E-ISSN:2456-3110

Case Report

Palmoplantar Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Holistic approach to treating Vipadika (Palmoplantar Psoriasis) with Ayurvedic Therapies: A Case Report

Lalwani A1*, Gupta R2
DOI:10.21760/jaims.9.8.49

1* Anita Lalwani, Assistant Professor, Shalya Tantra, SSSB Ayurveda College and Hospital Mundiyagarh, Jaipur, Rajasthan, India.

2 Rajesh Gupta, Professor and HOD, Shalya Tantra, Post Graduate Institute of Ayurvedaand Dr Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jaipur, Rajasthan, India.

In Ayurveda all skin disease has been considered under the headings of Kushta. Vipadika is one among such disease which has been included under the heading of Kshudra Kushta. It is characterized by Panipada Sphutanam (fissures), Teevravedana (severe pain) either in palms or soles or in both.[1] Its symptoms can be correlated with palmar-plantar psoriasis which is a chronic skin disease which mainly affects palms and sole region and is characterized by hyperkeratosis, fissures, erythema and occasionally inflammation and pustules. In present, case report a patient with complaint of dryness and cracking of both palms associated with burning and pain in the past 2-3 years, was successfully treated with Shodana (Virechana) and Shamana Aushadhi’s like Manjishthaadi Kashya, Kaishore Gugullu and Jatyadighrit externally for a period of one month. This is an effort to show the brighter side of Ayurvedic treatment not just in alleviating the symptoms but also in improving the immune strength and causing no recurrence of disease. Shodhana helps remove the root cause of the disease, and prevent from recurrence.

Keywords: Kushta, Vipadika, Palmar plantar psoriasis, Shodana, Shamana

Corresponding Author How to Cite this Article To Browse
Anita Lalwani, Assistant Professor, Shalya Tantra, SSSB Ayurveda College and Hospital Mundiyagarh, Jaipur, Rajasthan, India.
Email: 		Lalwani A, Gupta R, Holistic approach to treating Vipadika (Palmoplantar Psoriasis) with Ayurvedic Therapies: A Case Report. J Ayu Int Med Sci. 2024;9(8):312-316.
Available From
https://jaims.in/jaims/article/view/3749

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-01 2024-07-08 2024-07-15 2024-07-22 2024-08-01
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 11.16

© 2024by Lalwani A, Gupta Rand 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

The skin, the body's largest organ, is constantly exposed to various environmental agents such as physical, chemical, and biological factors. Its primary functions include protecting the body from microbes and elements, regulating body temperature, and allowing the sensations of touch, heat, and cold. The skin is composed of different layers. The outermost layer, called the epidermis, acts as a waterproof barrier and determines skin tone. Beneath epidermis lies dermis, which contains tough connective tissue, hair follicles, and sweat glands. The deeper layer, known as subcutaneous tissue or hypodermis, consists of fat and connective tissue. Skin diseases not only have physical effects on patient but also impact their mental and social well-being. In Ayurveda, skin diseases are categorized under Kushta, with 7 Mahakushta and 11 Kshudra Kushta being main classifications.

The aggravation of Doshas due to Nidanas (causative factors) of Kushta leads to Agnimandya (indigestion) and Dhatu Shaitilyata (weakness of muscles, etc.). Among the Doshas, Vata and Kapha are predominantly aggravated, resulting in the Shaithilyata of Dushyas such as the skin (Twak), blood (Rakta), muscles (Mamsa), channels (Lasika), and sweat glands (Lomakupa).

This vitiated Doshas then enters the Rasa Raktadi Dhatus, particularly the movement in Tiryaka Siras (vein), and settles in the skin, leading to Kushta.

Vipadika

Vipadika is a type of Kshudrakushta primarily caused by the imbalance of Vata-Kapha Dosha. It is identified by the presence of fissures in the palms and soles, along with severe pain. The detailed description of Vipadika can be found in the 7th chapter of Charaka Chikitsa Sthana and the 49th chapter of Madhava Nidana. Various factors such as improper diet, heavy and oily food consumption, eating during indigestion, daytime sleeping, and incorrect lifestyle practices can lead to the aggravation of all three Doshas, resulting in skin, blood, muscle, and lymphatic tissue vitiation and ultimately leading to the manifestation of Kushta. This condition bears resemblance to palmoplantar psoriasis, an autoimmune disease characterized by hyperkeratosis, fissures, redness, and sometimes inflammation and pustules.

Treatment options in conventional medicine are limited to topical steroids and drugs like methotrexate, which only provide symptomatic relief without curing the condition.

Case Report

Chief Complaint

The present case study is an Ayurvedic approach in the management of Vipadika. A 30-year-old male patient visited to the Shalya OPD of Shirdi Sai Baba Ayurveda College Kishangarh Renwal, presented with c/o of dryness, scaly lesions and cracking of both palms associated with occasionally burning and pain for last 2-3 years.

History of Present Illness

Patients gave a history of cracking of both the palms which gradually increased associated with burning, itching sensation, and pain in the palms. The condition worsens during winter season. Pain is said to be so severe such that the patient cannot do any work with hands. Patient took treatment from contemporary and other allied medicines for 2-3 yrs. but recurrence was seen on stopping of medication. Since, 3 months he is not under any medication and was came here for better relief.

Personal history

  • Appetite: Moderate
  • Bowel: Previously -irregular, two days a once
  • Micturition: Regular
  • Sleep: Sound
  • Food: Mixed diet

General examination

  • Appearance: Normal
  • Built: Moderate
  • Nourishment: Moderate
  • Pallor: Absent
  • Icterus: Absent
  • Oedema: Absent
  • Cyanosis: Absent

Vital data

  • Pulse: 80 /Min
  • BP: 110/90 MmHg
  • Respiratory Rate: 18/Min

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  • Weight: 65kg

Skin examination

  • Site: both palms
  • Distribution: Symmetrical (both palms)
  • Dryness, itching and cracking of both the palms is seen (Sphutana) which is painful
  • In and around the fingers cracking is seen
  • Surface: is rough and dry, margin- irregular

Laboratory Examination

  • Hb %: 12.6gm%
  • ESR: 20mm/hr
  • Total WBC count: 8,700cells/mm
  • Serum creatinine: 0.6 mg/dl
  • Blood urea: 16.8mg/dl

Ayurvedic Diagnosis

According to Ayurveda, Mr. A's condition was diagnosed as Vipadika, characterized by red, scaly lesions predominantly on palms and soles. The imbalance of Pitta and Kapha doshas was identified as contributing factors, necessitating a comprehensive treatment approach.

Treatment Protocol

  • Virechana[2] Therapy: Initially, patient underwent Virechana therapy by Haritaki phal, a detoxification procedure aimed at eliminating excess Pitta and toxins from the body. This was crucial for resetting his Doshic balance and preparing the body for deeper healing.
  • Manjishthadi Kashaya[3]: Following Virechana, he was prescribed Manjishthadi Kashaya, an herbal decoction known for its blood-purifying and anti-inflammatory properties. This formulation helped to reduce inflammation and detoxify his bloodstream, targeting the root cause of his condition.
  • Kaishore Guggulu[4] :To further enhance blood purification and regulate Pitta-Kapha imbalance, Kaishore Guggulu, a classical Ayurvedic formulation, was administered. It aids in reducing inflammation and promoting healing from within.
  • Jatyadighrit[5] ointment: Externally, Jatyadighrit ointment a specialized herbal ointment, was applied to the affected palms and soles.
  • This ointment not only provided local relief but also supported the systemic treatment by promoting skin regeneration and soothing irritation.

Treatment given

External application: Jatyadighrit

Internal medicines:

Deepan Pachan: Panchakola Churna[6]

Snehapan

Panchtikta Ghrita[7] was administered to the patient empty stomach every morning at 7.00 am. Starting dose was 25 ml with same amount of Luke warm water. Then symptoms presenting in the individual, the duration taken to digest Ghrita, the time taken by the patient to feel hunger was recorded. Patient was advised to avoid sleep during day time, excessive wind, sunlight, not indulge in activities that drain your energy such as loud talking, swimming, long distance walking, arguments, getting angry worrying. The patient was advised not to take any type of diet till he got feeling of hunger. He was just allowed to take Luke warm water till then. Gradually increased the dose of Ghrita by 25 ml every day for 7 days in the following manner.

Abhyanga and Swedana

Abhyanga and Swedana was advised to the patient after Samyaka Singdha Lakshana for 3 days. Abhyanga was done with lukewarm Taila (oil) was applied to the whole body. Patient was transferred to Vaspa Sweda room after Abhyanga and was given Vaspa Sweda for 15-20 minutes.

Diet in the evening of gap day (before Virechana)

One day before at night, prior to Virechana therapy, he had given the diet consisting of the Snigda, Drava, Ushna, and Bhat. Therefore, Laghu Aahar (light diet) moong dal, khichdi and lukewarm water was given.

Virechan day

On the third day after Abhyanga and Swedan. Virechan Yoga was given which consist of following constitutes, On the third day after Abhyanga and Swedan, Virechan Yoga was given which consist of following constitutes,
Haritaki 60gm
Munnaka 20 pieces


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Trikatu Churn 5gm
Rose petals

Yavkut of Haritaki Churna, Munnka is used to make Kwath preparation and Trikatu Churn, rose petals used as Prakshepa Dravya.

Now number of Vega is recorded accordingly, there were 17 number of Vega till 6 p.m

Shaman Aushadhi (given after sansarjan) for 15 days

  • Kaishore Gugullu 1-0-1 after food
  • Manjishthadi Kashaya 10 ml bd

Assessment criteria

Subjective criteria

SymptomsGrade 0Grade 1Grade 2Grade 3
Pani Pada SphutanaAbsentMildModerateSevere
KanduAbsentMildModerateSevere
VedanaAbsentMildModerateSevere
Burning SensationAbsentMildModerateSevere

Pani-Pada SphutanaKanduVedanaBurning Sensation
BTATBTATBTATBTAT
31303030

Outcome

After completing a 45-day course of Ayurvedic treatment, patient experienced significant improvement in his condition. The severity of scaling and redness reduced visibly, and the itching subsided. His palms regained normal texture, allowing him to resume his daily activities without discomfort.
jaims_3749_01.JPG

Follow-Up and Maintenance

To prevent recurrence, patient was advised on dietary and lifestyle modifications tailored to his Doshic constitution. He was encouraged to continue Manjishthadi Kashaya and Kaishore Guggulu in a maintenance dose for the next few months. Regular follow-ups were scheduled to monitor his progress and adjust as needed.

Conclusion

This case report underscores the efficacy of Ayurvedic therapies in managing challenging dermatological conditions like Vipadika (palmoplantar psoriasis). By addressing the root causes through Virechana therapy, Manjishthadi Kashaya, Kaishore Guggulu, and Jatyadighrit ointment, significant symptomatic relief and long-term improvement were achieved. Ayurveda's holistic approach not only treats the symptoms but also aims at restoring overall health and preventing recurrence, making it a promising alternative or complementary therapy for individuals with chronic skin disorders.

References

1. Acharya charaka, revised by Sri Satya Narayana Sastri, Charaka Samhita, part 2, Kushta chikitsa adhyaya, 7th chapter, verse 22, Chaukhamba Bharati Academy, 2002, P.No.252.
2. Kasinatha Shastri & Gorakahanatha Chatruvedi,Charaka Samhita,Edition(Reprint 2001) Chaukhamba Bharati Academy, Varanasi Charaka.kalpa 12/83
3. Sharangadharacharya, Deepika Commentary by Adamalla and Gudhartha Deepika commentary by Kasiram, Sharangadhara Samhita, Madhyama khanda, Kashaya Kalpana Prakarana, verse 136, Nirnaya Sagar Press Bombay, P.No. 162.
4. Kuchewar V. Management of chronic psoriasis through Ayurved. Joinsysmed, 2017; 111-115
5. The Ayurvedic Pharmacopoeia of India, Volume 1, Part 2, New Delhi: Government of India, Ministry of Health and family Welfare, Deptt. Of AYUSH, New Delhi;2007. P.73
6. https://ayurmedinfo.com/2012/07/21/panchakolachoornambenefits-dosage-ingredients-side-effects/


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