E-ISSN:2456-3110

Case Report

Kitibha Kushta

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

Ayurvedic management of Kitibha Kushta - A Case Study

Berbi P.1*, S Kokatnur S.2
DOI:

1* PS Berbi, 3rd Year Post Graduate Scholar, Department of Moulika Siddhanta, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.

2 Sourabha S Kokatnur, Assistant Professor, Department of Moulika Siddhanta, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.

Skin is a barrier protecting the underlying tissue from physical, chemical and biological toxic agents. Skin diseases are mainly affecting the external beauty of the patients that hampers the daily routine of one’s life. Skin disorders constitute one of the largest groups of health problems in general clinical practice. Kushta is a broad term which covers almost all the skin disease in Ayurveda. In general Twak Vikaras are mainly affecting due to altered lifestyle, lack of physical exercise, poor hygiene, mental stress and improper food habits. Kushta is further divided into Maha Kushta and Kshudra Kushta. Kitibha Kushta is one of the Kshudra Kushta. Here Tridosha, Rasa, Rakta, Mamsa, Ambu are affected. Rakta Dusti is the main cause of Twak Vikaras. Virechana is the Shodhana Karma for Raktaja Vikaras. After Shodhana, Shamana Chikitsa plays major role for Alpadosha Nirharana. This paper highlights a case study of Kitibha Kushta as a Raktavahasrotodusti Vikara treated with the Ayurvedic principles in particular Shodhana Chikitsa

Keywords: Kitibha Kushta, Shamana, Shodhana Chikitsa, Psoriasis

Corresponding Author How to Cite this Article To Browse
PS Berbi, 3rd Year Post Graduate Scholar, Department of Moulika Siddhanta, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.
Email: 		PS Berbi, Sourabha S Kokatnur, Ayurvedic management of Kitibha Kushta - A Case Study. J Ayu Int Med Sci. 2022;7(1):390-398.
Available From
https://jaims.in/jaims/article/view/1631

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-24 2022-01-25 2022-02-01 2022-02-08 2022-02-15
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by PS Berbi, Sourabha S Kokatnurand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)390
Berbi P. et al: Ayurvedic management of Kitibha Kushta - A Case Study

Introduction

Ayurveda, the eternal science which has its root in Vedas, the oldest available literature explains the health of an individual as the physical, mental, social and spiritual well-being. Ayurveda says “Dosha Dhatu Mala Mulam Hi Shareeram”.[1]

If any Dusti in this causes Vikaras to the individual. “Kushnati Shareerasya Shonitam Vikrute” means vitiation of Rakta Dhatu leads to Kushta.[2]

Twak Vikaras Nidana are most commonly arises due to Mithyahara, Vihara, Manasika vitiate Tridosha which further leads to the affliction and aggravation of Rasa, Rakta, Mamsa and Lasika.[3]

Each Dosha vitiation elicit the different Lakshanas in the Twacha. According to Charaka Acharya, Kitibha Kushta is one of the Raktapradoshaja Vikara caused by vitiation of Vata and Kapha Dosha in excess having Lakshanas like Shyava Varna (blackish brown colour), Kina Khara Sparsham (rough on touch), Parusham (Dryness), Ruksha Pidika (skin eruption) and Kandu (itching).[4]

According to Acharya Charaka a wise physician is one who closely observe the Vriddhi, Sthana, Kshaya Avastha of Roga, Deha, Agni, Chetas  of Rogi then should give the Chikitsa to the Rogi by treating all at the same time.[5]

The Ousadhi administered by Bhishak should not provoke another Vyadhi by subsiding one Vyadhi.[6]

The main line of treatment of Kustha is repeated Shodhana.[7].The Dosha which are pacified by Shodhana never re-occur. Virechana is the Shodhana Karma for Raktaja Vikara for eliminating Doshas from its root.[8]

Then Shamana Oushadhi given for Alpadosha Nirharana. In Modern, Psoriasis is considered as a genetic, immunological and systemic disorder. Generally, there is a clinical manifestations like Psoriatic arthritis, Psoriatic Pustules and psoriatic erythroderma as well as some cases of psoriasis palmoplantaris and inverse psoriasis are to be considered as severe. Even though modern way of treatment has many steroids, topical creams and ointment, the recurrence of psoriasis is common. It is also important to note that they have considerable side effect when used for the longer period.

Hence it is a need of an hour to search effective, adequate and safe ideal remedy from Ayurveda to cure the disease from its root.

Case Presentation

Presenting Complaints: A 63 yrs old female came to OPD of Ayurveda Mahavidhyalaya College and Hospital, who was apparently normal before 15 years developed small skin lesion over upper, lower limb, scalp and abdomen associated with severe itching and powdery discharge distributed all over the body. She is housewife belonging to low economic class, Hindu family background. She consulted an allopathic physician and was advised with antibiotics, anti-histamines and topical steroids. But there was no considerable relief. Later she consulted to our hospital OPD for treatment. She is not known case of DM, HTN.

Personal History

Diet: Excessive Guru Ahara (heavy food), Dadhi (curd), Mamsa Sevana (meat), Viruddha Ahara (incompatible food).

Appetite: Less appetite

Bowel: constipated

Micturition: Normal 4-5 times per day

Sleep: Disturbed

Clinical Findings

Patient was very much depressed with the present condition. O/E - Circular skin lesion with silvery scale like patches distributed over upper and lower limps, scalp, hands, abdomen associated with severe itching, blood discharge, scaly, dry, round, rough lesions were found.

Skin Examination: Candle grease sign was positive.

Laboratory Investigation: CBC – Hb% - 10.04%, TC – 11,800 /Cu.mm, DC - P - 66% L 30% E 4% ESR - 100 mm/hr, Platelet count - 3.90 lakhs / hr

Samprapti Ghataka

Dosha - Vata Kapha Pradhana Tridoshaja

Dushya - Rasa, Rakta, Mamsa

Ama - Jatharagnijanya Ama

Agni - Jatharagnijanya, Dhatwagni


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)391
Berbi P. et al: Ayurvedic management of Kitibha Kushta - A Case Study

Srotas - Rasavaha, Raktavaha Srotas

Srotodushti Prakara - Sanga

Rogamarga - Bahya

Udbhava Sthana - Amasaya

Vyaktasthana - Twacha

Roga Swabhava - Chirakari

Sadhyasadhyata - Kricchrasadhya

Samprapti

Nidana Sevana (Aharaja, Viharaja, Manasika) (Excessive intake of Dadhi, Guru Ahara, Atiamla, Lavana Rasa, Ati Mamsa, exposure to Sheeta Maruta, Krodha, Shoka)

↓

Causes Agni Vyapara Vikruti

↓

Tridosha Vikruti along with Rasa, Rakta, Mamsa, Lasika

↓

Anna Rasa Vikruti

↓

Vikruta rasa gets Margavarodha in Twacha

↓

Pidika with Kandu, Daha in Sarvanga

↓

Causes Kitibha Kushta

Chikitsa

“Samprapti Vighatanam Eva Chikitsa”. Ayurveda emphasizes on “Swasthasya Swasthya Rakshanam and Aturasya Vikara Prashamanam” hence Chikitsa can be considered as Kriya or Karma which maintains the Samyata in Dosha, Dhatu, Mala and Agni; and simultaneously also cures the disease. It can be classified under the 3 categories

  • Daivavyapashraya,
  • Yuktivyapashraya
  • Satwavajaya

Antahparimarjana Chikitsa includes Shodhana, Shamana and Nidana Parivarjana therapies.

As Kushta is the Raktavaha Srotodusti Vikara, Virechana is the main line of treatment adopted in it. Virechana is given with the help of Trivrut, Danti and Triphala etc. Virechana is advised when Kapha and Pitta Pradhana Kushta localized in Vata Sthana.

Vyavacchedaka Nidana


Lakshana Sidhma Kitibha Vipadika Dadru Charmadala
Dosha Vatakapha Pradhana Vatakapha Pradhana Vatakapha Pradhana Kapha Pitta Pradhana Pittakapha Pradhana
Vedana Kandu (Itching) Ugrakandu Teevravedana Mamsakandu (Severe Itching) Kandu Shoola (Pain), Kandu, Sparsha Sahatva Osha (Burning Sensation), Chosha, Toda, (Pricking Pain) Daha
Varna Sweta (White), Tamra (Coppery), Alabu (Bottle Guard) Puspavarna Shyava (Reddish Black), Krishna (Black), Asita Varna (Blackish) - Raga Atasipushpa Varna Tamra Raktavarna (Reddish Colour)
Samsthana Rukshamabhi Snigdham Anitah Dourgandaka Puspavat Ajogristam Vimunchati Slakshana Sparsha Khinakhara Sparsha Parusha Sravi Snigdha Ruksha Panipada Sputana, Saragapidika Pidika (Eruption) Mandala Utsanna Parimandala Visarpini Anushangini Sasphota (Carbuncle)
Sthana Bhuyasi Urahsi - Panipada Deergapratana Tala Hasta Padatala

Vyadhi Vinishchaya

Kitibha Kustha

Materials and Methods

Amapachana (Appetizer), Arohana Snehapana (oleation therapy), Virechana (Purgation), Samanoushadhi (Internal medicine), Pathya - Apathya Palana (Diet).


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)392
Berbi P. et al: Ayurvedic management of Kitibha Kushta - A Case Study

Treatment Schedule

The patient was administered with Shodhana and Shamana medicines


Date Treatment Medicine/Procedure
21/04/21 Amapachana Trikatu Churnam[9] 1 tsp BD with hot water after food for 3 days
24/04/21 Snehapana Pancha Tiktaka Ghrita[10] 30ml - 1st day 60ml - 2nd day 100ml - 3rd day 120ml - 4th day
28/04/21 - 30/04/21 Abhyanga and Swedana One day before Virechana Kaphautklesa Ahara Masha, Nimbu, Lavana, Sheeta Jala, Paniya, Katu Rasa Ahara given Manjisthadi Taila[11] Abhyanga followed by Bashpa Sweda
01/05/21 Virechana Karma       Trivrut Lehyam[12] 30gm morning 8am Total – 16 Vega observed Samsarjana Krama Advised Pathya Apathya, Nidana Parivarjana advised.

 

Drug Name Indication
Trikatu Churna Deepana, Amapachaka, Shleshmaghna, Medoghna, Kusthagna
Panchatiktaka Ghrita Deepana, Pachaka, Srotoshodhaka, Raktaprasadaka, Kandughna, Kushtaghna, Varnya
Manjishthadi Tailam Raktashodhaka, Vranaropaka, Twachya
Trivrut Lehyam Mridu Virechaka

Assessment of clinical features based on gradation system


Grading Vaivarnya Srava Kandu Ruja Lesion Size
00 Prakruta Twak Varna Nissrava   Akandu     Avedana Lesion as scar
01 Krishna Jala Sannibha Srava Madhyama Kandu but not disturbing normal activity Vedana on deep pressure over Pidaka Lesion less than 1 cm
02 Krishna Rakthabha Pooya Srava/ Rakta Srava Occasional Kandu disturbing normal activity Sa Vedana Sparsha   Lesion between 1 to 3 cm
03 Rakthabha Sa Raktha   Pooya Srava Satata kandu with nidranasha Asparsha Vedana Lesion more than 3 cm

Shamanoushadhi

  • Mahatiktaka Ghritam 1tsp BD bf with hot water
  • Tiktamrita 1 TID af
  • Panchatikta Ghrita Guggulu 1 TID af
  • 777 Oil External application

Results

Lakshanas BT AT
Vaivarnya 02 01
Srava 02 00
Kandu 03 00
Ruja 03 00
Lesion Size 03 00
Scaling Present Absent

Pathya Apathya

  • Pathya - Laghu Anna (light diet), Gritha Yukta Anna, Purana Dhanya, Mudga, Jangala Mamsa
  • Apathya - Ati Guru Anna, Amla Rasa, Dugdha, Dadhi, Anupa Mamsa, Matsya, Tila, Guda

Discussion

According to Ayurveda Kitibha Kustha is a Vatakaphapradhana Kushta. A 63 yrs old patient came with the complain of small skin lesion over upper, lower limbs, scalp, abdomen associated with severe itching distributed all over the body. On history taking patient had irregular diet pattern and excessive use of Dadhi, Atimamsa, Guru, Virrudha Ahara. Viharas such as more exposure to Sheetamaruta, Atichinta Krodha Shoka are the Nidana causes Agni Vyapara Vikruti leads to Tridosha Vikruti along with Rasa, Rakta, Mamsa, Lasika results in Ahara Rasa Vikruti. Vikruta Rasa gets Margavarodha in Twacha results in Pidika with Kandu and Daha in all over the body cause Kitibha Kushta. Because of Rasavaha Srotodusti the patient is having Agnimandhya and because of Apana Vayu Vaigunya cause Malabaddhata. There is significant increase of Ruksha, Khara and Sheetaguna in the patient, therefore Sneha Virechana was planned for Shodhana. Chikitsa was started with Amapachana with Trikatu Churnam for 3 days for Agni Sandeepana Karma and for Dosha Shithilakarana Snehapana with Panchatiktaka Ghrita planned for 4 days in Arohana Krama to bring the Dosha from Sakha to Koshta then followed by Abhyanga and Swedana for 3 days. Then Virechana with Trivrut Lehya contains ingredients like Trivrut,


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)393
Berbi P. et al: Ayurvedic management of Kitibha Kushta - A Case Study

Khanda Sharkara, Ghruta. Trivrut is mainly having Tikta, Katu Rasa, Ushna Veerya, Kaphapittahara and Kushtaghna property. It is a Sukha Virechaka. It removes Doshas from Koshta by its Rechana property. Due to Laghu, Rooksha, Teekshna Guna it does Deepana and Pachana. By its Srotoshodhana property it acts on minute channels and does Twak Prasadana. The mode of action of Virechana Oushadhi is Adhobhaga Dosha Harana having the property like Ushna, Tikshna, Sukshma, Vyavayi and Vikasi due to this property Aushadha reaches Hrudaya and circulate through the vessel. Due to Ushna property present in Aushadhi they liquefy the Doshas located in the channels of entire body, thus Doshas flows through GIT, morbid Doshas reaches the Amasaya carried by Udana Vayu, due to the predominance of Prithvi and Jala Mahabhuta of Doshas from Koshta and leads to Dosha Harana. 16 Vegas were attained, then Samsarjana Krama is advised. On discharge Shamana Ousadhi possessing Tikta, Snigdha Guna, Kusthaghna, Kandughna was advised to continue and patient was asked to come for follow up after 15 days. Pathya Apathya is advised.

Conclusion

This case study is documented evidence for the successful treatment of Kitibha Kustha through Shodhana and Shamana Chikitsa. Shodhana has great importance in Bahudosha Avastha. Acharya Sushruta opines that repeated Shodhana has great importance in Bahudoshaavastha in Kushta. Generally, Kustha Vyadhi has tendency to reoccur. So, Nidana Parivarjana should be done along with the Chikitsa.

jaims_1631_01.JPGBefore Treatment

jaims_1631_02.JPG

After Treatment

jaims_1631_03.JPGjaims_1631_04.JPG


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)394
Berbi P. et al: Ayurvedic management of Kitibha Kushta - A Case Study

Reference

  1. Sushrut, Sushrut Samhita, with Nibandhasangraha of Dalhanacharya and Nyayachandrika Panjika of Gayadasacharya edited by Vaidya Yadavji Trikamji Acharya, Sutrasthana 15th chapter verse 23, Chaukamba Surbharati Prakashan, Varanasi.
  2. Vd Yadavji Trikamji Acharya, Agnivesha, Charaka samhita, with Ayurveda Dipika commentary by chakrapani, sutra sthana 13th chapter verse 22, Chaukhamba Publication, New Delhi. Reprint 2018.
  3. Vd Yadavji Trikamji Acharya, Agnivesha, Charaka samhita, with Ayurveda Dipika commentary by chakrapani, nidana sthana 5th chapter verse 3, Chaukhamba Publication New Delhi. Reprint 2018.
  4. Vd Yadavji Trikamji Acharya, Agnivesha, Charaka samhita, with Ayurveda Dipika commentary by chakrapani, Chikitsa sthana 7th chapter verse 22, Chaukhamba Publication New Delhi. Reprint 2018.
  5. Vd Yadavji Trikamji Acharya, Agnivesha,Charaka samhita, with Ayurveda Dipika commentary by chakrapani, vimana sthana 8th chapter verse 36,37,Chaukhamba Publication New Delhi. Reprint 2018.
  6. Vd Yadavji Trikamji Acharya, Agnivesha, Charaka samhita, with Ayurveda Dipika commentary by chakrapani, vimana sthana 8th chapter verse 23, Chaukhamba Publication New Delhi. Reprint 2018.
  7. Vd Yadavji Trikamji Acharya, Agnivesha, Charaka samhita, with Ayurveda Dipika commentary by chakrapani, sutra sthana 16th chapter verse 20, Chaukhamba Publication New Delhi. Reprint 2018
  8. Vd Yadavji Trikamji Acharya, Agnivesha,Charaka samhita, with Ayurveda Dipika commentary by chakrapani, Chikitsa sthana 7th chapter verse 39, Chaukhamba Publication New Delhi. Reprint 2018
  9. Pandit Parasurama Sastri, Pandit Sarangadharacharya, Sarangadhara Samhita with Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika, Madhyama Khanda 6th chapter verse 12, Chaukhamba Publication, Varanasi. Reprint 2008.
  1. Pandit Parasurama Sastri, Pandit Sarangadharacharya, Sarangadhara samhita with Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika, Madhyama Khanda 9th chapter verse 11, Chaukhamba Publication, Varanasi. Reprint 2008.
  2. Sahasrayogam Taila Yoga Prakarana 42 K.Nishteswar, Dr. R.Vidyanath, Sahasrayogam text with English translation, Chowkhamba Krishnadas Academy, Varanasi. 2008
  3. Dr. Anna Moreshwar Kunte & Krsna Ramachandra Sastri Navre, edited by Pt. Hari Sastri, Astangahrdaya of Vagbhata, with the commentaries: Sarvangasundara of Arunadatta and Ayurvedarasyana of Hemadri, kalpasthana 2nd chapter verse 9, chaukhamba Sanskrit Sansthan, Varanasi, Reprint 2018.

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)395