E-ISSN:2456-3110

Case Report

Kitiba Kushta

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 1 January
Publisherwww.maharshicharaka.in

Ayurveda management of Kitiba Kushta - A Case Study

Rajeswari Y.1*, Chaitra H.2, Maneesha K.3
DOI:

1* Y Rajeswari, Post Graduate Scholar, Department of Agada Tantra, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 H Chaitra, Associate Professor, Department of Agada Tantra, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 K Maneesha, Post Graduate Scholar, Department of Agada Tantra, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.

Skin acts as 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 diseases are commonly observed due to altered lifestyle, lack of physical exercise, poor hygiene, mental stress and improper food habits. Skin disorders constitute as 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. 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 In this present case study a 42 years old male patient diagnosed with Kitibha Kushta got admitted under Agadatantra inpatient department complains of blackish white circular lesions over scalp, bilateral elbow, back, bilateral lower limb and thigh region associated with itching and powdery discharge since 3 years. This patient was treated with Snehapana, Virechana and Shamana Aushadhis for 10 days and marked changes were observed.

Keywords: Ayurveda, Kitiba Kushta, Snehapana, Virechana, psoriasis

Corresponding Author How to Cite this Article To Browse
Y Rajeswari, Post Graduate Scholar, Department of Agada Tantra, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Y Rajeswari, H Chaitra, K Maneesha, Ayurveda management of Kitiba Kushta - A Case Study. J Ayu Int Med Sci. 2023;8(1):149-154.
Available From
https://jaims.in/jaims/article/view/2147

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-23 2022-11-25 2022-12-02 2022-12-09 2022-12-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Y Rajeswari, H Chaitra, K Maneeshaand 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].

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Rajeswari Y et al: Ayurveda management of Kitiba Kushta A Case Study

Introduction

Ayurveda explains some codes and conducts of life which are supposed to follow for both physical and mental health. In present days, people have changed their life style that played an important role in Raktadushti and Dosha Vrudhhi, which lead to skin diseases especially Kushta.[1] Most of the skin diseases in Ayurveda have been discussed under the broad heading of Kushta, which are further divided into Mahakushta and Ksudra Kushta. Kitiba Kushta is considered as one among the Kshudra Kushta.[2]

According to Ayurvedic classics, Kushta is due to Tridoshaja manifestation. Kushta mentioned in Ashta Mahagad i.e., difficult to treat by Acharya Charaka. Kitiba Kushta is having symptoms like Shyava Varna (discoloration), Kina, Khara Sparsha (rough in touch/scaly), Parushatva (hard), Ruksha Pidika (dry vesicle) with Kandu (Itching). Kitiba Kushta is Vata and Kapha Dosha Pradhan Disease with Lakshanas (symptoms) of both Dosha. Kitiba Kushta manifests due to deranged physiology of seven factors. They are Vata, Pitta, Kapha, Tvaka (skin), Mamsa (muscle), Shonita (blood) and Lasika (Lymphatic system). For treating root cause of disease in Bahudoshavastha of Kushta Shodhana is necessary for elimination of aggravated Doshas from the body as mentioned in Samhita.[3]

Here the signs and symptoms were similar to psoriasis. Psoriasis is a chronic skin disease characterized by dry, reddish patches with scaling; occurs especially on the scalp, ears, genitalia and the skin over bony prominences. Prevalence rate of psoriasis in India is 0.44-2.8 per cent. It commonly affects male individuals in their third or fourth decade which is two times more than in females. Contemporary science treats psoriasis with PUVA and corticosteroids. However, the disease has high recurrence rate and these medications has serious side effects like liver failure, kidney failure and bone marrow depletion. Hence, Ayurveda can provide better management in Psoriasis.[4] Shodhana, Shamana and Nidana Parivarajana are the main line of treatment for any disease. So in the present case, for the purpose of Shodhana Chikitsa Virechana Karma[5] was selected. Snehapana was done with Panchatiktaka Guggulu Ghrita.[6] This paper highlights a case study of Kitibha Kushta as a Raktavahasrotodusti Vikara treated with the

Ayurvedic principles in particular Shodhana Chikitsa. Patient got relief in the symptoms. Better result achieved in this case using Shodhana Chikitsa and Shaman Chikitsa along with Bahirparimarjan Chikitsa (External application).

Case Report

Presenting complaint

A 42years old male patient complains of blackish white circular lesions over scalp, bilateral elbow, back, bilateral lower limb and thigh region associated with itching and powdery discharge since 3 years.

History of presenting complaints

Patient was apparently healthy 7 years back, later he underwent cholecystectomy. From past 3 years patient started complaining of blackish white circular lesions over scalp, bilateral elbow, back, bilateral lower limb and thigh region associated with itching and powdery discharge for which he consulted and took allopathic medication but haven’t noticed any relief. Later started with Ayurveda treatment and felt temporary relief. As the complaints got aggravated from past 1 month patient got admitted for better management in SDM hospital.

Past medical history

Patient underwent cholecystectomy 7 years back. He was under medication for low back pain. Patient had previously consulted a private hospital 2 years back (details of medications were not available) where he hasn’t noticed any relief. Later took Ayurveda treatment and felt temporary relief.

Personal history: Appetite: unaltered; bowel: regular; micturition: regular; sleep: disturbed; habits: outside food weekly thrice, non-veg consumption- weekly 3-4 times, alcohol consumption - once in 7-15 days

General examination: On physical examination, appearance was moderately built and no major variations. General complexion - fair; BP - 130/90mmhg; Pulse - 74/min; Respiratory rate - 18/min; Temperature - afebrile

Systemic examination: CVS - S1S2 heard, no murmurs; CNS - conscious and oriented to time, place and person; RS - NVBS heard, no added sounds.


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Integumentary system examination

Inspection: location- B/L lower limb, upper limb, back, scalp; Shape - circular lesion; Color - blackish white; Powdery discharge present; Inflammation present

Palpation: Temperature - present; Edema - slightly present over B/L lower limb, non-pitting; Texture of lesion - rough and scaly

Tests: Candle grease test - positive; Auspitz sign - negative; Koebner phenomenon - positive

Diagnostic criteria

Shyava Varna (discoloration), Kina, Khara Sparsha (rough in touch/scaly), Parushatva (hard), Ruksha Pidika (dry vesicle) with Kandu (Itching) present.

Table 1: Treatment given

Day Treatment given Observation
Day 1 §     Deepana Pachana with Chitrakadi Vati 1-1-1 A/F and Panchakola Phanta 30 ml TID B/F §     Sarvanga Udwartana with Udwartana Choorna §     Diet - Mudga Yusha at 8am §     Kichidi at 1pm and 8pm No marked difference is seen
Day 2 §     Snehapana with Panchatiktaguggulu Ghrita -30ml §     Diet - Ganji after feeling hungry and Kichidi at night §     Powdery discharge reduced
Day 3 §     Snehapana with Pancha Tikta Guggulu Ghrita -60ml §     Diet - Ganji after feeling hungry and Kichidi at night §     Dryness of lesions started reducing
Day 4 §     Snehapana with Pancha Tikta Guggulu Ghrita -90ml §     Diet - Ganji after feeling hungry and Kichidi at night §     Complaints of itching started reducing
Day 5 §     Snehapana with Pancha Tikta Guggulu Ghrita -120ml §     Diet - Ganji after feeling hungry and Kichidi at night §     Dryness of lesions reduced §     Itching and powdery discharge reduced
Day 6 §     Sarvanga Abhyanga with Marichadi Taila followed by Bashpa Sweda §     Diet - Rava idly in the morning, rice Rasam in the afternoon and Kichidi at night §     Dryness of lesions reduced §     Itching and powdery discharge reduced
Day 7 §     Sarvanga Abhyanga with Marichadi Taila followed by Bashpa Sweda §     Diet - Rava idly in the morning, rice Rasam in the afternoon and Kichidi at night §     Dryness of lesions reduced §     Itching and powdery discharge reduced
Day 8 §     Sarvanga Abhyanga with Marichadi Taila followed by Bashpa Sweda §     Virechana with Trivrit Leha - 50g and Draksha Kashaya §     Diet - Ganji after Vegas stopped. §     Number of Vegas - 10 §     Felt lightness of body, skin lesions and itching reduced.


The patient was discharged with Samsarjana Karma (dietary practice) to restore the digestion and metabolism along with palliative medicine (Shamana Oushadhi). Dietary restrictions included non-vegetarian diet, junk food, fried food items and milk products. And also advised to avoid day sleep and alcohol consumption.

Table 2: Medicines on discharge

SN Medicine  Dose  Duration
1. Dooshivishari Gulika 1-1-1 After food 14 days
2. Tiktaka Ghrita 1tsp-0-0 After breakfast 14 days
3. Eladi Taila Q.S For External application 14 days
4. Gandaka Rasayana 1-1-1 Before food 14 days

1st Follow-up: During first follow up, patient found significant improvement in signs and symptoms with no sign of recurrence. Blackish discoloration, powdery scaling and itching reduced significantly.

Medicine given is Haridra Khanda 1tsp-0-1tsp after food with warm water.

Discussion

Deepana and Pachana: For preparing the patient for Snehapana (oleation), the patient should be in a Nirama state. For this Pachana of Ama and Deepana of Agni (digestive fire) is needed. So, here initially Amapachana was achieved with the administration of Deepana-Pachana Dravyas like Chitrakadi Vati[6] and Panchakola Phanta. Along with this light diet such as Mudga Yusha (green gram soup) and Kichadi was advised.

Snehapana: As the Purvakarma (preparatory) for Virechana, Acchasnehapana was given with Panchatiktaka Guggulu Gritha[7]

The Tikta Rasa (bitter taste) helped in Kleda Shoshanam, and caused Kapha and Pitta Harana thereby relieving the symptoms of itching, dryness etc. Snehapana also helped in bringing the Leenadosha into Aleena Doshaavastha. After obtaining the Samyak Snigdha lakshanas[8] (symptoms of proper administration), Sarvanga Abhyanga (full body massage) with Marichadi Taila and Bashpa Sweda (steam fomentation) was administered to achieve Dosha Shithilikarana and bringing the Doshas from Shaaka to Koshta. Marichadi being Vatakaphahara and Kandu Nirharana (removes itching), it was selected for Abhyanga (massage).



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Virechana: After Snehapana and Swedana the Doshas were in Uthklishta state. As the patient was of Pitta Prakruthi and the lesions were presented below Nabhi (navel region), Sodhana procedure selected was Virechana (Purgation). Virechana was administered to expel the Dooshitha Dosha from the Koshta.

Palliative measures: After Sodhana medicine given were Thikthaka Ghritha, Haridra Khanda, Dooshi Vishari and Gandhaka Rasayana and Eladi Taila

Thikthaka Ghritha was given in order to balance Pitta in his body.

Haridra Khanda works efficiently for skin as the ingredients in this are Pitta-Kaphahara in nature, hence useful in this patient condition.

Dooshivishari Gulika[9] was administered for Shesha Dosha Harana. Gandhaka Rasayana is good for skin as it balances Tridosha and is also nourishing in nature.

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Figure: 1, 2 and 3 on the day of admission

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Figure: 4, 5 and 6 on the day of discharge

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Figure: 7, 8 and 9 on first follow up

Conclusion

Kushta is a disease which is having a high impact on the body and mind. This case study is documented evidence for effective management of Kitiba Kushta by Ayurvedic protocol. Shodhana Karma is a procedure that helps to remove the root cause of a disease and prevents the reoccurrence of the disease by eliminating the aggravated Doshas in the body. Also helps in reducing the no. of lesions, size of the lesions and symptoms like itching, powdery discharge and bringing back the skin color into normalcy. The orally prescribed medicines also played a vital role in alleviating the symptoms and worked as Immune booster.

Reference

1. Tripathi B. Charaka Samhita Chikitsasthana 7/13.Chaukhamba Surabharathi Prakashana, Varanasi: 2009. Pg 302.

2. Tripathi B. Charaka Samhita Chikitsasthana 7/28-29. Chaukhamba Surabharathi Prakashana, Varanasi: 2009. Pg 306.

3. Tripathi B. Charaka Samhita Chikitsasthana 7/22. Chaukhamba Surabharathi Prakashana, Varanasi: 2009.Pg305.

4. http://www.webmd.com / skin-problems - and treatments / psoriasis / understanding-psoriasis treatment [Last Accessed on 2021 Oct21]

5. Tripathi B. Charaka Samhita Chikitsasthana 7/41.Chaukhamba Surabharathi Prakashana, Varanasi: 2009. Pg308.


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6. Govindadas. Bhaishajya Ratnavali, Edited by Rajeshwardutt Shastri, Adhyaya 8, verse 26-27, Chaukhamba Prakashan, Varanasi. 2008, page no1240-1241

7. Sharangadhara, Sharangadhara Samhita, Choukhambha Surbharti Prakashan, Varanasi, Reprint 2013, p117-8.

8. Tripathi B, Astanga Hridayam Sutrasthana 16/30.Chaukhamba Sanskrit Prathisthan, Delhi: 1999. Pg 209

9. K.R. Srikantha Murthy, English commentary, Ashtanga Samgraha of Vagbhata, chaukhambha Orientalia Varanasi, Uttarsthan, ch 35, verse 39. Pg403-4


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