CASE REPORT

A 28 year old female presented with tightness, roughness, hardness, hyper pigmentation of skin, fingers, toes that turns into blue, hair loss, skin abnormally light. Stiffness and tightness of fingers, hands and fore arm, sores (ulcers) on finger tips, tight and mask like skin of the face. Multiple joint pain and stiffness of the joints, degenerative changes in fingers, breathlessness, occasional cough and wheezing, constipation, difficulty in swallowing, esophageal reflux, all these symptoms are started since 15 years. All above said symptoms are progressive in nature and in this period patient consulted many physicians, dermatologist and many other specialty clinics but did not found relief in the disease. On the basis of signs and symptoms patient were diagnosed as Scleroderma and Vatarakta according to Ayurvedic view. Since last few months she had been taking continuous Ayurvedic medicine and found good relief in above said symptoms.
General examination- pallor- present, icterus- absent, cynosis- localized cynosis present in distal part of the fingers, Clubbing – present, Lymhphadenopathy – non palpable, Edema- absent. BP- during the course of hospitalization fluctuation of blood pressure observed most of the time normal blood pressure observed. Pulse- regular and thready in nature
Systemic Examination: - CVS- no abnormality detected in cardiovascular system, RS- tightness of the skin observed over chest, basal crepitation, ronchi were heard. P/A- soft, non-tender, mild hepato-spleenomagally were palpated. CNS- higher mental functions were intact and no abnormality detected.
Local examination of the skin reveals that rough, hard and tightness of the skin and patient is unable to open the mouth fully only two fingers can insert in the mouth (fish type of mouth). Bluish and blackish discolouration of the skin was observed and degenerative changes in the skin were observed. Raynaud’s phenomenon is positive and intermittent cloudication also present.
USG reveals that Mild hepato spleeno megaly, chest X-ray shows- mild increase vassicular markings, mild non homogenous opacity in both lower lobs. Cardiac borders were intact. ECG- WNL, Hematological reports reveal that Hb% around 9 gm%, ESR 20 mm/1hour. TC, DC and other hematological parameters were normal, renal parameters and blood sugar also within normal limits.
Before Treatment Pictures
Picture shows that- Mask like facies, absence of skin wrinkling

On the basis of signs and symptoms of the condition this disease is diagnosed as Scleroderma and in Ayurvedic point of view it is considered as Vatarakta and treated accordingly.
Treatment given
After long term failure of treatment, patient is fed up with financial burden and progressing of the disease and lastly approached to Ayurvedic medicine.
Initially started with
SHAMANA THERAPY
1.Talakeshwara Rasa - 250 mg
Astamurty Rasayana -250 mg
Shudha gandhaka - 500 mg
Pittantaka yoga - 250 mg
Triphala vati - 2/2
1X2 matra
2. Manjistadi Kwatha 20 ml BD
Kahdirarista 20 ml BD
Kaishora Guggulu 2/2/2
Arjuna Twaka 2/2
Pushkaara Mula 250 mg
Godanti 500 mg

1X2 matra
5. Pancha Tikta Ghrita – 20 ml BD
6. Neem Taila + Tuvaraka Taila for Local application
7. Gojiwhadi Kwatha 20 ml BD
8. Gudichyadi Kwatha 20 ml BD
SHODHANA THERAPY
Course of VAMANA KRAMA fallowed by VIRECHANA KARMA

This whole course of the treatment is done in last 4 month with small changes in medicine. There is permutation and combination of the drugs has been changed according to response of the disease and response of the drugs.
IMPROVEMENT
There is softness and glow of the skin changed, found improvement in breathing difficulty, swallowing, found good improvement in black colored patches over hand and chest. Improved in digestion, evacuation of bowel and quality of health
DISCUSSION
Progressive systemic sclerosis is a multisystem disorder of unknown etiology affecting skin, CVS, GI tract, kidneys, musculo-skeletal system and lung. As such patient is poor, not affordable to do anti nuclear antibody test as it is a diagnostic criteria for scleroderma but on the basis of signs and symptoms this is diagnosed as scleroderma and Vatarakata.
The disease Scleroderma is not curable as we know all but we can improve the life span of the patient and quality of life. Here some of the preparation selected on the basis of involvement of dosha, dhatu of the disease. Talakeshwara Rasa, it is having anti microbial activity, Sarvakustahara, it shows good effect on Gram negative and gram positive bacteria. Purified Sulphur (Shudha Gandhaka) is an excellent rejuvenator and it is effective in treating liver disorders and various skin diseases. By nature, it is digestive and carminative. It is an excellent remedy to flush out the toxins from the body. It is also helpful in curing intestinal worms and enlargement of spleen. Triphala is a well known medicine for GIT as well as skin disorder. Keeping in mind that all the Shamana oushadhi which are helpful for GIT, Respiratory System, CVS, Skin and Musculoskeltal system. Course of Vamana and Veerechana also showed a very good effect on the disease. Pigmentation of the skin, GIT symptoms like constipation, loss of appetite, flatulence etc are improved. In breathing difficulty also patient found relief, even found relief in connective tissue symptoms like joint pain, stiffness of joints and discoloration of joints. No progression of the symptoms were seen during the course of the treatment now also she is on oral medication and patient on regular fallow up and satisfied with the treatment since 2 year.