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Agari et al. World Journal of Pharmacy and Pharmaceutical Sciences
AYURVEDIC MANAGEMENT OF PSORIASIS (EK-KUSTHA) – A CASE
STUDY
Dr. Rashmi Agari*1, Dr. Sanjay Kumar Tripathi
2, Dr. Shweta Shukla
3, Dr. Ajit Kumar
Singh4
1PG Scholar, Dept. of Kayachikitsa, Rishikul Campus, UAU, Haridwar.
2Prof., Dept. of Kayachikitsa, Rishikul Campus, UAU, Haridwar
3Assistant Prof., Dept. of Kayachikitsa, Rishikul Campus, UAU, Haridwar.
4PG Scholar, Dept. of Kayachikitsa, Rishikul Campus, UAU, Haridwar.
ABSTRACT
The word psoriasis is derived from Greek word Psora+ Iasis. Psora
means condition. So by combining the words together, psoriasis means
an itchy condition. Psoriasis occurs when the immune system mistakes
the skin cells as pathogens and sends out faulty signals that speed up
the growth cycle of skin tissues of the body psoriasis is a multi-
factorial disease that arises due to many factors such as genetic
predisposition, local trauma, general illness, smoking alcohol,
indigestion, excessive alcohol and stress, both hormonal and
immunological abnormalities are involved at a cellular level in
psoriasis. Dysfunctional of T-cells is the primary event and then hyperkeratosis occurs in the
epidermis. According to Ayurveda vitiation of Vata and Kapha dosha by dietary and lifestyle
changes play a primitive role in the generation of chronic psoriasis. In addition to this, Ama,
a variety of exogenous environmental stressors and genetic / epigenetic factors play a
significant role in the pathogenesis of psoriasis. These vitiated Doshas and males with and
without Ama, in turn, adversely affect the skin and blood tissues as well. So in psoriasis Vata,
Kapha, and Pitta/Rakta vitiation are major contributing pathological factors in its
manifestation. Although Ek-kustha is considered as a disease of Bahya Rogmarga, but its
initiation is from Koshtha, hence diet also plays a prominent role in early pathogenesis of Ek-
Kushtha.
KEYWORDS: Psoriasis, Ek-Kushta, Ayurveda, Ama.
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
SJIF Impact Factor 7.421
Volume 8, Issue 9, 575-583 Case Study ISSN 2278 – 4357
Article Received on
25 June 2019,
Revised on 15 July 2019,
Accepted on 04 Aug 2019,
DOI: 10.20959/wjpps20199-14516
*Corresponding Author
Dr. Rashmi Agari
PG Scholar, Dept. of
Kayachikitsa, Rishikul
campus, UAU, Haridwar.
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Agari et al. World Journal of Pharmacy and Pharmaceutical Sciences
INTRODUCTION
Skin is the vital sense organ of the human body.it is a vital as well as a coplex organ of the
body which usually is underappreciated in case of physical and mental health, unless a
problem or an ailment originates in it. It is the most important barrier of our outer body
against many microorganisms. It also helps in body temperature regulation, maintance of
immunity, excretion of wastes in the form of sweat an sebumand also helps in the vitamin d
synthesis in the presence of sunlight Psoriasis was described as a distinct cutaneous entity
nearly 200 years ago. Thereafter, it was recognised that the term Psoriasis included a variety
of different clinical appearances, which were collectively designated as psoriasis vulgaris. It
is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build
up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are
itchy and sometimes painful. Psoriasis is a chronic skin disease that often comes and goes.
the main aim of treatment is to stop the skin cells from growing so quickly. it has an equal
incidence in males and females. The disease has a polygenic trait with more than one gene
involved. When one parent has psoriasis, 8% of offsprings develop psoriasis, and when both
parents have psoriasis, 41% develop psoriasis.
Psoriasis is a non-infectious chronic inflammatory skin disease with unknown etiology and
relapsing in nature. It is characterized by well defined dry erythematous patches and covered
with adherent silvery white scales. It mostly & commonly affects extensor surfaces of
elbows, knees, scalp, nails & sacral region. It affects 1-2 % of World population. In
Ayurvedic texts, a compromised digestive system leads to an increased Vata Kapha and also
increase of Pitta Dosha in Ras and Rakta Dhatu, which leads to manifestation of Ek-Kustha.
In Charaka Samhita the Ek-Kustha symptoms are very similar to psoriasis.
“अस्वेदनं महावास्तु यन्मत्सस्यशकलोपमम ्तदेककुष्ठं” (च.नन.)
Aswedanam means- absence of sweating, Mahavastu means- extensive localization and
Yanmatsya Shakalopamum means – resembles the scales of fish.
As per ancient Ayurveda text, the Samprapti of psoriasis can be described as vitiated Vata
and Kapha Doshas which adversely affect the Jala Mahaboot of the affected skin region,
resulting in its appearance as whitish colour and scaly & thin skin tissues. These vitiated
Doshas dries the water content of skin and promote abnormal rapid proliferation of skin
tissues. Vitiated Kapha Dosha and accumulated Malas cause itching in the skin and the blood
vitiated by Vata Kapha and Malas alters the normal healing process and hence these vitiated
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Doshas permeate further and become deeply rooted in tissues. Ek-Kustha is one of the
Shudra Kustha Roga which is caused by both dietary imbalance and Ama Dusti which leads
to Raktadusthi.
MATERIAL AND METHODS
Case report
The present case study is a successful Ayurvedic management of Ek-kushta. A 18 year female
patient came to OPD of Kaya-Chikitsa, Rishikul Campus, Haridwar, UAU, Dehradun on
24/12/2018 with chief complaint of red erythematous lesions with severe itching as well as
scaling of skin over both legs, back of palm and back, abodominal region, face, since 2-3
years. which is aggrevated during winter season.
History of present illness
According to the patient, she was asymptomatic 3 year back. One day she noticed some
papules over lower legs with watery discharge and itching. She took allopathic medicine for
this but got no relief. Her condition worsens day by day. The papules spread and become red
patches with scaly skin and spread over to both legs, back of palm and back, face, and
abdominal region. Now she wants to take Ayurvedic treatment along with purification of
body through Panchkarma procedure. So, she came here for better management.
Past History
No previous H/O any other severe illnesses.
Personal history
General condition – average Nadi – Pitta Pradhan Vata (76/Min)
Mala – Saam Mutra – Samanya Gandh, Varna.
Temperature – 98.40f Agni – Vishamagni
Blood pressure – 110/70 mmHg Shabdh – Samnaya
Drika – Samanaya Akriti – Madhyam
Bala – Madhyam Jihva – Niraam
Addiction- tea Nidra- disturbed
Treatment History
Patient took allopathic and local medication for present complaint but could not get
satisfactory relief.
Surgical History
No H/O any surgery.
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Family History
Family history was negative for similar condition or skin disorder and no H/O severe
illnesses.
Investigation
All routine investigation (Hb, TLC, ESR, RBS etc.) done and were within normal range.
Hb % 11.5gm%
TLC 7200/cmm
ESR 30mm/hr
Urine (routineµscopic) normal
RBS 95mg/dl
Differential Diagnosis
According to modern science, based on the symptoms of Ek-Kushta, it can be co-related with
Palmo-planter Keratoderma, Palmo-planter Psoriasis Palmo-planter Xerosis, Palmo-planter
Dermatophytes.
Treatment Given
Ayurveda emphasizes on three fold therapeutic management of the disease viz: Sanshodhana
(biopurification), Sanshamana (pacification) and Nidana-Parivarjana (avoiding causative
factors) for almost all type of disorders including dermatological disorders. Sanshodhana
(Virechana) followed by Sanshamana Aushadha (to subside remaining Doshas after
Sanshodhana) is the backbone of present study in the management of Ek-Kushta (Psoriasis).
Schedule of therapy
Therapy Drug Matra (dose) Duration Anupan
Deepana Nagarmotha churna+
Ajmodadi churna 3gm +2gm
Twice a day
For 3 days Koshna-Jala
Snehpaan Panchatikta-Ghrit
Gugglu
25 ml On 1st day Koshna- Jala
50ml 0n 2nd
day Koshna- Jala
75ml On 3rd
day Koshna- Jala
100ml On 4th
day Koshna- Jala
125ml On 5th
day Koshna- Jala
150ml On 6th
day Koshna- Jala
175ml On 7th
day Koshna- Jala
Abhyanga 777 oil ----------- Next 2 days ------------
Swedana
(sarvanga )
Vaspasweda
(hot fomentation) ----------- Next 2 days ------------
Virechana Trivrit-Avleha
+Triphala Kwatha 80gm + 50ml Koshna- Jala
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Sansarjan
krama
Mand (rice water) According to
appetite 1
st day ------------
Boiled rice According to
appetite Next day -----------
Khichdi According to
appetite Next day ------------
Daal and roti According to
appetite Next day -------------
Sanshmana
aushadh
Nimbadi churna+shudh
gandhak+ras manikya
3gm
+250mg
+75mg
Twice a day
Koshna Jala
Mahatiktak ghrit One tab.twice a
day Koshna Jala
Gomutra arka 1tsf twice a day Koshna Jala
Triphala gugglu 2tab. Twice a
day Koshna Jala
Mahamanjishthadi
kwath 40ml Twice a day
777 oil L/A Twice a day
OBSERVATION AND RESULT
The improvement in the lesions of Ek-Kushta before Shodhana, after Shodhana and during
Samshamana Chikitsa is as shown in figures.
Before treatment
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Agari et al. World Journal of Pharmacy and Pharmaceutical Sciences
After Virechana
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After 1 month treatment
DISCUSSION
In the present case, Shodhana Chikitsa (Virechana) and Sanshaman Chikitsa (drugs) are
selected for the treatment of Ek-Kushta (Psoriasis) because of their ability to pacify the
involved Doshas (Vata &Kapha) and to provide relief in symptoms. Shodhana Chikitsa
(Virechana) is targeted to expel increased Pitta Dosha as well as Kapha Dosha out of the
body. Along with this, Shamana drugs which were given are proved drugs for skin disorders.
Because of Tikta, Kashaya Rasa, Laghu Guna, Sheeta Veerya and Katu Vipaka, Nimba
powder possesses Pitta Shamaka, Kaphaghna, Vrana Ropana, Krimighna, Kandughna, Daha
Prashamana and Rasayana properties. Because of its Anti-inflammatory, Anti-bacterial and
Anti-fungal properties, it is useful in treatment of skin diseases. Gandhaka also have the
property of wound healing. As Psoriasis is an auto immune disorder. Therefore, the
combination thus used has various effects like Vranaropaka, Vranashodhaka as well as acts
as blood purifier. The effect of Maha manjishthadi -Kwatha has Tridosha-shamaka as well as
Blood purifier action
The Probable mode of action of the treatment given is described below:
Chikitsa Mode of action
1- Deepana Enhances appetite and pacifies vitiated
Vata Dosha.
2- Snehapana ,abhyanga, swedana Expels vitiated Dosha from Shakha to
Kostha and also pacifies the Vata Dosha.
3- Virechana To expel increased Pitta & Kapha Dosha
out of the body.
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4- Sansarjana Krama Improve digestion and increases appetite
5- Sanshamana Aushadh To subside remaining Doshas after
Shodhan
CONCLUSION
This case study demonstrated that in Skin diseases, Ayurvedic management (Virechana as
Shodhana therapy and Sanshamana Aushadha) seems very effective. On the basis of the
result obtained in present study, it may be concluded that the addition of Virechana Karma
prior to administration of Sanshamana Aushadha increases the cure rate of Ek-Kushta
(Psoriasis).
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3. Prasad Mamedi, Kshama Gupta, Ayurvedic management of Palmoplanter psoriasis:
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