Ayurvedic Management of Herpes Zoster (Visarpa): A Case Report

Soon after, the area became erythematous and a lesion appeared. As a home remedy, he applied a paste prepared from neem leaves.

By the third day, his condition had worsened. The lesions began to transform into vesicles, and the itching, pain, and burning sensation intensified. Sun exposure and sweating further aggravated the discomfort.

History of Past Illness

No significant past history was reported.

Family History

All family members are reported to be healthy, with no history of autoimmune, genetic, or dermatological disorders.

Treatment History

No significant treatment history was noted.

Personal History

Ahara - Vegetarian diet, taken three times per day.

Vihara - Vata and Atapa.

Nidra - Prakrut: 8-10 hours per day.

Asthavidha Pariksha

1. Naadi - Vata Pitta.

2. Mala - Prakrut 1-2 times/day.

3. Mutra - Prakrut 3-4 times/day, 0-1 times/night.

4. Jivha - Niram.

5. Sparsha - Ushna Sparsha.

6. Shabdha - Spashta (clear voice).

7. Drik - Prakrut.

8. Akruti - Madhyam.

Dashavidha Pariksha

1. Prakruti - Pittakapha

2. Vikruti - Pitta Pradhan Tridosha Vikruti

3. Satwa - Pravara

4. Saara - Pravara

5. Samhanana - Madhyam

6. Ahara Shakti - Abhyavaharana Shakti - Madhyam

7. Jarana Shakti - Madhyam

8. Vyayama Shakti - Madhyam

9. Satmya - Madhyam

10. Pramana - Madhyama, Weight- 38 kg, Height- 145 cm, BMI -18.1

11. Vaya - Kumara

Samrapti Ghataka

Dosha - Pitta Pradhantridosha.

Dushya - Rasa, Rakta, Mamsa.

Srotodushti - Rasavaha, Raktavaha, Mamsavaha.

Sadhyasadyata- Yaapya.

General Examination

Gait - Normal

Pallor - Absent

Icterus - Absent

Cyanosis - Absent

Oedema - Absent

Lymph nodes - Not palpable

Systemic Examination

Respiratory system: Bilaterally symmetrical; clear

Cardiovascular system: S1, S2 heard; no added sounds

Central nervous system: Conscious and well-oriented; superficial reflexes intact

Gastrointestinal tract: Bowel movements regular; tongue coated

Per abdomen (P/A): Soft and non-tender

Skin Examination

Pidaka: Grouped rashes with fluid-filled blisters (vesicles) on a reddish base

Area: Lumbar region of the left lateral abdominal wall

Colour: Reddish

Odour: No specific odour

Secretion: Absent

Pain: Occasional mild pain

Itching: Present

Burning sensation: Present

Tendency to bleed: Absent

Loss of sensation: Absent

Vital Examination

Pulse rate: 92 /min

Respiratory rate: 20 /min

Temperature: 99.6°F

Investigations

Complete blood count (CBC) and C-reactive protein (CRP) tests were performed, and all results were within normal limits.

Diagnostic Assessment

The patient presented with clusters of vesicles on the left lateral abdominal wall. Initially, the rash appeared as vesicles accompanied by itching and a preceding burning sensation, with symptoms progressively worsening over time. Similar features are described in Ayurvedic texts under Pittaja Visarpa, which includes symptoms such as Sphotabahulta (appearance of vesicles), Daha (burning sensation), and Sambheda (pain).⁴

Differential Diagnosis

• Chicken pox (Masurika)

o Inclusion Criteria: Vesicular eruptions with watery blisters

o Exclusion Criteria: No history of fever, localized restricted rash

• Shitapita

o Inclusion Criteria: Sudden onset red wheals, intense itching, elevated patches; symptoms relieved by cold and aggravated by heat

o Exclusion Criteria: Absence of vesicles/blisters, no fever or burning, non-successional, non-fluid lesions

• Kustha

o Inclusion Criteria: Redness, itching

o Exclusion Criteria: No chronicity, absence of scaling or thickened skin

• Visarpa

o Inclusion Criteria: Rapidly spreading fluid-filled blisters, shiny inflamed skin, redness, burning, and itching

The patient’s symptoms align with Visarpa, as evidenced by the rapidly spreading fluid-filled vesicles, redness, itching, and shiny appearance, which are not typical of Masurika, Shitapita, or chronic Kustha. The acute progression and vesicular nature strongly support Visarpa as the most appropriate diagnosis.

According to Ayurveda

Clinical features such as Sphotabahulta (appearance of vesicles), Daha (burning sensation), and Sambheda (pain) correspond with the lakshanas of Pittaja Visarpa.

The therapeutic regimen was structured in a stepwise manner to address Pitta imbalance and promote healing. The therapeutic regimen was structured in a stepwise manner to address Pitta imbalance and promote healing (Table 1).

Clinical improvement was visually evident, as shown in the lesion images before and after treatment (Figure 1)

Timeline

The overall clinical course and interventions are illustrated in the timeline of the patient’s recovery (Figure 2)

Case Progress

The patient first presented on 17/09/2024 with fever, a reddish patch, burning sensation, and vesicular eruptions on the left lateral abdominal wall. Oral medication was initiated to reduce inflammation and relieve symptoms. After one week, on 23/09/2024, the patient showed gradual improvement with reduced burning, although vesicles were still present; therefore, the same line of treatment was continued. By 27/09/2024, pain had completely subsided, with only mild itching remaining, indicating notable improvement. At this stage, internal medications were adjusted and a new external application was introduced to further promote recovery. On 07/10/2024 (Day 22), the patient displayed significant improvement with resolution of vesicles and only mild residual skin discolouration. Continued external application was advised to support complete restoration of the skin. Overall, the case demonstrated steady progress and symptom reduction with consistent therapeutic response.

Discussion

Kamadudharasa is a classical Ayurvedic preparation known for its Pitta-pacifying properties.5 It is prepared using Amalaki juice, Guduchi extract, Swarna Gairika, along with cow's ghee. The hydrolysable tannins present in Amalaki possess antimicrobial, anti-inflammatory, and immunomodulatory actions. Guduchi, being rich in saponins and triterpenoids, exhibits antiviral properties, and is particularly beneficial in herpes. Swarna Gairika helps regulate metabolism and provides antioxidant effects, making Kamadudharasa effective in Pitta imbalance conditions such as fever and herpes zoster.

Arogyavardhini Vati is indicated in Kustha, Medo-dosha, Yakrit-vikara, and chronic fever. It supports toxin metabolism and helps correct imbalances in the Rasa dhatus.⁶

Tikta Rasa is crucial in the treatment of Pitta Dosha disorders due to its Pittashamaka and Amapachana effects. Its Vayu and Aakasha composition render it Laghu, Ruksha, and Lekhana properties that contribute to the removal of cellular obstructions, facilitating efficient passage of nutrients, and soothing Kapha and Pitta, thereby exerting antipyretic and detoxifying actions. In Patolkatukrohinyadi Kashaya, components in Tikta Rasa such as Patola and Guduchi help reduce moisture content, purify the blood, and decongest the liver, thereby effectively managing Visarpa-related conditions.⁷

Gandhak Rasayana is used primarily for skin disorders, mainly for acne and eczema.⁸ In Visarpa, it acts by purifying the blood, reducing Pitta-Rakta issues, and improving immunity. Its antimicrobial and anti-inflammatory properties help control infection, redness, and swelling, while its antiparasitic action inhibits microbial growth. As a Rasayana, it strengthens skin tissues, accelerates wound healing, reduces scarring, and prevents recurrence, thereby ensuring faster recovery and restoration of healthy skin. Topically, Dashanga Lepa and Shatdhouta Ghrita with Panchavalkal powder are used to support wound healing in herpes.^9,10,11 The astringent, cooling, and cleansing properties of Panchavalkal reduce inflammation, oozing, and microbial load in Visarpa, while the cooling, penetrating, and healing actions of Shatdhouta Ghrita’s pacify Pitta, soothe burning, and promote tissue repair. Together, they limit the spread, cleanse the lesions, prevent infection, and accelerate healing with minimal scarring.

In this case study, the primary factors inducing Visarpa or herpes zoster were vitiated Pitta and Rakta. The patient initially experienced a few rashes accompanied by herpetic pain and a burning sensation lasting for two days. During the course of treatment, the symptoms (size and number) showed aggravation for 3-4 days. However, by the 6th or 7th day, the symptoms had begun to decline and had fully resolved by the 21st day.

This case illustrates that a stepwise treatment approach can be effective in treating Visarpa. The therapeutic regi-men employed Tikta Rasa dravya (bitter substances), sometimes in association with Rakta Shodaka dravya (blood-purifying substances), along with topical application of cooling and drying pastes. It is indeed noteworthy that the patient was administered only Ayurvedic medicines and was not given antiviral medication. The positive outcome supports the efficacy of Ayurvedic therapies in the management of Visarpa.

Conflict of Interest

Nil