
Langhana means lightening therapies (which produce lightness in the body). Langhana is of 10 types. They are:

• Vamana – therapeutic emesis
• Virechana – therapeutic purgation
• Shirovirechana (nasya) – nasal medications
• Niruha vasti – evacuation or cleansing enemas
• Pipaasa – not drinking water
• Maruta – exposure to breeze
• Aatapa – exposure to sunlight
• Paachana – medicines or treatments which can digest and destroy ama (metabolic wastes)
• Upavasa – starvation
• Vyaayaama – exercise

Read related: Itching, Pruritus: Causes, Mechanism, Diagnosis, Treatment, Research

Managing Raktavaha Sroto Dushti

Keeping away the causes of vitiation of Raktavaha srotas, namely –

• Vidaahee anna paana – foods and drinks which cause burning sensation after their consumption (corrosive foods and drinks)
• Snigdha aahara – oily foods
• Ushna aahara – hot foods
• Drava aahara – liquid foods
• Aatapa – exposure to sunlight
• Anala – exposure to fire

Management of vitiation of Raktavaha Srotas –

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Vidhi shonita adhyaaye raktajaanaam bhishak jitam (Ref – Charaka Sutra 28/25)

The diseases caused due to vitiation of Rakta vaha srotas should be managed on the lines of treatment and management explained in the chapter ‘Vidhi shonitiya’ of Charaka Sutra sthana.

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Kuryaat shonita rogeshu rakta pitta harem kriyaam
Virekam upavaasam cha sraavanam shonitasya cha (Ref – Charaka Sutra 24/18)

The management includes:

• Raktapitta hara kriyam – Treating on the lines of management of Raktapitta (bleeding disorders)
• Virechanam – therapeutic purgation
• Upavaasam – starvation
• Rakta mokshana – bloodletting

Krimi Chikitsa

Krimi Chikitsa (treatment for worms, healing infections) –
When it comes to itching we always need to think of Krimi or involvement of worms.

In my clinical experience,
I have always started my treatment for kandu by administering the krimihara (worm expelling or de-worming) chikitsa as the first measure. Many times, I was not even needed to prescribe something extraordinary. When the patient is a kid, we have to prefer this as the first step of treating kandu. But the logic also applies to the adults. Ayurvedic anti-helminthic formulations or de-worming compounds are so brilliantly formulated that many medicines also expel the toxins and morbid doshas along with destroying the krimis, example krimishodini vati from Arya Vaidya Sala pharmacy.

Many Krimihara formulations, in my experience are also good at removing the root cause (causative dosha or disease). Example, a combination of Arogyavardhini, Krimikutara ras and Vidangarishta is seen to destroy krimis, correct metabolism and ama, correct liver functions, expel toxins and act as a laxative.

Simple formulations to treat Krimi –
Decoction of Dadima twak (bark of pomegranate tree) mixed with Tila taila (sesame oil)

Khadiradi kwatha – Decoction of Khadira (Acacia catechu), kutaja (Holarrhena antidysenterica), nimbi twak (neem bark), Vacha (Acorus calamus), shunti (ginger), pippali (long pepper), maricha (black pepper), amalaki (Indian gooseberry), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica) and Trivrit (Operculina turpethum) mixed with urine of cow (gomutra)

Nimbadi churna – Powder of Nimba twak (bark of neem), vatsaka twak (bark of Holarrhena antidysenterica), Vidanga (Embelia ribes), Saindhava Lavana (rock salt) and Hingu (purified asafoetida) taken with honey

Vidanga rasa – decoction of Embelia ribes
Vidanga churna – Embelia ribes powder with honey
Nimbi patra rasa – juice of tender leaves of neem with honey
Palasha beeja churna – powder of seeds of Butea monosperma with honey
Nimba twak churna (powder of bark of Neem plant) and Hingu (powder of asafoetida) mixed with honey
Powder of Nimba twak (powder of neem plant), ajamoda (celery seeds), vidanga (Embelia ribes), Palasha beeja (seeds of Butea monosperma), Hingu (asafoetida powder) and Guda (jaggery)

• Krimi mudgara rasa
• Krimi kutara rasa
• Krimighna vati
• Krimi ghatini vati
• Vidangarishta
• Vidanga churna

Management of Secondary Kandu

Secondary kandu is a part and parcel of the disease which causes it. If any disease associated with kandu is treated well, the associated kandu too will go away. Prompt diagnosis of the disease or pathological conditions behind the causation of kandu and comprehensive treatment of the same is the key to combat pruritus or itching.

Many diseases give rise to Kandu or itching but generally we would have an approach following the lines of treatment of Kushta (skin disorders) or Sheetapitta and udarda (urticaria) to treat kandu because these diseases are invariably associated with kandu and most of the formulations which could relieve kandu are mentioned in these contexts, may be internal or external. Some medicines, formulations and treatments explained in Visarpa (herpes), Kshudra Roga (some minor diseases), Visphotaka (eruptive diseases) and Visha Chikitsa (treating poisonous conditions) are also useful in relieving Kandu.

Treating Kandu on the lines of Kushta, Sheetapitta, Udarda, Visphotaka Chikitsa –
Vataja Kushta (Vata predominant Kushta) – Sarpipana or intake of medicated ghee like Tiktaka Ghritam, Guggulutiktakam Ghritam, Aragwadhadi Ghritam etc is the best option

Pittaja Kushta (Pitta predominant Kushta) – Virechana (therapeutic purgation) and Raktamokshana (bloodletting) are the best options

Kaphaja Kushta (Kapha predominant Kushta) – Vamana (therapeutic emesis) is the best option

External treatments

External treatments and Applications (Lepa) –
Pathyadi Lepa: Paste of Haritaki (Terminalia chebula), Karanja (Pongamia pinnata), Sarshapa (mustard), Haridra (turmeric), Krishna Jeraka (Caram carvi), Saindhava Lavana (rock salt) and Vidanga (Embelia ribes)

Karanja beejadi lepa – Paste of seeds of Karanja (Pongamia pinnata), Chakramarda beeja (seeds of Cassia tora) and Kushta (Saussurea lappa) made in gomutra (urine of cow)

Aragwadha lepa – Paste of Aragwadha (Cassia fistula) made in Kanji (sour fermented medicated drink)

Durvadi Lepa – Paste of Durva (Cynodon dactylon), Chakramarda beeja (seeds of Cassia tora), Saindhava Lavana (rock salt), Haritaki (Terminalia chebula), Tulasi (Holy basil) made in Kanji (sour fermented medicated drink) and Takra (buttermilk)

Vidangadi Lepa – Paste of Vidanga (Embelia ribes), Chakramarda beeja (paste of Cassia tora), Kushta (Saussurea lappa), Haridra (Turmeric), Saindhava (rock salt) and Sarshapa (mustard) made in Kanji (fermented medicated drink)

Chakramardadi lepa – Paste of Chakramarda beeja (seeds of Cassia tora) and Twak (Cinnamon) made in milk
Shikari rasadi lepa – Paste of juice of Apamarga (Achyranthes aspera) and seeds of Mulaka (radish)
Saindhavadi lepa – paste of Saindhava lavana (rock salt), Chakramarda beeja (seeds of Cassia tora), Sarshapa (mustard) and Pippali (long pepper) made in Kanji (fermented medicinal drink)

Simhasyapallava lepa – paste of tender leaves of Vasa (Adhatoda vasica) and Haridra (turmeric) made in gomutra (urine of cow)

Gandhakadi lepa – paste of gandhaka churna (powder of purified sulphur) made in sarshapa taila (mustard oil)
Sarshapa taila abhyanga – massage with mustard oil (sheetapitta – urticaria)
Saindhavadi lepa – paste of Saindhava lavana (rock salt) and Kushta (Saussurea lappa) made in ghrita (ghee), useful in sheetapitta and udarda i.e. urticaria and eruptive disorders associated with itching
Tulasi swarasa – applying fresh juice of basil leaves (Sheetapitta – urticaria)

Internal medications

Guluchyadi Kwatha – Decoction of Guduchi (Tinospora cordifolia), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica) and Daruharidra (Berberis aristata) added with powder of purified Guggulu (Commiphora mukul)

Khadirashtaka – decoction of Khadira twak (bark of Acacia catechu), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Nimba twak (bark of neem tree), Patola patra (leaves of pointed gourd), Guduchi (Tinospora cordifolia) and Vasa (Adhatoda vasica)

Navaka Kashaya – Decoction of Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Nimba twak (bark of neem tree), Patola patra (leaves of pointed gourd), Manjishta (Rubia cordifolia), Katuki (Saussurea lappa) and Haridra (turmeric)

Khadirodaka – Juice, decoction, powder of Khadira (Acacia catechu) should be used for anointing, upward massage, application, bathing, drinking and eating (mixed with food)

Khadira rasa – pieces of bark, wood, leaves, roots of Khadira plant (Acacia catechu) should be boiled in a big vessel, when they are processed well, filter, mix juice of Indian gooseberry, ghee and honey and should be used internally

Nimbadi kalka – eating mixture of leaves of Nimba (neem plant) and Amalaki (Indian gooseberry)

Vidangadi kalka – Paste of Vidanga (Embelia ribes) and Bakuchi (Psoralea corylifolia)

Vidangadi Churna – Powder of Vidanga (Embelia ribes), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Pippali (long pepper) mixed in honey

Gudadi yoga – Jaggery with Yavani (Bishop’s weed)

Yavanyadi yoga – powder of Yavani (Bishop’s weed), Shunti (ginger), Maricha (black pepper), Pippali (long pepper) with milk

Nimba patra yoga – Powder of Nimba patra (leaves of neem plant) with ghee or powder of neem leaves and Indian gooseberry with ghee

Vardhamana Pippali – Long pepper treatment in which the powder, decoction or paste of long pepper (pippali) is given in an ascending way (increasing the dose gradually) and later tapered (gradually decreasing the dose and ending with the dose with which the treatment was started).

Medicines for Kandu from Sahasrayoga Text book

1.Tiktaka Ghrita
2. Mahatiktaka Ghrita
3. Eladi Taila
4. Durdhuradi Taila
5. Jeemutadi Taila
6. Brihat Madhusnuhi Rasayana
7. Khadira Triphaladi Kashaya
8.Nalpamaradi Thailam

Swastha Vritta

Following the rules and regulations mentioned in –

• Dinacharya – daily regimen and day-to-day lifestyle activities and diet
• Rutucharya – coping up with seasons and following the regulations of seasons with respect to diet and lifestyle changes
• Achara Rasayana – following ethics of social and community behaviour, maintaining, following and preaching health and hygiene
• Vega dharana – not withholding the body reflexes or urges and also keeping away the stress
• Viruddha ahara – not consuming incompatible foods

Panchakarma Chikitsa

Scope of Panchakarma Chikitsa –
Among the Panchakarma Chikitsa, the below said are highly beneficial in the treatment of Kandu:
Vamana (Therapeutic emesis) – Vamana expels morbid kapha, ama and pitta, throws away the toxins, rectifies the metabolism and cures Kandu.
Virechana (Therapeutic Purgation) – Virechana expels morbid pitta and kapha and does the same job of vamana
Vasti (therapeutic enemas) – rarely needed but may be required to eliminate gut infections of chronic nature
Nasya (nasal medication) – required in some cases of infections and worm infestations of scalp, head and nose associated with itching
Raktamokshana (bloodletting) – highly beneficial in almost skin disorders associated with itching and also in contaminated blood conditions associated with kandu

When to prefer Panchakarma
Panchakarma might not be essential in mild to moderate itching. It shall be kept as a last option wherein the itching is severe and is chronic or is associated with chronic systemic disorders (secondary kandu).

Panchakarma should be preferred when there is severe morbidity of doshas and when the medicines are not giving the desired relief from itching and in people who have good physical and mental strength.
Consult Dr Raghuram MD (Ayu)