Blisters: Ayurvedic Understanding, Treatment Principles

Article by Dr Raghuram Y.S. MD (Ay)
Blisters cannot be compared directly to any particular disease mentioned in Ayurveda. But below mentioned conditions can be correlated to blisters.
All the below mentioned conditions present with blisters, either filled with fluid, blood, serum or pus, some are of the post blister stages wherein dry lesions with pain, burning and or itching are left over. Also when the treatment of the below mentioned conditions have been used in the treatment of blisters we have found good results. 

Seeing the general symptoms of Visphota, any eruption or blister which is inflammatory in nature, caused and filled with blood (blood blisters) can be included under visphota. Since fever, burning sensation and redness are seen, inflammation will be predominant. Fever also indicates infection, thus pus filled blisters also fall under visphota.

Ayurvedic correlation

Treating on the lines of Visphota – Blisters can be compared with Visphota. Read more to understand the concept of Visphota, Types and Ayurvedic Treatment 

Blisters that can be compared with certain Kushta – Skin diseases
Kushta is a broad term which includes 18 types of skin diseases. Few among them present with blisters. These conditions can also be included under the diseases causing blisters. They are:

Charmadala kushta – presents with sphota (blisters) which are red in colour and associated with pain and itching. The blisters open by themselves and are tender to touch. Symptoms resemble to those of Pemphigus vulgaris, Dermatitis herpetiformis and Impetigo.

Visphota Kushta – present with blisters which have shyava (blackish brown) or rakta varna (red colour). These look like infected blisters or blood blisters. They can be compared to bullae.

Pama and Kachchu – Pama presents with multiple small blisters which have discharges (ooze) and associated with severe itching and burning sensation. Same type of blisters when associated with severe burning sensation and occur on the hands and buttocks is called Kachchu. Bothe these conditions are compared to Scabies but can also be correlated with Pemphigus vulgaris, Dyshidrotic eczema, Bulbous pemphigoid, Dermatitis herpetiformis and Impetigo due to resemblance in symptoms.

Vicharchika – presents with multiple blisters which are blackish brown in colour, associated with severe itching and lot of discharges. This can be compared to eczema and allergic eczema due to resemblance in symptoms.

Shataru Kushta – presents with multiple red coloured or blackish brown coloured blisters associated with burning sensation. All types of blisters with inflammation can be correlated with this type of kushta. Pemphigus vulgaris and Chronic bullous dermatitis fall into the category of this type of kushta.

Alasaka kushta – red coloured blisters with lot of itching is the hallmark symptom of alasaka kushta. Dermatitis herpetiformis and eczema can be correlated to this condition.

Pundareeka kushta – blisters with white or reddish border, elevated at the centre and having reddish white hue is called Pudareeka Kushta, the colour resembles that of a lotus flower. Blisters with suppuration or tendency to form pus and infected blisters can be correlated to this type of skin disorder explained in Ayurveda.

Raktagata Kushta – kushta located in blood or contaminating the blood causes blisters filled with pus and will have severe itching. All infected and inflamed blisters fall into this category.

Mamsagata Kushta – kushta contaminating the muscle tissue will cause hard and firm blisters associated with pricking pain. This resembles Dermatitis herpetiformis in presentation.

Treatment

Kushta Chikitsa

Treatment on the lines of Kushta – skin diseases
Principles of treatment of Kushta:
In Vata predominant kushta wherein pain is the presenting symptom along with dryness – Sarpi pana or intake of medicated ghee should be advised. This will help in dry blisters or pressure blisters.

In pittaja kushta wherein inflammatory process is more including the destruction of tissues and suppuration, associated with burning sensation and redness Virechana (therapeutic purgation) and or Rakta mokshana i.e. bloodletting should be done. Similar treatment should be adapted in the blisters with inflammation and blood blisters, and also in suppurative (infected) blisters of chronic origin.

In kapha predominant kushta wherein there is accumulation of fluids, associated with hardness, itching etc symptoms Vamana (therapeutic emesis) should be administered. Similar line of treatment should be followed in blisters with fluid (serum or watery accumulation).

Visphota Chikitsa

Treating Blisters on the lines of Kushta, Visphotaka Chikitsa:
External treatments and Applications (Lepa) –
Pathyadi Lepa

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)

Saindhavadi lepa – paste of Saindhava lavana (rock salt) and Kushta (Saussurea lappa) made in ghrita (ghee)

Tulasi swarasa – applying fresh juice of basil leaves (Sheetapitta – urticaria)

Internal medications:
Guluchyadi Kwatha

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

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).

Masurika Chikitsa

Masurika chikitsa – small pox
Masurika is compared to small pos and its variant laghu masurika to chicken pox. The shapes of blisters in these conditions are similar to masura or lentils.

Vata type of Masurika present with blisters which are reddish or brownish black, dry in appearance and with severe pain, they are hard and suppurate in a long time

Pitta type of Masurika present with red, yellowish white blisters associated with burning sensation and severe pain, suppurate quickly

Kapha type of Masurika present with big blisters, white and unctuous and associated with mild pain, itching and delayed suppuration

Rakta type of Masurika are similar to Pitta type of blisters

Chicken pox, shingles and small pox fall into the category of masurika. Another variant of Masurika is also mentioned and is called Sheetala. The symptoms of sheetala also resemble chicken pox. Brihati shitala will have large blisters and is similar to small pox. When the blisters are small, they resemble chicken pox.

Treatment on the lines of Masurika and Sheetala –
Masurika should be treated on the lines of Kushta and Visarpa (pitta-kapha type)
Vamana (therapeutic emesis) – with decoction of Patola (pointed gourd), Nimba (neem), Vasa (Adhatoda vasica) mixed with paste of Vacha (Acorus calamus), indrayava (seeds of Holarrhena antidysenterica), Yashtimadhu (Glycyrrhiza glabra), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula) and Bibhitaki (Terminalia bellirica)

Virechana (Therapeutic purgation) – should be administered after Vamana

Guduchyadi Yoga – Powder of Guduchi (Tinospora cordifolia), Draksha (raisins), Yashtimadhu (Glycyrrhiza glabra) and Ankola (Alangium salvifolium) mixed in dadima rasa (pomegranate juice) and guda (jaggery)

Dashamuladi kwatha – decoction of dashamula (10 roots), Rasna (Alpinia galanga), Amalaki (Emblica officinalis), Ushira (Vetiveria zizanioides), Yavasa (Alhagi camelorum), Guduchi (Tinospora cordifolia), Dhanyaka (coriander), Musta (Cyperus rotundus)

Drakshadi Kwatha – Decoction of Draksha (raisins), Kashmarya (Gmelina arborea), Kharjura (dates), Patola (leaves of pointed gourd), Nimba (bark of neem), Vasa (Adhatoda vasica), Laja (parched rice), Amalaki (Emblica officinalis) and Yavasa (Alhagi camelorum) mixed with sharkara (sugar)

Nyagrodhadi lepa

Khadiradi lepa – paste of Khadira (Acacia catechu), Nimba (leaves of neem), Shirisha (Albizia lebbeck) and Udumbara (bark of Ficus racemosa)

Panchamuladi kwatha
Vasa swarasa – Juice of Vasa (Adhatoda vasica leaves) mixed with madhu (honey)

Duralabhadi kwatha – Decoction of Duralabha (Fagonia cretica), Parpataka (Fumaria indica), Patola patra (leaves of pointed gourd) and Katuki (Picrorrhiza kurroa)

Nagaradi Kwatha – decoction of shunti (ginger), musta (Cyperus rotundus), guduchi (Tinospora cordifolia), dhanyaka (coriander), bharangi (Clerodendrum serratum) and vasa (Adhatoda vasica)

Effective Formulations For Chickenpox (Masurikahara Kashaya)

a. Jivantyadi Kashayam

b. Shuntyadi Kashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 50

2. Dhatrichandanadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam,83

3. Draksha Kashmaryadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 84

4. Panchamooladi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 85

5. Masurikahara Kashaya

Visarpa chikitsa

Treating on the lines of Visarpa:
Visarpa is often compared to erysipelas and herpes due to similarity in presentation. Hence, Visarpa line of treatment is also applicable to certain blisters. Read more about Visarpa, types, treatment and useful medicines 

Kshudra roga chikitsa

Kshudra Roga – Minor diseases –
We can find a group of diseases which are explained under the name Kshudra Roga which means minor diseases. A few of them present with blisters. They are as below mentioned:

Ahiputana – they are caused due to contamination of kapha and rakta and are mainly manifested in children and infants. It occurs in the buttocks in the form of itchy blisters in infants whose butts are not washed or cleansed after defecation, who are not given a thorough bathing or when the butts are contaminated with sweating. They can be compared to napkin rashes and also occur due to long wear of napkins. They are also compared to impetigo.

Agnirohini – small eruptions which occur in the axillae by destroying the muscle tissue will form blisters which causes severe burning sensation as if burnt by fire. It is associated with fever and burning sensation inside the body. This might be compared with axillary lymphadenitis or erysipelas or herpes.

Gandhamala – are blisters occurring on the skin anywhere in the body especially in the axilla, scapular region or flanks, caused due to vitiation of pitta.

Kaksha – presents with blisters caused by vitiated pitta in the arms, flanks, shoulder and axilla, they are painful and black in colour. This can be compared to acute lymphadenitis of axillary glands or herpes zoster.

Many other kshudra rogas present with eruptions but the above said are closer to the appearance of blisters.

Treating on the lines of Kshudra Roga –
Ahiputana should be treated by initially administering shodhana (cleansing) medicines to the mother or wet nurse to cleanse the breast milk. Later the blisters should be washed and cleansed by the decoction prepared from haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Amalaki (Emblica officinalis) and Khadira (Acacia catechu).

Agnirohini should be treated on the lines of pitta visarpa. Later Langhana (lightening treatments), raktamokshana (bloodletting), rukshana (drying therapies or medicines) and shuddhi or cleansing treatments mainly virechana (therapeutic purgation) should be administered.

Kaksha and Gandhamala should be treated on lines of pitta visarpa. This shows that these diseases closely resemble herpes zoster and erysipelas.
Read related: Blisters: Causes, Differential Diagnosis, How They Manifest?

Prameha Pidaka Chikitsa

Prameha Pidaka – Diabetic carbuncles
Among many types of Prameha Pidakas, Masurika and Alajee are 2 conditions which produce blisters.

Masurika – the shape of the blister resembles that of lentil or masura, thus the name masurika
Alajee – painful red and white coloured or reddish-white coloured blisters are called alajee

Blisters or carbuncles associated with prameha can occur in any condition of prameha (urinary disorders or diabetes mellitus) but are mostly found in obese diabetics, those suffering from diabetes mellitus (madhumeha), renal glycosuria (ikshumeha), lipuria (vasameha) and chyluria (majjameha) conditions. They are manifested over the joints, muscles and vital organs.
Read related: Diabetic carbuncle – Ayurvedic Understanding And Treatment Modalities

Treatment on the lines of Prameha pidaka –
Prameha pidakas can be treated on the lines of Prameha and Madhumeha chikitsa. Effectively treating the urinary disorders, diabetes and the above mentioned variants of the premeha will cure the pidakaas. The blisters can be treated on the lines of treatment of visphota and or kushta.

Vidradhi Chikitsa

Vidradhi (abscess) –
Blisters can be treated on the lines of Vidradhi treatment or treatment of abscess. Read related: Vidradhi causes, types, treatment, medicines.

Vrana Shotha Chikitsa

Vrana Shotha (swelling or blisters formed at the site of wound)
If swelling or blisters form at the site of tear or injury, they are called Vrana shotha.

Vrana shotha is of 7 types namely Vataja, pittaja, kaphaja, raktaja agantuja (due to injury) and ama shotha (immature or unripe blisters). Among these, raktaja vrana shota can be closely compared to blood blisters.

Treatment on the lines of Vrana Shota
Principles of treatment of Vrana SHota are as below said:

• Vimlapana – the vrana shota should be massaged using ghee or oil, heat should be provided with hot bamboo, and the blister should be lightly pressed with the palm or thumb
• Avasechana – blood letting
• Upanaha – poultices
• Paatana – cutting open or excision (not all blisters should be opened)
• Shodhana – cleansing the wounds and removing the left outs
• Ropana – measures to bring about healing
• Vaikrutapaha – measures to remove the scars

Read related: Blisters: Prevention Tips, Treatment, Chances Of Cure

Other treatment measures

Other areas of approach –
Krimi Roga Chikitsa – the patient shall be treated with krimihara formulations (de-worming, antihelminthic medicines) like Vidanga churna (powder of Embelia ribes), Nimbadi churna, Vidangarishta, Krimighna vati etc medicines especially when the blisters are infected

Upadamsha chikitsa – the patient should be treated on the lines of Upadamsha or sexually transmitted diseases (STD) especially gonorrhoea, causing blisters on the genitals.

Mukharoga chikitsa or Mukhapaka chikitsa – treatment on the lines of treating mukhapaka (oral ulcers or stomatitis) should be considered in blisters occurring in the mouth.
Click to Consult Dr Raghuram Y.S. MD (Ayu)