GUIDED BY

DR.UMESH SHUKLA MD(ayu), PhD

DR.KAMINI SONI MD(ayu) DR.BABITA DASH

MD(ayu), PhD

PRESENTED BYPRAKASH SINGH RAJPUT

MD-FIRST YEAR

DEPARTMENT OF PANCHAKARMA

INTRODUCTION

All skin disease in ayurveda have been discussed under the

broad heading of “Kustha” which are further divided in

Mahakustha and kshudrakustha. Ekakustha is considered one

of the kshudrakustha in Ayurveda.

Acc. to Ayurvedic classics each type of kustha is to be a

Tridoshaja menifestation.their Doshik identity can be

established on the basis of dominance of Dosha in the

Samprapti.

The Ekakustha is Vata-Kapha dominance

Causes and Specific etiology for Ekakustha has been not

described in any Ayurvedic text . So it can be understood by

general etiology of Kustha all causes ok Kustha can be

considered under two main causes.

Aharaj hetu Faulty diet and dietetic pattern, the most common

Hetu cause of Kustha mentioned in all the Samhitas.

Viharaj hetu Faulty life style proper follow up of Dincharya,

Ritucharya, Aachar Rashayana, Ahara Vidhi Vidhana.

Accumulation of low potency poisons (dooshi

visha),exposure to severe climatic conditions, controlling

natural urges like vomit, micturition, bowel emptying etc.

Taking bath in cold water immediately after physical exertion,

afternoon sleep.

PATHOGENESIS

Nidan Sevana,

Tridoshas will get vitiated.

These vitiated Doshas move in the Triyaka Sira.

Then they have Sammurchchana with the Dushya.

Then it will reach the Bahya Roga Marga

The doshas thus lodges into the skin continue to aggrevate

If these Doshas are not treated properly they enter the deeper Dhatus

Resulting in discoloration in the form of patches on the skin.

Dosha Vata, pitta, kapha

dushya Tvaka, rakta, mamsa, laseeka

srotash Rasavaha, raktavaha, mamsavaha, svedavaha

srotodusti Sanga, vimargagamana

marga Baahya rogamarga

Adhishthana svabhava tvaka

Aswdanam- Absence of sweating. Predominance of Vata and

Kapha dosha cause Sankoch and Sanga respectively to cause

obstruction in Swedavaha Srotasa leading to Aswdanam.

Mahavastu- Extensive lesions invading whole body. The area of

involvement of the lesion is vast due to Sighkari Guna of Vata,

Redness ( due to Pitta ), Itching (due to Kapha ) through Rakta

spread quickly in vast area.

Matsyashakalopamam- Scaling resemble of fish. Due to Vata

dosh increase mitosis and produce more dead cells (Scaling ) in

Twacha within 2 – 14 days by increasing frequent cell division.

Krisna- aruna varnata

It is difficult to say that ekakustha is in terms of

modern science. There is no disease in modern science

which can be exactly be correlated with ekakustha. But

symptomatology of psoriasis are mostly related to

ekakustha.

Many researchers have tried to attribute psoriasis with

one or other type of kustha.

ekakustha psoriasis

aswedanam The lesion of this desease are dry and rough

mahavastum Lesions are found all over the body

matsyasaklopam Well defined raised macules, papules & plaques

of erythema found which are covered with

silvery scales.

Krishna- aruna varna The lesion are raised & erythamatous, thick

lesion becomes black colour.

Psoriasis is defined as chronic non-infectious inflammatory

skin disease.

Size from few milimetre to several centimeter, individual

lesion are well demarcated,

It is characterized by well defined Erathematous slightly

raised plaques and papules with silvery scales,

They may be covered by dry, brittle, silvery or grayish white

loosely adherent micaceous scales. and typically on extensor

distribution.

In psoriasis skin cells replicate at an extremely rapid rate .

New skin cells are produced eight times faster i.e. within

three days in comparison to normal duration of i.e. 21 – 24

days.

But the rate at which old cells slough off is unchanged. This

causes cells to build up on the skin’s surface forming thick

patches.

The exact cause of Psoriasis is not known but it is believed

to have a genetic component i.e. family history.

Several factors act as a trigger i.e. stress, climate change,

excessive alcohol consumption, smoking.

Metabolic factors (e.g. ca deficiency), Drugs (lithium salts,

iodine, beta blockers, ace inhibitors, anti epileptic drugs,

NSAIDs, Sun burn, Hormonal Imbalance, Throat infection

(Streptococcal), Trauma etc.

The pathogenesis of psoriasis remains unclear. The initial reaction is passibly on intrinsic defect of keratinocytes

increased cytokines production

expansion of CD45RO-T cells

production of type 1 cytokines

results in changes in epidermal proliferation,

migration of neutrophils in to the epidermis

proliferation of vessels in the pappilary dermis.

Sites of Psoriasis; extensor surface of Elbow,

Anterior aspect of Tibia, Palm, Soles, Nails,

back of trunk, Scalp. Lips are not involved ,

oral lesions rare.

(1) Guttate psoriasis.

(2) Pustular psoriasis.

(3) Palmo-Plantar psoriasis.

(4) Psoriasis erythroderma.

(5) Flexural psoriasis.

To study the treatment of Kustha systematically it is

necessary to look at three principles of treatment which are

described in Krimi Chikitsai.e.

Samsodhana ,

Samsamana and

Nidana Parivarajana separately.

All Acharyas have emphasized on Shodhana therapy in the

management of Kustha.

Acc to Acharya Charaka

Shodhana may be administered based on predominance of

vitiated Dosha.

Acc to Acharya Charaka

In Vata - Ghritapana,

Kapha - Vamana, and

Pitta - virechana, raktamokshana

Acc to Acharya Chakrapani

In excessive morbidity of the Doshas repeated Shodhana

should be performed at regular intervals i.e.

Vamana karma -15 days,

Virechana karma - in a month,

Raktamokshana - in 6 month ,

Nasya - in every 3 days.

Acharya Sushruta - also advised to carry out

“Ubhyato Samsodhana” even at the Purvarupa

condition of kustha .

Acharya Shusruta also advised Samsodhana treatment

in the management of Rasogata, Raktogata,

Mamsogata, Medogata kustha.

In Kustha Rakta Dhatu is considered as one of the main

Dhatu which is responcible for Prasraya stage of Kustha

Samprapti,

Pitta Dosha and Rakta Dhatu have Ashraya- Ashrayi

relationship,

hence treatment modality of Pitta Dosha and Rakta Dhatu

complimenting to each other.

It is a specific modality for the elimination of Pitta Dosha

and it is also effective upon Kapha and Rakta.

Acharya Sushruta recommends Nitya Virechana for Kustha

as it is a Bahudoshajanya Vyadhi.

When compared to Virechana Karma, Nitya Virechana can

be easily employed without hospitalization even for Alpa

Bala patient.

Previous studies shown that Nitya Virechana is highly

significant over -Matsyasakala, Mandala, Aswedanam,

Rukshta, and in Kandu.

Virechana removes vitiated pitta dosha from body .

Pitta dosha is resides in rakta dhatu (mala of rakta)

therefore the purificative measures of pitta dosha, also

improves the rakta dhatu.

Because of this reason virechana is very effective for the

management of ekakustha.

Potent stimulus for causing the G.B. contraction is from cholecystokinin hormone.

This cause increased secretion of digestive enzymes from pancrease .

The stimulation for this hormone is the presence of fatty foods in deodenum & G.B. is also stimulated by acetylecholine secreting nerves fibres from both vagus &

intestinal enteric nervous systems.

This bile contains bile acids, bile pigments, cholesterol, lecithin, water, sodium, potasium, bicarbonates ions, which

are eliminated out

can be called as pitta.

Panchakarma is a treatment modality which offers biological

purification and thereby the rejuvenation of cells, organ and

system.

It is a therapy for cleansing body toxins .

Among the Shodhana karma in ekakustha, Virechana karma

was adapted more in comparision to Vamana karma.

It might be due to the fact that according to Ayurved, Kustha

is considered as one among the Rakta Pradoshaja Vyadhies.

As such Pitta Dosha is accepted as mala of Rakta, so

Virechana is specific for Pitta dosha. Pitta shodhana occurs

due to Virechana karma and ultimately it decreases Dushta

Rakta (impure blood).

due to the deep level purification of Rakta Dhatu and

Pitta Dosha, Kustha ( Ekakustha) gets controlled easily.

Shaman Chikitsa was also very commonly utilized after

Virechana (Shodhana Chikitsa) to control the Sneha

Dosha.

Virechana karma ( sodhana ) there are least possibilities

of recurrence as vitiated Doshas are expelled out

completely. Psoriasis being a typical example of

increased toxic material “DOSHA” has therefore been

advocated to be treated with Virechana karma.

The Lakshnas of Ekakustha is similar to that of Psoriasis.

Faulty diets and life style are the main causative factor in Kustha Rogas.

Ekakustha is Kshudra Kustha with Vata-Kaphadominancy and In Kustha, Rakta Dhatu is considered as one of the main Dhatu which is responcible for Prasraya stage of KusthaSamprapti,

Pitta Dosha and Rakta Dhatu have Ashraya-Ashrayi relationship,.

Hence treatment modality of Pitta Dosha and RaktaDhatu complimenting to each other ,

Virechana is most important measures of Shodhanafor Kustha . Though it is a specific modality for the elimination of Pitta Dosha but it is also effective upon Kapha and Rakta.

Virechana karma followed by shaman Aushadhawith Pathya aahara was found as a suitable treatment plan to manage Ekakustha (psoriasis).

Prevalence of psoriasis varies in different part of the world. Prevalence in different population varies from 0% to 11.8% in the USA. The prevalence of psoriasis was estimated to be around 4.6% Prevalence studies from India are mostly hospital-based. Highest incidence was noted in the age group of 20-39 years.

Acc to Acharya Charaka

Usna , Tikshna , Sukshma , Vyavayi , Vikashi are the Guna

of Virechana Dravyas.

Because of their potency reaching the heart and circulating

through vessels effect the mass of impurity in the entire

body,

liquefy it out through large and small ducts due to Agni

nature and

disjoin it due to Tikshna guna, consequently the disjoined

mass floating in the body like honey in vessels,

reaches the stomach due to Sukshma guna nature

and being propelled by Udana (Vayu) is thrown down

because of the natural composition of the drug with jala and

prathvi (Mahabhutas) and the specific potency.