E-ISSN:2456-3110

Case Report

Treatment of Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 5 May
Publisherwww.maharshicharaka.in

Ayurvedic treatment of Psoriasis (Ekakustha) through Shaman therapy : Case Study

Dalasinghray T1*, Ku Sahu A2, Kumar Padhar B3, Lekhak P4, Santosh Sahoo S5
DOI:10.21760/jaims.9.5.42

1* Tapaswini Dalasinghray, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda Deemed to Be University De Novo, Jaipur, Rajasthan, India.

2 Ajay Ku Sahu, Associate Professor, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University De novo, Jaipur, Rajasthan, India.

3 Bharat Kumar Padhar, Assistant Professor, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University De novo, Jaipur, Rajasthan, India.

4 Pooja Lekhak, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University De novo, Jaipur, Rajasthan, India.

5 Satya Santosh Sahoo, Post Graduate Scholar, Department of Shalya Tantra, National Institute of Ayurveda Deemed to be University De novo, Jaipur, Rajasthan, India.

This case study highlights the successful management of psoriasis (Ekakustha) through Ayurvedic Shaman Chikitsa in a 30-year-old male patient with dry, scaly lesions on the scalp and extensors. The patient, unresponsive to allopathic treatment, exhibited dietary indiscretions and irregular bowel habits. Ayurvedic treatment involved Shamana Chikitsa, incorporating Panchanimba Churna, Kaishor Guggulu, Khadirarista and Psoria oil, alongside dietary modifications. Over four months, the patient experienced progressive improvement in itching, erythema and scaling, leading to a significant reduction in the Psoriasis Area and Severity Index (PASI) score from 22.1 to 0.6 which is near remission. This case underscores the efficacy of Ayurvedic Shaman therapy and the importance of personalized treatment strategies guided by classical Ayurvedic principles in managing psoriasis.

Keywords: Psoriasis, Ekakustha, Kaishor Guggulu, Khadirarista, Psoria Oil, Ayurveda

Corresponding Author How to Cite this Article To Browse
Tapaswini Dalasinghray, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda Deemed to Be University De Novo, Jaipur, Rajasthan, India.
Email: 		Dalasinghray T, Ku Sahu A, Kumar Padhar B, Lekhak P, Santosh Sahoo S, Ayurvedic treatment of Psoriasis (Ekakustha) through Shaman therapy : Case Study. J Ayu Int Med Sci. 2024;9(5):248-253.
Available From
https://jaims.in/jaims/article/view/3360

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-03-13 2024-03-23 2024-04-03 2024-04-15 2024-04-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 23.85

© 2024by Dalasinghray T, Ku Sahu A, Kumar Padhar B, Lekhak P, Santosh Sahoo Sand 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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Introduction

Psoriasis is a type of papulosquamous disorder characterized by erythematous, scaly, annular lesions with relapsing and remitting course.

It is a chronic autoimmune, inflammatory condition often distributed on scalp, pressure points and extensors. It affects 0.5% - 3% of global population posing a significant health burden, which has impact on patient’s quality of life and psychosocial health.[1] The exact etiology of psoriasis is not clearly understood. The role of genetic component is well recognized and over 50% of patients shows a positive family history.

In Ayurveda, Psoriasis is often corelated with Ekakustha, which is a type of Vata-Kaphaja Khsudra Kustha (~minor skin disease) characterized by Aswedanam (~anhidrosis), Mahavastu (~Broad based), Matsyasakalopamam[2] (~alike scales of fish), Krishnaaruna[3] Varna (~Blackish Red). In Samhitas (classics) the factors such as Mithya Achar (~Irregularity in daily routine), Virudhaahar (~incompatible food habits), Vega Dharana (~suppression of natural urges) followed by Divaswapna (~Day sleeping), and Papakarma (~indulgence in sinful acts) are mentioned as important predisposing factors for manifestation of this disease.[4] This case report will give an approach how to manage a case of Ekakustha through Ayurvedic Shamana Ausadhis.

Case Report

30 years- old, non-hypertensive, non-diabetic male patient presented at OPD on 26th April 2023 with chief complaint of dry, scaly, annular lesions on scalp and extensors since 2 years. There was a significant family history of chronic skin disease. There was no history of any major illness, no history of alcohol Intake, smoking, and any other type of addiction. Not any drug allergy and surgical history was found. Appetite and sleep were normal with regular bladder function but bowel habit was irregular with inadequate evacuation. The patient gave positive history of daily consumption of dairy products like; curd, buffalo milk etc., excessive salt rich diets, fast food and day time sleeping etc.

Clinical Findings

The patient was presented with asymmetrical, dry,

itchy, reddish patches over scalp, elbow, leg, back and abdomen without Pain. [fig. 1]

Examination the Auspitz sign, Koebner’s phenomenon and Candle grease sign were positive. Nail, mucosal linings and joints were not affected. The patient was found afebrile with normal vitals. Further examination of Respiratory, Cardiovascular, Musculoskeletal and Central nervous system was found to be normal.

Table 1: Evolution of treatment and interventions for Ekakustha management.

DatePatient summaries from initial to follow up visitInterventions
April 26, 2023 (Before Treatment)§ Dry, scaly, reddish, annular lesions on scalp, elbow, leg, back and abdomen
§ Patches were well defined.
§ Auspitz Sign and Candle Grease sign were positive.		§ 3g of Panchanimba Churna twice a day with luke warm water.
§ 500mg of Kaishor Guggulu thrice a day.
§ 20ml of Khadirarista with equal quantity of water after food twice a day.
§ Psoria oil for Local application
§ 1gm Kutaki Churna with luke warm water at night time
§ Patient was also advised to avoid excessive sour, salty, spicy, dairy product, packaged diet intake and to avoid day time sleeping etc.
May 10, 2023Moderate improvement was present in itching, erythema and scaling.Continuation of same treatment (except Kutaki Churna and Kaishor Guggulu) + Arogyavardhini Vati 250mg twice a day after food and Triphala Churna 3gm at night time.
July 26, 2023Marked improvement was seen in scalp, and lesions on the other parts of the body were also reduced.Continuation of same (Kaishor Guggulu, Khadirarista and Psoria oil) + Cap. Charmarogantak 2 cap twice a day with luke warm water + Eranda Bhrista Haritaki Churna 3gm at night time + Nisoria soap for local application.
August 16, 2023 (After treatment)The lesions of scalp, arms and trunk were subsided and also itching was reduced. Auspitz sign, candle grease sign and koebner’s phenomenon were not present.§ Continuation of Cap. Charmarogantak and Psoria oil +
§ Guduchi Ghan Vati 2 tab twice a day with luke warm water.
§ 20ml Sarivadyasava with equal quantity of water after food.
§ 1gm Kutaki Churna with luke warm water at night time.

Diagnosis Assessment

On March 20, 2022, the


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patient went to an allopathic hospital with complaints of multiple scaly, itchy lesions on scalp and was diagnosed with psoriasis. He took allopathic medications for 3 months and got symptomatic relief for 3-4 months. However, by September 2022 lesions gradually developed on different body surface and became more worsen. The patient revisited an allopathic dermatologist in October 2022 and resumed previous medications, but he didn’t find any satisfactory improvement. Therefore, he came to Ayurveda Hospital at National Institute of Ayurveda for proper management of the disease. The severity of psoriasis was assessed using the Psoriasis Area and Severity Index (PASI) score which indicate the severity level of 22.1. All allopathic medications were discontinued before initiating Ayurvedic treatment.

Clinically case was assessed based on classical signs and symptoms of Ekakustha (Aswedanam, Mahavastu, Matsyasakalopamam, Krishnaaruna Varna). Routine laboratory investigations were conducted and most of the results were within normal limit, except for the erythrocyte sedimentation rate (ESR) which was elevated, measuring 39mm/hr. Ayurvedic treatment was started on April 26, 2023 with only Shaman therapy for nearly 4 months. Improvement was assessed using PASI score and symptomatic relief was present.

Dashavidha Pareeksha (~tenfold examination of patient) was assessed for Aturabala Pramana (~strength of individual) described as below,[5]

1. Prakriti (~physical constitution) - Vata-Kaphaja

2. Sara (~excellence of tissue elements) - Madhyama

3. Samhanana (~compactness) - Madhyama

4. Pramana (~measurement of body constituents) - Madhyama

5. Ahara Shakti (~power of intake and digestion of food) - Madhyama

6. Satva (~psychic condition) - Avara

7. Vyayama Shakti (~power of performing exercise) - Madhyama

8. Satmya (~homologation) - Madhyama

9. Vaya (~Age) - Yuvaavastha

10. Vikriti (~Morbidity) - Vata-Kaphaja

Table 2: Samprapti Ghatakam

DoshaVata-Kapha
DushyaTvak (~ Skin)
Rakta (~Blood Tissue)
Mamsa (cMuscle Tissue)
Ambu (~Watery element of the body)
SrotasRasavaha Srotas (~Channels carrying nutrients in body), Raktavaha Srotas (~Channels carrying blood in body)
Sroto DustiSanga
AdhisthanTvak
AgniMandagni (~mildness)
SvabhavaChirakala Anubandhini

Discussion

In Ayurveda, there are 2 basic treatment principle such as Shodhan and Shaman therapy.[6] Those patients who are not able to take Shodhana Chikitsa for any sort of reason they can be treated as well by Shaman Chikitsa. This patient got dramatic improvement in all his symptoms by a planned Shamana Chikitsa and proper dietary regimen. In this case the patient was having Tridosha vitiation with predominance of Vata-Kapha-Dosha, so treatment plan was based upon Dosha-Dushya Shamak Chikitsa as mentioned below.

Probable mode of action of interventions

In Arogyavardhini Vati the main ingredient Kutaki (Picrorhiza kurroa Royle ex Benth) which is with 18 parts and most of the ingredients present are used in skin disease which has Kusthaghna, Hepatoprotective, Blood purifier, Anti- inflammatory and Anti-oxidant properties.[7]

  • Kaishor Guggulu composed of variety of herbal ingredients such as Guggulu, Guduchi, Triphala, Vidanga and many more. These ingredients work synergistically to provide therapeutic effects like reducing redness, inflammation and act as natural blood purifier by pacifying the deep seated vitiated doshas involved in psoriasis.[8]
  • Panchanimba Churna there are 5 parts of Nimba are used such as: leaves, root, bark, flowers and fruit which combinedly has Immunomodulatory, Anti-inflammatory, Anti-oxidant and Anti-fungal properties.[9]
  • Khadirarista, with Khadir as its main ingredient, possesses anti-inflammatory, antibacterial, and wound-healing properties. It's traditionally used in Ayurveda to treat various skin conditions,

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  • particularly psoriasis, due to Kusthagna and Kandughna The formulation is noted in Ayurvedic texts for its effectiveness in addressing all types of skin diseases, especially Ekakustha.[10]
  • Triphala Churna and Eranda Bhrista Haritaki Churna both act by their Anti- inflammatory, Anti-oxidant, Anti-bacterial and Anti-fungal properties. Both the Churna contain a similar drug named as Haritaki which prevents accumulation of pus in skin diseases, act as a Rasayana along with wound healing properties.[11]
  • Psoria oil made from Wrightia tinctoria leaves mainly used for psoriasis and skin conditions similar to it, which retrieves the skin texture and relieves from itching and scaling.[12]
  • Guduchi Ghana Vati is an Ayurvedic classical preparation prepared from aqueous extract of Guduchi It is otherwise known as Samsamani Vati which takes Dosas to Sama Sthiti. It has Anti-inflammatory, Anti-pyretic, Hepatoprotective action and many more.[13,14]
  • Sarivadyasava having ingredients like Anantamula, Nagarmotha, Guduchi having Rakta Shodhaka, Tridosha Shamaka and Sodhana properties which are used in various skin disorders.[15]

Table 3: Patient’s Psoriasis Area Severity Index Score Before and After Treatment

ParametersHead and NeckArmsTrunkLegs
BTATBTATBTATBTAT
Skin area involved score %30-4910-2910-29030-49030-49<10
Redness31202021
Thickening40302030
Scaling30303030

BT (total PASI score = 22.1); AT (total PASI score = 0.6)

PASI (Psoriasis Area severity Index); BT (Before Treatment); AT (After Treatment)

Conclusion

The above case demonstrates the significant impact of Shaman Chikitsa in alleviating the symptoms of psoriasis. The patient experienced notable improvements such as reduced itching, scaling, and redness, as well as a significant decrease in their PASI score within duration of 4 months. Patient has done proper dietary restrictions

as advised. Therefore, Shaman Chikitsa along with proper adhering to Pathya (therapeutic measures) and Apathya (avoidable measures), can play a significant role in managing the symptoms of psoriasis (Ekakustha).

Patient Consent Declaration

The observed satisfactory relief in this case suggests that while complete symptom relief may not be achieved with short-term treatment lasting three months, Ayurvedic therapies can yield promising results in alleviating psoriasis symptoms without significant adverse effects.

jaims_3360_01.JPGjaims_3360_02.JPG

Figure 1: Lesions on abdomen before treatment

Figure 2: Lesions on abdomen after treatment

jaims_3360_03.JPGjaims_3360_04.JPG

Figure 3: Lesions on leg before treatment.

Figure 4: Lesions on leg after treatment

jaims_3360_05_a.JPGjaims_3360_06.JPG

Figure 5: Lesions on arm before treatment.

Figure 6: Lesions on arm after treatment


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2. Acharya JT, editor. Charaka Samhita of Agnivesha, Sutra Sthana, Chapter 7, Verse 54-56. Varanasi: Chaukhamba Orientalia; 2016.

3. Sushruta, Acharya, editor. Sushruta Samhita of Sushruta, Nidana Sthana, Chapter 5, Verse 13-14. Varanasi: Chaukhamba Orientalia; 2017.

4. Acharya JT, editor. Charaka Samhita of Agnivesha, Nidana Sthana, Chapter 4, Verse 5-10. Varanasi: Chaukhamba Orientalia; 2016.

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6. Vagbhata, Acharya, editor. Ashtanga Hridaya of Vagbhata, Sutra Sthana, Chapter 11, Verse 1-4. Varanasi: Chaukhamba Krishnadas Academy; 2009.

7. Shetty SN, Mengi S, Vaidya R, Vaidya AD. A study of standardized extracts of Picrorhiza kurroa Royle ex Benth in experimental nonalcoholic fatty liver disease. J Ayurveda Integr Med. 2010 Jul;1(3):203-10. doi: 10.4103/0975-9476.72622. PMID: 21547049; PMCID: PMC3087357.

8. https://www.researchgate.net/figure/Ingredients-of-Kaishore-Guggulu_tbl1_337421043

9. Bhaisajya ratnavali of Kaviraj Shri Govind Das Sen,Dr.G.Prabhakar rao, Chaukhamba orientalia reprint 2019

10. https://www.researchgate.net/publication/320868554_KHADIRARISHTA_A_MEDICAL_REVIEW

11. Kumar MS, Kirubanandan S, Sripriya R, Sehgal PK. Triphala promotes healing of infected full-thickness dermal wound. J Surg Res. 2008 Jan;144(1):94-101. doi: 10.1016/j.jss.2007.02.049. Epub 2007 Jul 27. PMID: 17662304.

12. https://www.ayurveda-total.com/nl/zelfzorg/huid-haren/psoria-oil-nagarjuna-100ml/

13. Patgiri B, Umretia BL, Vaishnav PU, Prajapati PK, Shukla VJ, Ravishankar B. Anti-inflammatory activity of Guduchi Ghana (aqueous extract of Tinospora Cordifolia Miers.). Ayu. 2014 Jan;35(1):108-10. doi: 10.4103/0974-8520.141958. PMID: 25364210; PMCID: PMC4213960.

14. Chavan T, Ghadge A, Karandikar M, Pandit V, Ranjekar P, Kulkarni O, Kuvalekar A, Mantri N. Hepatoprotective Activity of Satwa, an Ayurvedic Formulation, Against Alcohol-induced Liver Injury in Rats. Altern Ther Health Med. 2017 Jul;23(4):34-40. PMID: 28646813.

15. https://www.researchgate.net/publication/322220338_SARIVA_HEMIDESMUS_INDICUS_AN_ANCIENT_MIRACULOUS_BREAKTHROUGH_TO_CURE_ACNE_VULGARIS


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