SHWITRA – TYPES, LAKSHANA, AND SADHYA-ASADHYATA

SHWITRA – TYPES, LAKSHANA, AND SADHYA-ASADHYATA

Shwitra is a type of Kshudra Kushta (minor skin disorder) mentioned in Ayurveda, characterized by white or discolored patches on the skin due to the loss of pigmentation. It resembles the condition Vitiligo in modern medicine. It is a Tridoshaja Vyadhi with predominant Pitta and Bhrajaka Pitta involvement and affects Rakta, Mamsa, and Medo Dhatu.

ETYMOLOGY AND SYNONYMS

• Shwitra: Derived from "Shweta" meaning white.

• Synonyms: Shwetakushta, Kilasa (some consider a synonym or a variety of Shwitra)

TYPES OF SHWITRA (ACCORDING TO DOSHA DOMINANCE)
As per Charaka Samhita, Shwitra is classified based on Doshic predominance:

१. वातज श्वित्र (Vataja Shwitra):

• Patches are dry, rough, reddish-brown

• Associated with itching, pricking pain

२. पित्तज श्वित्र (Pittaja Shwitra):

• Patches are red or coppery

• Burning sensation and oozing present

• Associated with bad odor

३. कफज श्वित्र (Kaphaja Shwitra):

• Patches are white, thick, smooth, cold

• No itching or pain, slow spreading

Reference:
"श्वित्रं तु दोषजं ज्ञेयं त्रिविधं सानुबन्धकम्।
वातं पित्तं तथा कफं त्रयमेव तु कारणम्॥"
– Charaka Samhita, Chikitsa Sthana 7/13

LAKSHANA (CLINICAL FEATURES) OF SHWITRA

१. वर्णविपर्यय (Discoloration)

• Loss of pigmentation in patches – white, red, or coppery depending on dosha.

• No elevation or depression of skin.

२. त्वग्गुणपरिवर्तन (Altered Skin Texture)

• Kaphaja: Smooth and thick

• Pittaja: Thin and may ooze

• Vataja: Dry, rough patches

३. सन्धानभेद (Loss of Normal Sensation)

• Usually no pain, may have itching or burning in pittaja or vataja types.

४. स्थूलता / सूक्ष्मता (Size and Nature of Patches)

• Kaphaja: Larger and thick

• Vataja: Small and dry

५. मनोविकार (Psychological Impact)

• Due to cosmetic disfigurement, it causes stress, anxiety, and social embarrassment.

Reference:
"वर्णं च श्वेतं, नीलं वा, तम्रं वा, न पिच्छिलम्।
अस्पृष्टमस्थि पित्ताद्यं च श्वित्रं दोषविशेषजम्॥"
– Ashtanga Hridaya, Nidana Sthana 14/4

SADHYA-ASADHYATA (PROGNOSIS) OF SHWITRA

Shwitra is classified based on prognosis as follows:

१. सध्यम् (Curable):

• Recent onset

• Involvement of only skin

• Limited area affected

• Good digestive power and compliance to treatment

२. क्रुछ्छ सध्यम् (Difficult to Cure):

• Chronic cases

• Involvement of deeper dhatus

• Patches in vital areas (face, genitalia)

• Poor compliance to diet and regimen

३. असध्यम् (Incurable):

• Hereditary origin

• Large area involvement

• Total pigment loss

• Associated with other systemic conditions

Reference:
"अतिस्निग्धे रुचिकले, बलवत्यग्निसंयुते।
नवश्वित्रे त्वनुपहते सध्यमाहुरतन्द्रिणे॥"
– Charaka Samhita, Chikitsa Sthana 7/17

NIDANA (ETIOLOGY) OF SHWITRA

According to Ayurveda:

• Viruddhahara (incompatible food)

• Guru, Snigdha, Abhishyandi food

• Suppression of natural urges

• Mental factors: Shoka, Bhaya

• Krumi, Kushtha history

Reference:
"दुष्टं रक्तं च सम्प्राप्तं दोषैः त्वङ्मांसमेदसः।
श्वित्रं तदभिनिर्वृत्तं निःस्नेहं सानुबन्धनम्॥"
– Sushruta Samhita, Nidana Sthana 5/12

MODERN CORRELATION (VITILIGO)

Definition:
Vitiligo is an acquired, idiopathic, hypopigmentary disorder characterized by destruction or malfunction of melanocytes, resulting in white patches of skin.

TYPES:

• Non-segmental vitiligo (more common)

• Segmental vitiligo

• Focal vitiligo

ETIOLOGY:

• Autoimmune destruction of melanocytes

• Genetic predisposition

• Neurogenic factors

• Oxidative stress

CLINICAL FEATURES:

• Milky-white depigmented macules

• Symmetrical in distribution

• Commonly affects face, hands, feet, genitalia

• No scaling or itching (non-inflammatory)

• May be associated with autoimmune diseases like thyroiditis

HISTOPATHOLOGY:

• Loss of melanocytes

• Degeneration of basal keratinocytes

• Mild lymphocytic infiltrate may be present

PROGNOSIS (MODERN):

• Difficult to predict

• Better prognosis in recent onset, localized vitiligo

• Poor prognosis in segmental, widespread involvement