E-ISSN:2456-3110

Case Report

Eka Kushta

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 11 NOVEMBER
Publisherwww.maharshicharaka.in

A clinical experience in the management of Eka Kushta - A Case Study

Sneha K1*, Prashanth A S2
DOI:10.21760/jaims.9.11.55

1* Sneha K, First Year Post Graduate Scholar, Department of Pg Studies in Kayachikitsa, Ayurveda Mahavidyalaya Hospital, Hubballi, Karnataka, India.

2 Prashanth A S, Principal Professor, Department of Pg Studies in Kayachikitsa, Ayurveda Mahavidyalaya Hospital, Hubballi, Karnataka, India.

Kushta is the broad spectrum word used in Ayurveda to describe all the skin diseases under one heading, which is mainly classified into Mahakushta and Kshudra Kushta. Ekakushta is one among the Kshudra Kushta. It is of prime importance due to its chronicity and severity which involves larger extent of the body. In contemporary science, Ekakushta can be compared to Plaque Psoariasis, In the present case study, we have reported 39 years old male patient came with the complaints of severe dryness of the skin along with white scaly powdery discharged skin lesions all over the body associated with severe itching. The treatment protocol adopted here are Antah Parimarjana Chikitsa (Shodhana) and Bahir Parimarjana Chikitsa (Sarvanga Pariseka and Jaloukavacharana) and Shamanoushadhis. After treatment, patient got satisfactory results and complaints are reduced by 60-70%.

Keywords: Ekakushta, Antah Parimarjana Chikitsa, Bahir Parimarjana Chikitsa, Jaloukavacharana

Corresponding Author How to Cite this Article To Browse
Sneha K, First Year Post Graduate Scholar, Department of Pg Studies in Kayachikitsa, Ayurveda Mahavidyalaya Hospital, Hubballi, Karnataka, India.
Email: 		Sneha K, Prashanth A S, A clinical experience in the management of Eka Kushta - A Case Study. J Ayu Int Med Sci. 2024;9(11):363-369.
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https://jaims.in/jaims/article/view/3719

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-10-09 2024-10-19 2024-10-29 2024-11-19 2024-11-24
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© 2024by Sneha K, Prashanth A 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].

J Ayu Int Med Sci 2024;9(11)363
Download PDFBack To ArticleIntroductionCase StudyMaterials and MethodsObservationsResultDiscussionConclusionReferences
Sneha K et al. A clinical experience in the management of Eka Kushta

Introduction

In Ayurveda, almost all the skin diseases are described under Kushta Rogadhikara. Kushta is considered to be Ashtamahagada Roga[1] and Aupasargika Roga.[2] As per Acharya Charaka, the vitiation of Tridosha along with Twak, Rakta, Mamsa and Lasika have major role in the pathogenesis of Kushta.[3] But still the signs and symptoms produced in Kushta depend on the type of predominance Dosha in it. Ekakushta is one among the11 types of Kshudra Kushta which is characterized by, Aswedana (absence of sweating), Mahavastu (covers entire body) and Matsyashakalopama[4] (resembles the scales of fish). Acharya Bhavaprakasha[5] describes that, the lesions of Ekakushta are in Chakrakara (Circular in shape), Abhrakapatrasama (silver colored mica sheets). It primarily manifests due to imbalance in the Vata -Kapha Dosha and Rakta as Pradhana Dushya.

The clinical features of Ekakushta are similar to that of Plaque Psoriasis explained in Contemporary science. About 3% world population suffers from Psoriasis. In India, prevalence of Psoriasis varies from 0.44 - 2.88%.[6] It is immune mediated disease characterized by Erythematous and Rounded Plaques covered by Silvery Micaceous Scale which are variably Pruritic. Common sites are Scalp, Elbow, Knee, Chest, Trunk, Lower and Upper back region. Plaque Psoriasis remains as challenge to be treated.

In Ayurveda, Ekakushta is treated with both Antah Parimarjana Chikitsa and Bahir Parimarjana Chikitsa therapies. Since the nature of the disease is such that there is higher chance of remissions and exacerbations, hence the disease needs to be managed by Shodhana followed by Shamanoushadhis.

Case Study

The present case study deals with 39 years old male patient presented with the complaints of skin lesions with white powdery discharge all over the body associated with severe dryness and itching since 2 years.

History of present illness

Patient was apparently healthy 2 years ago.

Gradually, he developed Erythematous Skin lesion over the Extensor part of Upper and Lower limb. Later, Skin lesion with White Powdery Plaque discharge was distributed all over the body including Scalp, Chest, Trunk, Upper and Lower Back, and Gluteal region associated with severe itching. Patient was treated conservatively at Allopathic Hospital. But he did not get any satisfactory results. Later he got admitted in Ayurveda Mahavidyalaya and Hospital, Hubballi for further management.

History of past illness

  • Patient was not a known case of Type 2-Diabetes, Hypertension.
  • There was no Surgical history.

Personal history

  • Food habit: Mixed diet (Non-veg –Weekly twice)
  • Sleep: Disturbed due to itching.
  • Bowel: Constipated
  • Micturition: 5-6 times/day, 1 time/night.

Family history: All Family members are said to be healthy.

Vital examination

Pulse Rate78 bpm
Respiratory Rate18cpm
Heart Rate72bpm
Blood pressure130/90mmhg

Nidana Panchaka

Nidana - Virudhha Aahara and Vihara Sevana, Dadhi Sevana, Ati Katu and Amla Rasa Sevana.
Purvarupa - Kandu
Rupa - Aswedana, Mahavastu and Matsyashakalopama .
Upashaya - External application of Narikela Taila.
Anupashaya - Exposure to too cold and hot weather.

Samprapti

Nidana Sevana
↓
Tridosha Prakopa
↓
Dosha-Dushya Samurchana (Sapthako Dravya Sangraha - Tridosha, Twacha, Rakta, Mamsa and Lasika)
↓
Khavaigunyata in Twacha


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Sneha K et al. A clinical experience in the management of Eka Kushta

↓
Lakshanas like Aswedana, Mahavastu and Matsyashakalopama appeared in Twacha of Sarvashareera.
↓

Ekakushta

Samprapti Ghatakas

  • Dosha - Pitta Pradhana Tridosha.
  • Dushya - Rasa, Rakta, Mamsa, Ambu.
  • Srotas - Rasavaha, Raktavaha, Mamsavaha, Ambuvaha.
  • Srotodushti - Sangha
  • Agni - Jataragni, Dhatwagni and
  • Ama - Jataragnijanya Ama, Dhatwagnijanya Ama and Bhutagnijanya Ama.
  • Udbhavasthana - Amashaya
  • Sancharasthana - Rasayani
  • Vyakta Sthana - Sarvashareera
  • Rogamarga - Bahya Rogamarga
  • Sadhyaasadhyata - Kashta Sadya

Ashta Sthana Pariksha

1.  NadiPittaja (78bpm)
2.  MalaVibandha
3.  MutraPrakrita
4.  JihwaIshat Liptata
5.  ShabdaPrakrita
6.  SparshaAnushna Sheetha
7.  DrukPrakrita
8.  AkritiMadhyama

Dashavidha Pariksha

1.  PrakrutiVata-Pitta
2.  VikritiTridosha+Rakta
3.  SaraMadhyama
4.  SamhananaPravara
5.  PramanaMadhyama
6.  SatwaMadhyama
7.  SatmyaShadrasa
8.  AharashaktiMadhyama
9.  VyayamashaktiPravara
10. Vaya Madhyama

Systemic Examination

  • Respiratory System: Normal Vesicular Breath Sound heard.
  • Cardiovascular System: S1 S2 heard. No added sound heard.
  • Central Nervous System: Patient is conscious and oriented to time, place and person.
  • Gastro-Intestinal Tract: Soft and Non-Tender
  • Integumentary System Examination:
1.  OnsetGradual
2.  Duration2 years
3.  CourseProgressive
4.  Aggravating factorCold and Hot weather
5.  Relieving factorExternal application like Narikela Taila
  • Site - Scalp, Chest, Extensor part of upper and lower limbs, Trunk, upper and lower back and Gluteal region.
  • Shape - Irregular scaly reddish patch.
  • Size - Multiple, No specific size. (Ranging from 8mm to 9cms too).
  • Color - Pinkish white.
  • Uniformity - Generalized Plaques.
  • Boundary - Not well-demarcated.
  • Lesions - Plaques.

Special tests in Plaque Psoriasis

  • Candle grease sign - Positive (Presence of dry white scaly discharge)
  • Auspitz sign - Positive (Presence of Pinpoint - like bleeding foci that appear when plaques are scraped deeper)
  • Koebner phenomenon - Positive (New skin lesions forming on an area of injured skin)

Materials and Methods

Aragwadhadi Kwatha Niruha Basti

  • Saindhava Lavana - 6 gms
  • Madhu - 30ml
  • Kalka - Guggulu Panchapala Churna - 15gm
  • Gritha - Guggulu Tiktaka Gritha - 30ml
  • Kwatha - Aragwadhadi Kwath - 80ml and Guduchyadi Kwath - 80ml
  • Jala - 250ml
  • Total - 500 ml

Shamanoshadhis

  • Guggulu Tiktaka Gritham – 1-1-1 after food.

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Sneha K et al. A clinical experience in the management of Eka Kushta
  • Manjishtadi Kashayam – 1-1-1 before food.
  • Gandhaka Rasayana – 1-0-1 after food.
  • Eladi Taila + Brihatdanthapala Taila + Karanja Taila for External Application .
DateProcedureAoushadhaDaysObservations
9/1/24 to 13/1/24Arohana Snehapana
Matra:
Day 1-30ml
Day 2-60ml
Day 3 -80ml
Day 4 -100ml
Day 5- 120ml		Aragwadha Mahatiktaka Ghrita5 daysItching has been increased.
Snigdha Varcha.
14/1/24 to 16/1/24Sarvanga AbhyangaEladi Taila3 daysVishrama Kaala
17/1/24VirechanaTrivrut Lehya (25gms with Ushna Jala at 7.30 am)1 day10 Vegas
Glani, Klama observed
18/1/24 to 20/1/24Samsarjana
Karma		Peyadi 3 daysReduction in itching by 10% and White powdery discharge reduced by 20%.
21/1/24 and 23/1/24Jalaukavacharana (Alternate days)-2 days (Alternate days)21/1/24 - 50ml blood collected
23/1/24 - 35 ml blood collected.
24/1/24 to 29/1/24Sarvanga ParisekaAragwadhadi Kashaya Pariseka6 days50% Itching has been reduced.
Dryness still persists.
30/1/24 to 01/2/24Jalaukavacharana (Alternate days)-2 days (Alternate days)30/1/24 - 80ml blood collected.
01/2/24 - 80ml blood collected.
60% of Itching has been reduced.
04/2/24 to 07/2/24Yoga BastiAragwadhadi Kwatha and Guduchyadi KwathaNiruha Basti - 4 daysDryness reduced,
White powdery discharge reduced.
03/2/24 to
08/2/24		Yoga BastiGuggulu Tiktaka GrithaAnuvasana Basti - 6 daysDryness reduced,
White powdery discharge reduced.

Assessment Criteria

  • Subjective Criteria

Gradation Scales[7]

Table 1: Aswedanam

GradeScore
Normal0
Improvement1
Present in few lesions2
Present in all lesions3
Aswedanam in lesions and uninvolved skin4

Table 2: Kandu

GradeScore
No itching0
Occasional itching1
Frequent but tolerate itching2
Very severe itching disturbing sleep and activity3

Table 3: Rukshata

GradeScore
Normal skin0
Slightly dry skin1
Excessively dry skin2
Lichenified3
Bleeding through the skin4
  • Objective Criteria

Table 4: Mahavastu

GradeScore
No lesions on Mahasthanam0
Lesion on partial parts of Hand, Leg, Neck, Back, Scalp1
Lesion on most parts of Hand, Leg, Neck, Scalp and Back2
Lesion on Mahasthanam (vast area)3
Lesion on whole body4

Table 5: Scaling

GradeScore
No scaling0
Mild Scaling by rubbing/by itching1
Moderate Scaling by rubbing/by itching2
Severe Scaling by rubbing/by itching3
Scaling without rubbing/by itching4

Table 6: Candle grease sign, Auspitz sign and Koebner phenomenon

GradeScore
Absent0
Present1

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Sneha K et al. A clinical experience in the management of Eka Kushta

Observations

Following observations were found before and after the intervention.

Clinical featuresBefore treatmentAfter treatment
Aswedanam31
Kandu32
Rukshata21
Mahavastu44
Scaling30
Candle grease sign10
Auspitz sign10
Koebner phenomenon10

jaims_3719_01.JPG
During Treatment

jaims_3719_02.JPG
After Treatment

Result

Significant improvement was observed in the subjective as well as objective parameters of the patient.

Discussion

Ayurvedic management of Ekakushta includes both Antar Parimarjana Chikitsa, Bahir Parimarjana Chikitsa followed by Shamanoushadhis. In this case, Virechana, Basti, Jaloukavacharana along with Sarvanga Pariseka were adopted.

Virechana

Purva Karma: Aragwadha Mahatiktaka Gritha was selected for Snehapana. Aragwadha is the Ghataka Dravya, does Sramsana. This Gritha possess Tikta Pradhana Rasa and acts as Pitta Shamaka. Mainly indicated in Kushta. It also helps to bring Dosha from Shakha to Koshta where these vitiated Doshas can be removed through Virechana Karma.

During Vishrama Kala, Eladi Taila was selected for Sarvanga Abhyanga as it is mainly indicated in Kandu and it does Varna Prasadana in Shareera.

Pradhana Karma: Trivrut Lehya is selected as Virechana Dravya. As this Lehya contains Trivrut Kalka and Trivrut Kashaya which acts as Sukha Virechaka.

Virechana is mainly indicated in Rakta and Pitta Dushti. As the Virechana Dravya contains Vyavayi, Vikasi, Sukshma Gunas responsible for quick absorption of medicines. Mainly due to Prabhava, Prithvi and Jala constitution and presence of Sara Guna, Virechana occurs, thus helps in the evacuation of vitiated Doshas from the body.[8]. Thus, helps in pacifying Kushta.

Pashchat Karma: Peyadi Samsarjana Karma was advised, as it helps to kindle the Agni.

Basti

Aragwadhadi Kwatha Niruha Basti: In Niruha Basti, Madhu possesses Yogavahi and Sukshma Marga Anusarita Guna, functions as Catalyst, penetrating the Sukshma Srotas. The Laghu and Tridosha Shamaka Gunas were introduced through Saindhava Lavana. The Snigdha Guna of Sneha Dravya (Guggulu Tiktaka Gritha) combats Ruksha and Laghu Gunas of Vata. Guggulu Tiktaka Gritha does Pitta Shamana. Kalka (Guggulu Panchapala Churna) which is mainly indicated in Twak Vikara. Kashaya (Aragwadhadi Kashaya and Guduchyadi Kashaya) having Tikta Rasa Pradhana acts as Pitta Shamana, Rakta Prasadana, Kleda and Lasika Shoshana.[9] Thus helps in pacifying the Kushta.


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Sneha K et al. A clinical experience in the management of Eka Kushta

Jaloukavacharana: As we know, Kushta is Pitta Pradhana Vyadhi, Raktamokshana through Jaloukavacharana plays a significant role, where it contains Hirudine which helps in local circulation and drains the blood toxins.[10]

Sarvanga Pariseka: Here Aragwadhadi Kashaya Pariseka was done, where it helps to mitigates itching in the body.

Shamanoushadhis

  • Guggulu Tiktaka Gritham: This is very potent drug of choice in Eka Kushta (Vata-Kapha Pradhana). As this drug contains Pancha Tikta (Nimba, Patola, Guduchi, Kantakari and Vasa) which is Tikta Rasa in nature that acts on both Vata and Kapha and Guggulu which is Yogavahi and Kledahara.
  • Gandhaka Rasayana: It is having properties like Kushtaghna, Rakta Doshahara, Vishaghna, Vranasodhana, Ropana, Rakta-Tvakgata Vishahara, Durmedhohara, Rasayana, Dhatubalya. All these properties are essential to treat Eka Kushta.
  • Manjistadi Kashayam: This medicine is mainly used in treatment of various skin diseases. It also helps in natural purification of blood so it can be used in skin related problems. Manjishtadi Kashayam helps in blood detoxification and also dissolves the obstructions in blood flow.

For External Application

Combination of Eladi Taila, Brihatdantapala Taila and Karanja Taila was given. Eladi Taila, having Kandughna and Varna Prasadana property. Brihatdanthapala Taila, having Sarva Kushtaghna property and Karanja Taila which balances Vata and Kapha and also it is Kushtaghna in nature.

Conclusion

From this case study, we can conclude that combined Ayurvedic treatments along with proper diet regimen will be effective in Ekakushta. No adverse effects were found in this patient during and after the treatment. Since, Ekakushta is a chronic and relapsing condition, Acharya Charaka mentioned Punah-Punah Shodhana.[14] Hence, hereafter the above-mentioned treatment protocol can be adopted in further similar cases.

References

1. Acharya Sushrutha. Sushrutha Samhita. Hindi Commentary "Ayurvedatattva sandeepika" by Kaviraj Dr. Ambikadutta Shastri. Sutrasthana, Chapter 33, Verse 4. Reprint edition 2023. Varanasi: Chaukambha Orientalia; 2023. p. 163.

2. Acharya Sushrutha. Sushrutha Samhita. Hindi Commentary "Ayurvedatattva sandeepika" by Kaviraj Dr. Ambikadutta Shastri. Nidanasthana, Chapter 6, Verses 32-33. Reprint edition 2023. Varanasi: Chaukambha Orientalia; 2023. p. 325.

3. Acharya Charaka. Charaka Samhita of Agnivesha. Hindi Commentary "Vidyotini" by Dr. Gorakhanatha Chaturvedi and Pandit Kashinatha Pandey Shastri. Chikitsa Sthana, Chapter 7, Verse 9. Reprint edition 2023. Varanasi: Chaukambha Bharati Academy; 2023. p. 223.

4. Acharya Charaka. Charaka Samhita of Agnivesha. Hindi Commentary "Vidyotini" by Dr. Gorakhanatha Chaturvedi and Pandit Pandey Kashinatha Shastri. Chikitsa Sthana, Chapter 7, Verse 21. Reprint edition 2023. Varanasi: Chaukambha Bharati Academy; 2023. p. 226.

5. Acharya Bhavamishra. Bhavaprakasha, Madhyama and Uttara Khanda by Dr. Bulusu Sitaram. Chapter 24, Verse 6. Reprint edition 2017. Varanasi: Chaukambha Orientalia; 2017. p. 529.

6. Thakre P. A case study on plaque psoriasis with Ayurvedic management. International Journal of Ayurvedic Medicine [Internet]. 2023 [cited 2023 Feb 4];11(2). Available from: http://ijam.co.in.

7. Tosshikhane SH. Management of Ekakushta, with special reference to psoriasis, through Panchakarma: A case study. International Journal of Ayurvedic Medicine [Internet]. 2023 [cited 2023 Feb 4];11(4). Available from: http://ijam.co.in.

8. Patil VC. Principles and Practice of Panchakarma. Chapter 12. Reprint edition 2018. New Delhi: Chaukhambha Publications; 2018. p. 404.

9. Pardhi GM, Jaane PU. Role of Basti in management of Kitibha Kushtha (psoriasis): A case study. International Journal of Ayurvedic Medicine. 2017 Feb;6(2).

10. Lohith BA. A Textbook of Panchakarma. Chapter 8. First edition 2016. Varanasi: Chaukhambha Orientalia; 2016. p. 391.


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