E-ISSN:2456-3110

Case Report

Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

A case study on Kitibha Kusta (Psoriasis) with Samshodana Chikitsa

Akshata1*, Mathapati I2, Dharmannavar G3
DOI:10.21760/jaims.8.11.33

1* Akshata, Post Graduate Scholar, Department Of Post Graduate Studies In Kaya Chikitsa, Shri Shivayogeshwar Rural Ayurvedic Medical College And Hospital, Inchal, Karnataka, India.

2 I S Mathapati, Professor, Department of Post Graduate Studies in Kaya Chikitsa, Shri Shivayogeshwar Rural Ayurvedic Medical College and Hospital, Inchal, Karnataka, India.

3 G S Dharmannavar, Asisstant Professor, Department of Post Graduate Studies in Kaya Chikitsa, Shri Shivayogeshwar Rural Ayurvedic Medical College and Hospital, Inchal, Karnataka, India.

All the skin diseases in Ayurveda have been discussed under the broad heading of “Kustha”. In general Twak Vikaras are mainly affecting due to altered lifestyle, lack of physical exercise, poor hygiene, mental stress and improper food habits. Kitibha Kushta is one of the Kshudra Kushta. Here Tridosha, Rasa, Rakta, Mamsa, Ambu are affected. Kapha-Vata is the Dosha predominant in the Kitibha Kustha and Rakta Dusti is the main cause for all Twak Vikaras. Vamana and Virechana is the Shodhana Karma for Twak Vikara. 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
Akshata, Post Graduate Scholar, Department Of Post Graduate Studies In Kaya Chikitsa, Shri Shivayogeshwar Rural Ayurvedic Medical College And Hospital, Inchal, Karnataka, India.
Email: 		Akshata, Mathapati I, Dharmannavar G, A case study on Kitibha Kusta (Psoriasis) with Samshodana Chikitsa. J Ayu Int Med Sci. 2023;8(11):206-210.
Available From
https://jaims.in/jaims/article/view/2891

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-14 2023-09-19 2023-09-25 2023-09-30 2023-10-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.67%

© 2023by Akshata, Mathapati I, Dharmannavar Gand 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].

J Ayu Int Med Sci 2023;8(11)206
Akshata et al. A case study on Kitibha Kusta (Psoriasis) with Samshodana Chikitsa

Introduction

Ayurveda has given some codes and conducts of life which everyone should follow to be healthy physically and mentally, but nowadays life style is changed. Now we are in 21st century, people have changed their life style as per so called western life style. The main cause for Kustha is vitiated Tridoshas, Dushya, Sharira Dhatus like Twak, Rakta, Mamsa, Lasika[1] vitiates and may lead to 7 types of Kustha after this. Kustha may spread all over the body. Nidana Sevana, Pradnyparadha, Ahitakara Dinacharya, Purva Janmakruta Papa and Vegavarodha may cause Kustha. As Poorvarupa is Asweda, discoloration of the skin, itching, horripilation (Romancha), roughness of skin feels like Ati Ushnata in Sharira are the Purvaroopa explained in Charaka Samhita.[2]

Psoriasis is a chronic skin disease characterized by dry red patches covered with scales occurs especially on the scalp, ears, genitalia and the skin over bony prominences. Modern medical science treats psoriasis with PUVA and corticosteroids.[3] But the disease recurrence and gives serious side effect like liver, kidney failure bone in marrow depletion. Here, Ayurveda plays an important role; present study is under taken to provide safe and effective remedy for psoriasis.

The different Chikitsa in our classics like Shamanoushadi, Shodana, Raktamokshana[4] many Lepas are explained. The present case is treated with Shodhana and Shamanoushadi Chikitsa.

Case Report

A 40 year male patient visited Kayachikitsa OPD of SSRAMC Hospital, Inchal on Date 19/09/2023 with following details:

Patient Name: ABC
Age/Sex: 40yr/male
OPD NO: 41512
DOA: 19/09/2023
Address: Inchal

Chief complaints

  • Wide spread patches on hands and back side on lumbar region, face and abdomen with itching since 2 years.
  • Redness and blackish discoloration of skin.


Associated Complaints

  • Disturbed sleep since 2 months.
  • Loss of appetite since 2 months.

H/O Present Illness

He is apparently normal before 2 years than he gradually developed symptoms like patches and itching on hands, back side over lumber region, face and abdomen. He has taken treatment from local doctor but didn’t get complete cure, then the symptoms got aggravating gradually, along with that he also suffered from disturbed sleep since 2 months and loss of appetite since 2 months. Sever itching since 6 months, so condition got worsen so he visited to our hospital for further management.

Past History

  • No history DM /HTN.

Personal History

Prakriti: Vata-Kaphaja

Ahara: Mixed

Vyavasaya: Farmer

Vyasana: Tea

Nidra: Disturbed

Vihara: Diwaswapna for 1 hr after taking meals. Ratri Jagarana

Mala: Once/day

Mutra: 4-5 times/ day

Asta-Sthana Pareeksha

Nadi: 74 bpm

Mala: once/day, Saama

Mutra: 4-5 times/day

Jihwa: Lipta

Shabda: Prakruta

Sparsha: Anushna-Sheeta

Drik: Prakruta

Akriti: Madhyama

On Examination

  • Red patches
  • Discoloration of the skin
  • Inflammation is also present.

J Ayu Int Med Sci 2023;8(11)207
Akshata et al. A case study on Kitibha Kusta (Psoriasis) with Samshodana Chikitsa

Investigations

  • ESR - 80mm/hour
  • Eosinophils count - 9%

Diagnosis - Kitibha Kustha

Methodology/Treatment given

Deepana - Pachana

Agnitundi Vati 500 mg three times a day with warm water after meals for 3 days Chitrakadi Vati 500 mg three times a day with warm water before meals for 3 days.

Shodhana Chikitsa

Patient was given Snehapana with Mahatiktaka Ghrita,[5] morning at 7 AM for 4 days with increasing quantity along with Sukoshna Jala as Anupana i.e., 1- 4th day 30ml, 50ml, 80ml and 120ml respectively.

Vamana Karma

Poorvakarma

After Samyaka Snehapana Lakshanas like Mala Snigdhata, Twaka Snigdhata, Snehadwesha was seen on 4thday. Sarvanga Abhyanga with Sarshapa Taila followed by Sarvanga Bashpa Swedana with Dashamoola Kashaya for 1 day. Night before Vamana Karma patient was advised to take Kapha Utkleshakara Ahara. Written consent was taken from patient before beginning the treatment.

Pradhana Karma

All the instructions regarding Vamana Karma were explained to the patient. After examining the blood pressure, pulse, respiratory rate, and abdominal examination, patient was fit for procedure. At 7 AM patient was given Sarvanga Abhyanga and Bashpa Sweda. Then patient was given Madana Phala Kashaya. Patient had 6 Vegas which is Madhyama Shuddhi.

Paschyat Karma

Patient was advised for 5 days Samsarjana Krama.

After 7 days interval Virechana Karma was given.

Virechana Karma

Snehapana by Mahatiktaka Gritha for 3 days started with 30ml, 50ml, 80ml respectively

After Snehasiddhi Lakshana, Sarvanga Abhyanga with Nimba Taila and Sarvanga Bhashpa Swedana with Dashamoola Kashaya for 3 days.

Pradhana Karma

On 4th day Sarvanga Abhyanga and Swedana is done followed by Trivrit Avaleha (50gm). Patient was instructed to take sip of Ushna Jala frequently and wait for Vega. Patient was advised not to strain during defecation. 1st Vega was observed after 1 hour of intake of Ausadha. Total 12 Vegas were observed.

Paschat Karma

Samsarjana Krama for 3 days

Shamana Aushadhi

SNShamanoushadiDose
1.Gandhaka Rasayana 1 BD with lukewarm water (15days) AF
2. Arogyvardhini Vati2 OD with lukewarm water (15days) AF
3.Manjistadhi Kashaya 15ml BD (15days) AF
4.777 OilOnce in morning and advised to expose early morning sun rays
5.Patolakaturohinyadi Kashaya15ml BD (15days) AF

Advised Diet: Should eat ghee, vegetables, should avoid oily food and alcohol, red meat junk food and beverages.

Before Treatment
Jaims_2891_1.jpg

After Treatment
Jaims_2891_2.jpg



J Ayu Int Med Sci 2023;8(11)208
Akshata et al. A case study on Kitibha Kusta (Psoriasis) with Samshodana Chikitsa
    Pathya     Apathya
   Sadvrutta Palana   Junk food
  Healthy food habits   Avoid stress
   Vyayama, Yoga   Consuming sour, salty, meat
   Satvika Ahara   Ati Maituna

Observation and Result

SNSymptomsBefore treatmentAfter treatment1st follow up
1.Itching (Kandu)PresentMild reducedReduced
2.Redness (Raga), blackishnessPresentMild reducedReduced
3.Disturbed sleep (Anidra)PresentMild improvementSufficient sleep

Discussion

According to Ayurveda Kitibha Kustha is a Vatakaphapradhana Kushta. A 44 yrs old patient came with the complains of skin lesion over upper, lower limbs, face, back and 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.

There is significant increase of Ruksha, Khara and Sheetaguna in the patient, therefore Vamana and Virechana was planned for Shodhana. Kitiba Kushta is Kapha Vata Pradana and its treatment is “Vamanam Shleshmottareshu Kushteshu” therefore, first Vamana Karma was done to eliminate the vitiated Kapha Dosha along with Pitta. There was significant increase of Ruksha, Khara and Sheeta Guna in the patient therefore Sneha Virechana was planned endowing Snigdha and Ushna Guna. Pitta is responsible for Srava and Syava indicated presence Vata. Among all Shodhana Karma, Virechana Karma can be said as Vishesha Rechana to clear different type of toxic materials due to metabolic activity the things to be execrated through the intestinal mucosa along with the unabsorbed residues in the GIT, Virechana Karma also helps to reduce Srava, as Virechana expels aggravated Doshas from body Daha, Kandu is the symptoms present in the Kitiba Kusta and severity may be reduced by Virechana.

Panchatiktaka Ghrita - Has Katu, Tikta, Kashaya, Madhura, Laghu, Ruksha, Sheeta, Snigdha and Ushna Veerya helps to pacify Vata Pitta and Kapha Dosha.

Manjistadi Kashaya - helps in natural purification of blood. It also detoxifies and dissolve the obstructions in blood flow.

777 Oil - It is a Siddha medicine oil prepared with Shweta Kutaja (Wrightia tictoria) and coconut oil having impairs keratinocyte multiplication. It interferes in co-stimulatory molecules communications. It balances the micro and macro level of activities. Ideal hydrolipo quotient, reduces xerosis of skin and associated itching. It gives quick relief from clinical symptoms and early onset of remission.

Conclusion

Kusta is Rakta Pradoshaja Vyadhi. Kitiba Kusta is a Vata Kapha Pradhana Vyadhi. So, Samshodhana Karma is needed. Vamana is helpful for pacifying the Kapha Dosha. Virechana is helpful for pacifying the Pitta and Vata Dosha.

References

1. Charaka. Charaka Samhita, Comentatory Ayurveda dipika, edited Vd.Hrish Chandra Singh Kushawaha, Chaukhambha Orientalia, Varanasi, Reprint 2017, Chikitsa stana, vol II, Chapter 7, Shloka 9-10,p no-197.

2. Charaka. Charaka Samhita, Comentatory Ayurveda dipika, edited Vd.Hrish Chandra Singh Kushawaha, Chaukhambha Orientalia, Varanasi, Reprint 2017, Chikitsa stana, vol II, Chapter 7, Shloka 11-12,p no-197.

3. http://www.webmd.com/skin- problems-and- treatments/psoriasis/understanding- psoriasis-treatment

4. Charaka. Charaka Samhita, Comentatory Ayurveda dipika, edited Vd.Hrish Chandra Singh Kushawaha, Chaukhambha Orientalia, Varanasi, Reprint 2017, Chikitsa stana, vol II, Chapter 7, Shloka 39,p no-201

5. Charaka. Charaka Samhita, Comentatory Ayurveda dipika, edited Vd.Hrish Chandra Singh Kushawaha, Chaukhambha Orientalia, Varanasi, Reprint 2017, Chikitsa stana, vol II, Chapter 7, Shloka 144-150,p no-214


J Ayu Int Med Sci 2023;8(11)209