E-ISSN:2456-3110

Case Report

Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

Ayurveda is a single hope for Autoimmune disease Psoriasis: A Case Study

Rahangdale P.1*, Meshram R.2, Sharma S.3
DOI: http://dx.doi.org/10.21760/jaims.8.3.32

1* Prachee Rahangdale, Post Graduate Scholar, Department of Kayachikitsa, Pt. Khushilal Sharma Govt.(auto) College & Institute, Bhopal, Madhya Pradesh, India.

2 Rajesh Meshram, Reader & HOD, Department of Kayachikitsa, Pt. Khushilal Sharma Govt.(auto) College & Institute, Bhopal, Madhya Pradesh, India.

3 Shraddha Sharma, Assistant Professor, Department of Kayachikitsa, Pt. Khushilal Sharma Govt.(auto) College & Institute, Bhopal, Madhya Pradesh, India.

An autoimmune disease are arises due to abnormal response of immune system. Psoriasis is one of very common autoimmune disease characterized by dry skin and raised, rough, red areas on the skin covered with fine silvery scales and itching in the lesion of skin they disturb the daily routine of the patients. In Ayurveda all the skin diseases are described under a broad term of Kustha, which are further divided in Mahakustha & Kshudra Kustha. Kitibha Kustha one among 11 varieties of Kshudra Kustha which resembles psoriasis clinically. In modern medicine There is no certain cure for this disease, it provides symptomatic relief but also has side effects in long course. Here an effort was made to treat a 29year old female diagnosed case of plaque psoriasis, by Ayurvedic regimen. In the study initially Virechan Karma was performed. After Sanshodhan, Sanshamana drugs were given for 30 days. After 30 days we observed a marked improvement in overall condition of the patient with no recurrence since last 4 months.

Keywords: Kustha, Mahakustha, Kshudra Kustha, Virechan, Sanshodhan, Sanshamana

Corresponding Author How to Cite this Article To Browse
Prachee Rahangdale, Post Graduate Scholar, Department of Kayachikitsa, Pt. Khushilal Sharma Govt.(auto) College & Institute, Bhopal, Madhya Pradesh, India.
Email: 		Prachee Rahangdale, Rajesh Meshram, Shraddha Sharma, Ayurveda is a single hope for Autoimmune disease Psoriasis: A Case Study. J Ayu Int Med Sci. 2023;8(3):169-173.
Available From
https://jaims.in/jaims/article/view/2355

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-01-24 2023-01-26 2023-02-02 2023-02-09 2023-02-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Prachee Rahangdale, Rajesh Meshram, Shraddha Sharmaand 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 2023;8(3)169
Rahangdale P et al: Ayurveda is a single hope for Autoimmune disease Psoriasis

Introduction

The term Psoriasis originated from the Greek word ‘Psora’ that means, ‘itch’.[1] Psoriasis is a chronic inflammatory, hyperproliferative skin disease. It is characterised by well – defined erthromatous scaly plaques, particularly affecting extensor surfaces, scalp and nails and usually follows a relapsing and remitting course.[2] In psoriasis, main abnormality is of increased epidermal proliferation to excessive multiplication of cells in the basal layers. The transit time of keratinocyte is shortened and epidermal turnover is reduced to 5-6 days from 28-30 days.[3]

Because of its relapsing nature the disease has remained a great problem. In this disease patients not only have physical problems, but also suffer mental and social distress. Diagnosis of the disease is made mainly on the basis of clinical symptoms.[4] Globally psoriasis affects only 1% of the total population, with men and women being equally affected. The overall incidence in India ranges from 0.44% to 2.2%, with an overall prevalence of 1.02%.[5] Methotrexate, corticosteroids etc. can be used for the management of psoriasis in modern medicine, but long term use of these medicines are very harmful.

On the basis of symptoms, it can be correlated with Kitibha Kustha. Kitibha Kustha is mentioned in all Ayurvedic classics under Kshudra Kustha and has predominance of Vata and Kapha Dosha.[6] The causative factors of Kitibha Kustha is same as Kustha. Dietary factors as Viruddha Aahara, excessive consumption of Drava, Snigdha, Guru Aahara, Navanna, Vega Dharana specially of vomiting are major aetiologies. Indulgence in sinful act and ill Manovritti (negative mentality) are associated mental factor for causing the disease.[7] Acharya Charak has mentioned the symptoms of Kitibha Kustha as Shyava, Khar Sparsh, Parusha[8] and Acharya Sushruta described its symptoms as Stravi, Vrittam, Ghan, Ugra Kandu, Snighda, Krishna.[9] The etiological factor leads to vitiation of Tridosha especially Vata and Kapha. These Dosha through Tiryakvahini Siras proceed to Bahya Rogamarga i.e., Twacha, Rakta, Mamsa, and Lasika and cause the symptoms of disease.[10] Repeated Samshodhana along with Samshamana is main line of treatment.[11] Both Antah Parimarjan and Bahiparimarjan therapies have been indicated in Kushtha Roga.

In present case study there is Vata-Kapha dominancy with involvement of Tridosha. Therefore for this study, Virechana as Samshodhana and Panchatikta Ghrita Guggulu tablet (it contains drugs having Tikta, Kashay Rasa, Ushna Virya and Katu Vipak) and Mahamarichyadi Tailam for local application as Shamana drug was planned for the management of psoriasis.

Aim and Objective

To evaluate the role of Samshodhan and Sanshaman Karma in the management of psoriasis.

Material and Methods

Selection of patient: for this study, patient was registered from OPD of Pt. Khushilal Sharma Govt. Ayurvedic Hospital Bhopal.

Plan for study: Patient taking allopathy medicine was stopped during study period. The drug required for Virechana Karma were procured and prepared in Prakalpa of Panchakarma in Pt. Khushilal Sharma Govt. Hospital Bhopal.

Duration of study: 30 Days. Follow up every 30 days for 6 months.

Case Report

Basic information of the patient

Age - 28 yrs

Sex - Female

Religion - Hindu

Socio economic status - Middle class

Chief complaints

1. Erythematous rashes overhead, both hands and legs, abdomen and back since 10 yrs.

2. Itching in rashes.

3. Scaling on scratching.

4. Low back ache.

History of present illness
The patient was normal 10 year back. Since then patient have been suffering from reddish patch all over head, scaling of skin and itching gradually increasing all over body.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)170
Rahangdale P et al: Ayurveda is a single hope for Autoimmune disease Psoriasis

For this complaints she got diagnosed psoriasis in allopathic hospital and she took treatment from different doctors but got no satisfactory relief, than she came to Pt. K.L.S. Govt. Auto. Ayurveda College & Hospital on 24/11/2021 in Kayachikitsa Department OPD.

History of past illness - no

Family history - no

Personal history

Appetite - Normal

Bowel - constipated often

Sleep - Normal

Micturition - Normal

On examination

Candle-Grease sign - Positive

Auspitz sign - Positive

Koebners phenomenon - Positive

Vitals were normal.

Treatment protocol

1. Deepan Pachana - Chitrakadi Vati 500mg BD, Panchkol Phanta 10ml BD for 5 days.

2. Abhayantara Snehan - Panchtikta Ghrita for 7days in increasing order from 50 ml to 180 ml with luke warm water followed by Mridu Snehan and Swedana for 3 days. Then Virechana Karma was performed.

3. Virechana Karma - with Trivritta Kashayam.

4. Samsarjana Karma - for 7days was done before starting Samshamana

5. Samshamana therapy - for Samshamana therapy following medicine were used -

  • Tablet Panchatikta Ghrita Guggulu - it contains having like Tikta, Kasaya Rasa, Ushna Virya and Katu Vipak. These properties collectively possess Vatahara and Kaphahara properties and act as excellent antimicrobial and ant inflammatory agents.
  • Mahamarichyadi Tailam - It is ant inflammatory and antipruritic, moisturising agent.

PASI Score[12]: The current gold standard for assessment of extensive Psoriasis has been the

Psoriasis area severity index (PASI). PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). The PASI is a measure of the average redness, thickness and scaling of the lesions (each graded on a 0-4 scale), weighted by the area of involvement.

Steps in generating PASI score

a. Divide body into four areas head, arms, trunk to groin and legs to top of buttocks.

b. Generate a percentage for skin covered with psoriatic plaques for each area and convert that to 0-6 scale as below.

c. Generate an average score for the erythema, thickness, and scale for each of the areas.

d. Sum the score of erythema, thickness, and scale for each of the areas.

e. Multiply item (c) and (d) for each area and multiply that by 0.1, 0.2, 0.3 and 0.4 for head, arms, trunk and legs respectively.

f. Add these scores to get the PASI score.

Percentage Rating scale
00 00
00<10% 01
10<30% 02
30<50% 03
50<70% 04
70<90% 05
90-100% 06

Assessment criteria: The improvement of condition of the patient was assessed on the basis of PASI scale

Before treatment

  Head and neck Arms Trunk Legs Total
Skin area involved score 3 4 2 4  
Redness 2 3 2 4  
Thickening 2 4 2 4  
Scaling 4 3 2 3  
Total 2.4 8 3.6 17.6 31.6

After 3 months

  Head and neck Arms Trunk Legs Total
Skin area involved score 2 3 1 3  
Redness 2 3 2 2  
Thickening 2 2 1 2  
Scaling 3 3 2 3  
Total 1.4 4.8 1.5 8.4 16.1

Journal of Ayurveda and Integrated Medical Sciences 2023;8(3)171
Rahangdale P et al: Ayurveda is a single hope for Autoimmune disease Psoriasis

Result and Discussion

Psoriasis is a chronic inflammatory, hyperproliferative skin disease. It is characterised by well – defined erthromatous scaly plaques, particularly affecting extensor surfaces, scalp and nails. Here a case of plaque psoriasis has been discussed, which is correlated with Kitibha Kustha. Kitibha Kustha is one among 11 varieties of Kshudra Kustha which resembles psoriasis clinically.

Kitibha is a Kshudra Kustha and have Vata-Kapha dominance and even involvement of Tridosha can be evident from its signs and symptoms. The vitiated Doshas reaches to Shithila Dushya like Twaka, Rasa etc. and results into Sthana Samshraya Avastha and then produces symptoms of Kitibha Kustha. Acharya Charaka has mentioned the symptoms of Kitibha as shyaw, Kin Khar Spars, Parusha and Acharya Sushruta described its symptoms as Stravi, Vrittam, Ghan, Ugra Kandu, Snighda, Krishna. The line of treatment mentioned in Ayurvedic classics for Kushtha Roga are Nidana Parivarjana, Shodhana, Snehana, Swedana, Raktamokshana, Prakriti Vighatana, Shamana, Lepana etc. Repeated Samshodhana along with Samshamana is main line of treatment. It is a disease of Bahya Rogamarga, so both Antah Parimajana and Bahi Parimarjana treatments should be used. Considering the above facts, composite treatment plan was adopted. Initially Abhyantara Shodhana was done with Virechana Karma and after completion of Samsarjana Krama, Samshamana treatment was performed. Sanshamana drug (Panchatikta Ghrita Guggulu tablet and Mahamarichyadi oil) contains drugs having like Tikta, Kasaya Rasa, Ushna Virya and Katu Vipak. These properties collectively possess Vatahara and Kaphahara properties, act as excellent and antimicrobial and anti-inflammatory agents.

For the basis of improvement of lesions, PASI scale was considered. PASI score was 31.6 after 3 months it was 16.1, the patient remained in follow-up once every month and her PASI score varied from 12 to 16.1 and have no aggravation of complaints till September 2022.

Conclusion

The present case study shows that Virechan Karma and Sanshamana Chikitsa work effectively in the management of psoriasis.

Virechan Karma by Trivritta Kashay and Sanshaman Chikitsa (Panchtikta Ghrit Guggulu tablet and Mahamarichyadi Tailam) can be efficiently done as no adverse effects were observed. There is good result in psoriasis. No adverse effect and aggravation of the symptoms was found in the patient during and after the treatment.

Reference

1. Z. Zaidi and S.W.Lanigan; Dermatology in Clinical practice, 2010 Springer-Verlag London Limited, Immune system of the skin, pg185.

2. Davidson’s. Principles and practice of medicine. 21st edition. Churchill living stone publication, 2010, Chapter (Diseases of the skin), pg1247.

3. Davidson’s. Principles and practice of medicine. 21st edition. Churchill living stone publication, 2010, Chapter (Diseases of the skin), pg900.

4. De Korte J, Sprangers MAG, Mombers FMC et al. Quality of life in patients of Psoriasis: A systemic literature review. J invest Dermatol Symp Proc 2004;9:140-7

5. https://www.researchgate.net>4779.

6. Pandit Kashinath Pandey, Gorakhnath Chaturvedi. Charak Samhita, Savimarsha Vidyotini-Hindi Vyakhya. Varanasi; Ed 2011; Chaukhamba Sanskrit Sansthana. Pg253.

7. Pandit Kashinath Pandey, Gorakhnath Chaturvedi. Charak Samhita Poorvardh, Savimarsha Vidyotini-Hindi Vyakhya. Varanasi; Ed 2011; Chaukhamba Sanskrit Sansthana. Pg643.

8. Pandit Kashinath Pandey, Gorakhnath Chaturvedi. Charak Samhita, Savimarsha Vidyotini-Hindi Vyakhya. Varanasi; Ed 2011, Chaukhamba Sanskrit Sansthana Pg252.

9. Kaviraj Ambikadatta Shastri; Sushruta Samhita, Ayurveda Tatva Sandipika. Varanasi; Ed. 2007; Chaukhambha Sanskrit Sansthana. Pg321.

10. Brahmananda Tripathi. Ashtang Hridaya, Nirmala Hindi Tika. Varanasi; Ed. 2010, Pub-Chaukhamba Sanskrit Sansthana. pg369.

11. Pandit Kashinath Pandey, Gorakhnath Chaturvedi. Charak Samhita, Savimarsha Vidyotini-Hindi Vyakhya. Varanasi; Ed 2011; Chaukhamba Sanskrit Sansthana Pg255.


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12. W sterry, R Paus, W Burgdorf; Sterry dermatology; Ed 2006; Thieme; New York; Pg 267.


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