Metabolic Syndrome Linked With Parasitic Scabies.

Metabolic syndrome linked with parasitic scabies.

Case study- Patient name Mr.Satpal Singh, Male/72 years old suffering from severe allergic rashes and severe itching at night, obesity, Insomania, stress, irritability since 4-5 months.

K/C/O-HTN, Dyslipidemia, Obesity, underwent for allopathy treatment- Antifungal, Antiparasitic antihistamines, Steroids, and ointments, Anti-hypertensive drugs.

Vitals before treatment-                                                             

 BP-160/100 mmgh                           CVS-S1,S2 Heard     

Pulse-89bpm                                      RS-A/E B/L Normal    

 Temp-Afebril                                      CNS- Conscious,Oriented      

 Spo2-98@RA                                     P/A- Abd.Distended and soft.     

Weight-82.5 kg                                   Height-5’5 inches     

Abd Girth-117cm                                R bicep-32cm L bicep-32.5cm   

 R thigh-54cm                                      L thigh-55cm    

 BMI-30.12 Obesity.

Investigations-Enclosed 

Differential Diagnosis-Metabolic syndrome, Parasitic scabies,Seborrheic dermatitis,Psoriasis,Eczema.

Ayurvedic Diagnosis- Kusta Roga- Vicharchika,sthoulyata,Pama(kapha+pitta)association.

Scabies in Ayurveda-In Ayurveda, scabies is called Pama. Pama is caused due to aggravation of Kapha+Pitta dosa in association with indigestion and Pitta.

Types Depending upon the features- it is classified into 1-Dry scabies and 2-Pustular scabies.

Dry scabies - It is commonly found in the anal orifice, over the scrotal skin and over the nipshes.

Pustular scabies - Starts in the finger webs and later spreads to other skin folds. Pus is also filled in the blisters, gradually. Pathophysiology acc.to Modern science-Scabies mites burrow into the top layer of the epidermis where the adult female lays eggs. The eggs hatch in 3-4 days and develop into adult mites in 1–2 weeks. After 4–6 weeks the patient develops an allergic reaction to the presence of mite proteins and faeces in the scabies burrow, causing intense itching and rash. 

Pathophysiology (Samprapti)acc.to Ayurveda-The pathogenesis of Kushtha as a whole can be represented as 

Dosha- Vata, Pitta, Kapha

Dushya-Twak, Rakta, Mansa, Lasika.

Srotas-Rasavaha, Raktvaha, Mamsvaha and Ambuvaha.

Agni-Jathragni or Dhatwagnimandya.

Udbhavasthan-Amasaya.

Adhisthan-Whole body (specially twak)

Rogmarg-Bahya/Abhyantra.

Sancaya-At the own sites of vata, pitta and kapha

Prakopa-At the own sites of vata, pitta and kapha.

Prasara-Through the triyagga siras to the sakha.

Sthansamsraya-In the sithilibhuta Twak, Rakta ,Mansa and Lasika, (Purvarupa utpatti) 

Metabolic syndrome and obesity linked to Skin diseases.

The gut microbiome is a well-recognized factor in the pathophysiology of obesity. This review highlights the mechanisms by which gut dysbiosis can contribute to the pathophysiology of obesity. In particular, we discuss gut microbiota’s contribution to host energy homeostatic changes, chronic low grade inflammation and bile acid metabolism via bacterial metabolites, such as short-chain fatty acids, and bacterial components, such as lipopolysaccharides, among others. Finally, therapeutic strategies based on next-generation probiotics aiming to re-shape the intestinal microbiota (Purishaja krimi)and reverse metabolic alterations associated with obesity are described. obesity is associated with chronic low grade inflammation. As a result, a person with obesity experiences decreased immune tolerance to antigens, which increases the chances of allergies and other immune diseases.

In Ayurveda -Starting from Kosta Intestinal microbiota (Purishaja krimi) Purishaja Krimi get absorbed (Prasar avatha) through Microvilli of small intestine and get into the blood stream through gastric arteries where they will take sthana samshraya in the Sakha that is Skin and shows their signs and symptoms(Vyakta avastha and Bheda) like intense itching or skin burrow,pimple-like skin rash,Dermatitis  Severe itching (pruritus), especially at night-leads to Kustha roga Linked with Sthoulyata.

Role of Virechna in Skin Disease-Virechana is effective in the management of the obesity as it helps to reduce colonization of aerobic bacteria -correction of the gut flora dysbiosis, and expel/drains out the extra cellular and intra cellular fluid which was due to low grade inflammation thus initiated the weight loss mechanism in the body, resulting in diminution in the signs and symptoms of obesity and Scabies. 

Virechana Karma clears the Srotoavarodha (obstruction), normalizes the Agni and brings balanced state of Tridosha. Gastrointestinal (GI) disorders often accompanied by skin manifestations. Exactly how the gut microbiome is related to skin inflammation and influences the pathophysiology mechanism of skin disorders .The associations between the gut microbiome with inflammatory skin disorders, such as acne, psoriasis, Parasitic scabies,atopic dermatitis, and urticaria, so here Virechan karma helps to clean the GI microbiome from intestines and helps to reduces both Parasitic scabies linked to obesity/Metabolic syndrome.

After Treatment Vitals- 20 days of Ayurvedic Treatment.     

BP-150/100 mmgh                            CVS-S1,S2 Heard     Pulse-93bpm   

RS-A/E B/L Normal                           Temp-Afebril         

CNS- Conscious,Oriented                Spo2-97@RA     

P/A- Abd.Distended and soft.         Weight-72.5kg        

Height-5’5 inches                             Abd Girth-104cm      

R bicep-30.1cm                                L bicep-30.3cm     

R thigh-52cm                                   L thigh-52.5cm    

 BMI-26.45 Overweight.  

By:-Dr.Nitin Dhruv

Assist.Prof. at Kayachikitsa Dept.@GGIMS,Gorakhpur.

MD in Internal medicine,BAMS

P.G.D.E.M.S, D.I.H.M,D.D.M.

C.C.P.T,Kerala