Scleroderma is an autoimmune disease of the connective tissue featuring skin thickening, spontaneous scarring, blood vessel disease, varying degrees of inflammation, associated with a deranged immune system.
Autoimmune diseases are illnesses that occur when the body’s tissues are attacked by its own immune system. Scleroderma is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body. This leads to thickness and firmness of involved areas. Scleroderma, when it’s diffuse or widespread over the body, is also referred to as systemic sclerosis.
Modern science does not understand the cause of scleroderma. Researchers have found some evidence that certain genes are important hereditary factors, but the environment seems to also play a role.
Ayurveda defines scleroderma as a form of skin disease. Charaka (Chikitsa Sthanam – Chapter VII) explains that in all stubborn skin diseases, are caused by the simultaneous imbalance of Vata, Pitta and Kapha (the Doshas) which disrupt Tvak (skin), Ambhu (lymph i.e. Rasa Dhatu), Rakta Dhatu and Mamsa Dhatu (these are the Dushyas or “sites” or “victims” of Dosha invasion). [CS.NS.VII.9-10]
This is one reason why skin diseases are so hard to heal. While all three Doshas are aggravated, one or two are generally more dominant. These are defined as the causal Doshas. For example, if Vata is the main causal Dosha, the disease will be termed “Vaatja”. The “Ja” indicates “causal”.
The Doshas, once aggravated, cause vitiation of Agni. This leads to the production of Ama in the inner disease pathway (digestive tract). The aggravated Doshas, mainly Vata, will then carry Ama and other Doshas into the outer pathway (Rasa and Rakta Dhatus) causing skin diseases.
Charaka elaborates a number of “classical” types of skin diseases, but then explains that there are many others. The main thing to do therefore is to determine the Dosha which is dominating by examination of signs and subjective symptoms. Treatment is then twofold, in order of priority:
- Reduce and balance the causal Dosha or Doshas (usually one, sometimes two) and,
- Balance the remaining Dosha(s) and Dhatus.
The following signs help to determine which Dosha is causing the skin disease:
- Vataja: roughness, dryness, hardness, coarseness/thickening, horripilation (goose bumps), brown (dark) and reddish discolorations.
- Pittaja: burning sensation, redness, exudation (oozing), suppuration (discharging pus), smell like raw meat, stickiness, sloughing of limbs (skin is shedding).
- Kaphaja: white discolouration, cold to touch, itching, localisation, elevation (raised in nature), heaviness, stickiness, maggot formation (heaven forbid!!!).
These are important diagnostic tools to help differentiate the type of skin disorder.
Applied to scleroderma, we see mainly a Vata type presentation. Scleroderma is a chronic systemic autoimmune disease (primarily of the skin) characterized by fibrosis (or hardening), vascular alterations, and autoantibodies.
What are scleroderma symptoms and signs?
The symptoms of scleroderma depend on the type of scleroderma present and the extent of external and internal involvement in the individual affected. Because scleroderma can affect the skin, esophagus, blood vessels, kidneys, lungs, blood pressure and bowels, the symptoms it causes can involve many areas of the body.
Scleroderma affects the skin to cause local or widespread signs of inflammation (redness, swelling, tenderness, itching, and pain – this is mainly Pitta Vriddhi) that can lead to skin tightness or hardening (Vata Vriddhi). These skin changes can be widespread, but it’s most common for them to affect the fingers, feet, face, and neck. This can lead to decreased range of motion of the fingers, toes, and jaw. Tiny areas of calcification (calcinosis), while not common, can sometimes be noticed as hard nodules at the tips of the elbows or in the fingers. (Again, Vata Vriddhi).
Scleroderma affecting the esophagus leads to heartburn (Pitta Vriddhi / Pachaka Pitta). This is directly a result of stomach acid flowing back up into the esophagus. Sometimes this can lead to scarring of the esophagus (Vata Vriddhi), resulting in narrowing with difficulty swallowing food and/or localized pain in the central chest. (Vata Vriddhi).
Blood vessels that can be affected include the tiny arterioles of the finger tips, toes, and elsewhere. These vessels can have a tendency to spasm when the areas are exposed to cold, leading to blueness, whiteness, and redness of involved fingers, toes, and sometimes nose or ears. (Vata Vriddhi / Vyana Vayu).
These color changes are referred to as Raynaud’s phenomenon. Raynaud’s phenomenon can cause inadequate supply of oxygen to the involve tips of fingers or toes, causing tiny ulcers or blackened (dead) skin. Sometimes Raynaud’s phenomenon is also associated with tingling. (Rasa & Rakta Gata Vata / Vata Vriddhi).
Other blood vessels that can be involved in scleroderma are the tiny capillaries of the face, lips, mouth, or fingers. These capillaries widen (dilate), forming tiny, red blanching spots, called telangiectasias. (Vata/Pitta Vriddhi)
Elevated blood pressure is potentially serious and can lead to kidney damage (renal crisis). Symptoms include headache, fatigue, and in severe cases, stroke. Blood pressure monitoring and control is essential.
Inflammation of the lungs (Pachaka Vriddhi) in scleroderma can cause scarring (Rasa Gata Vata), resulting in shortness of breath, especially with physical exertion. Elevated pressure in the arteries to the lungs (pulmonary hypertension) can also cause shortness of breath and difficulty getting an adequate breath with activity. (Again: Rasa Gata Vata causing constriction based congestion)
Scleroderma affecting the large bowel (colon) most often causes constipation but can also lead to cramping and diarrhea. When this is severe, complete stool blockage (faecal impaction) can result. (Apana Vaya)
Ayurvedic treatment protocol for Scleroderma
Langhana (purification) is generally needed to remove Dosha/Ama/Mala from Dhatus, especially Rasa & Rakta Dhatu. Generally, Shodhana (purification) is indicated, thus patients should be referred for Panchakarma if possible.
Outpatient treatment should be Shamana in nature (pacification of Doshas and gentle elimination of Ama). The further the disease progresses, the more likely we will have Dhatu Kshaya (destruction / reduction of Dhatus) which requires Brimhana therapies. So a careful balance of Shamana and Rasayana therapies are required for the long term management of this condition and other serious skin diseases.
Care should be taken not to simplify this condition and define it by its more chronic symptoms of Vata Vriddhi (dryness and hardening). It is possible that there is an underlying state of Pitta Vriddhi or even Kapha Vriddhi (less common) in the inner pathway. Take care to evaluate which Dosha is most dominant by skin examination and by examination of the inner pathway (Samana, Apana, Pachaka, Kledaka, Jatharagni, type of Ama in the gut.). Though it is true that further the disease progresses, the more likely Vata will be deranged.
For cases where there is high Vata (wasting, dryness) be careful not to use internal and external oleation prior to having established some removal of Ama and support for Agni. Otherwise, oleation therapy will only increase Ama.
- Identify and treat Causal Dosha (usually Vata or Pitta) – there will usually be an underlying cause in the digestive system. Carefully evaluate Samana, Pachaka, Kledaka and Apana and balance them through diet, lifestyle and simple Dipana and Pachana spices. This treatment will also support the balancing of Jatharagni and removing Ama.
- Balance Jatharagni (Dipana. Using carminatives and digestive stimulants).
- Remove Ama from the inner pathway (digestive tract).
- Balance Prana Vayu (always implicated in auto-immune disease).
- Balance Bhrajaka Pitta and Vyana Vayu. This will be helped by purifying / removing Ama (toxins) from Rasa & Rakta Dhatu and Annavahasrotas. Alterative (blood cleansers) and mild circulatory stimulants are needed here.
- Rasayana for Rasa Dhatu, Rakta Dhatu & Shukra Dhatu (to promote Ojas and immune function).
- Rasayana for additional Dhatus/organs affected in systemic scleroderma.
Obviously we can elaborate this protocol to suite each patient and their needs. Many treatment modalities can be explored. Diet and lifestyle are central. Ayurvedic supplements or medicines are generally needed. Clinical purification is highly advisable (Panchakarma).
Since the main cause of all auto-immune diseases is Ama based, thus digestive in origin, care should be taken to help patients improve their nutrition. A hypo-allergenic, or Ama-reducing diet. Clinical fasting would be advised. Intermittent fasting is also useful. A moderately strict wholefoods plant-based diet is needed in the long term to reduce Ama production.
For best results, Ayurvedic herbs and supplements need to be used under trained supervision. A protocol for self-treatment using herbs and spices would be:
- Use spices (500 mg – 1 gr 2-3 X per day with meals) for balancing Doshas and Jatharagni:
- Use Hingvastak Churna or equal parts cumin, fennel and cardamom for Vataja
- Use equal parts fennel, cumin and coriander for Pittaja
- Use Trikatu or equal parts cumin, ginger and fenugreek for Kaphaja
- Use herbs or supplements to remove Ama from Inner and Outer pathways:
- Triphala powder (2 grams per day) or
- Spirulina (1-3 grams per day) or
- Equal parts Burdock Root, Turmeric Powder, Barberry Powder. Mixed together equal parts. Use 1-2 grams per day along with  digestive spices.
- Use herbs or supplements to correct immune function. Guduchi is the safeset most balanced for all types. 2 grams per day.
An ayurvedic professional would create a tailored treatment including the use of herbs to best suit the patient. I would not personally self-treat if I suffered from scleroderma or another serious skin condition.
Copyright © 2012 Alex Duncan