E-ISSN:2456-3110

Case Report

Vipadika Kushta

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 11 NOVEMBER
Publisherwww.maharshicharaka.in

An Ayurvedic approach in the management of Vipadika Kushta w.s.r to Plantar Psoriasis - A Case Study

Surendran S1*, Sinha CB2*
DOI:10.21760/jaims.9.11.43

1* Sambu Surendran, Post Graduate Scholar, Department of Shalya Tantra, Hass Ayurveda Mahavidhyalaya, Hubballi, Karnataka, India.

2* Chandra Bushan Sinha, Associate Professor, Department of Shalya Tantra, HASS Ayurveda Mahavidhyalaya, Hubballi, Karnataka, India.

Kushta is the broad term used for most of the diseases related to skin, the reference of Kushta is seen in all Brihat Trayes and Laghutrayes, Vaipadika Kushta is one of the commonest types of Kushta that has similarities with plantar and palmar psoriasis, the seven components involved in the manifestation of Kushta are Tridosha, Twak, Mamsa, Rakta and Ambu, Kushta is said under Rakta Pradoshaja Vikara, Rakthamokshana helps in Rakta Shodhana, and Virechana with Eranda Thaila helps Ama Pachana and Vata Shamana, and the Eladi Keram is Vata Kapha Hara, so the treatment protocol is selected for the management of Vaipadika Kushta.

Keywords: Kushta, Vaipadika Kushta, Rakta Pradoshaja Vikara, Rakthamokshana, Virechana, Eladi Keram.

Corresponding Author How to Cite this Article To Browse
Chandra Bushan Sinha, Associate Professor, Department of Shalya Tantra, HASS Ayurveda Mahavidhyalaya, Hubballi, Karnataka, India.
Email: 		Surendran S, Sinha CB, An Ayurvedic approach in the management of Vipadika Kushta w.s.r to Plantar Psoriasis - A Case Study. J Ayu Int Med Sci. 2024;9(11):299-302.
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https://jaims.in/jaims/article/view/3806

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-10-11 2024-10-21 2024-10-30 2024-11-11 2024-11-24
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© 2024by Surendran S, Sinha CBand 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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Sambu S et al. Management of Vipadika Kushta w.s.r to Plantar Psoriasis

Introduction

Twak is one of the Gnyanendriya,[1] the Adhishtana of Sparshanendriya, developed in the Tritiyamasa of intrauterine life. According to Acharya Susruta, there are 7 layers of Twak.[2] The anatomical concepts of Twak have many similarities with skin anatomy.

Skin is the largest organ of the human body, accounting for about 15% of the total adult body weight. It has many functions as it acts as an anatomical barrier that protects from external factors like physical, mechanical, and chemical exposures, as well as prevention of excess water loss from the body.

All the skin diseases in Ayurveda have been discussed under the broad heading “Kustha”. It is one among the Ashta Mahagada,[3] the two types of Kushta are Maha Kushta and Kshudra Kushta, there are 7 Mahakushta and 11 Kshudra Kushta.[4] Vaipadika Kushta is one among the Kshudra Kushta, which is manifested due to Vata and Kapha Dosha. “Vaipadikam Pani Pada Spudanam Theevra Vedanam”[6] i.e, lesion in Pani and pada along with pain. There are striking similarities between the concept of Vipadika Kushta with palmar-plantar psoriasis of modern dermatology, it is a chronic skin disease affecting the palms and sole region, It features pain, thick hyperkeratosis plaque, dryness, and cracked skin, bleeding and itching. Though the incidence has not been determined, the palmoplantar variant of psoriasis comprises 3% to 4% of all cases of psoriasis, which affects 2% to 5% of the population.[7] Palmar plantar psoriasis is caused by a combination of genetic and environmental factors. This case is about a patient complaining of cracking, scaling, itching and pain in both soles for 3 years, The Patient was treated with Shodhana (Virechana) and Shamana Aushadhi followed by Raktamokshana This has shown a significant result. The total treatment was about one month.

Case Report

A 53-year-old male, who is a farmer complained of cracks on both soles with pain, itching and bleeding since last 10 days

Chief Complaints Cracks, Dryness, scaling, itching, pain, and bleeding in both sole

History of Present Illness

The patient was apparently normal before 4 years gradually he developed a small fissure associated with itching on the right sole and later on the left sole, after a few months fissure aggravated with scaling and itching, and gradually pain developed which aggravated on walking, the complaints he consulted an allopathic dermatologist and got symptomatic relief but after few months complaints reoccurred. So, he consulted our hospital for further treatment.

Personal History

BowelRegular
AppetiteGood
MicturitionRegular, 4-6 times per day
SleepDisturbed
HabitsAlcoholism for the past 15 years
DietMixed

Vital Data

Pulse rate - 72 per minute
Blood pressure - 140/90mmhg
Respiratory rate - 20 cycles per minute
Weight - 79 kg

Local Examination

  • Site - both sole region, dorsum of foot or sole
  • Distribution - Symmetrical (both soles)
  • Dryness, itching and cracking of both the soles are seen) which is painful bleeding from the cracked region is seen
  • Surface is rough and dry, margin- irregular Colour: white scaly
  • Texture - hard

Treatment

Shamana Chikitsa

Internally

  • Indukantham Kashya 15 ml Kashaya in 45 ml luke warm water 10 days
  • Aragwadadi Kashaya 15 ml Kashaya in 45 ml luke warm water 20 days
  • Kaishora Guggulu 1 BD 30 days

Externally

  • Aragwadha Twak Kashaya Parisheka 20 days
  • Eladi Kera application 30 days

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Sambu S et al. Management of Vipadika Kushta w.s.r to Plantar Psoriasis

Shodhana Chikitsa

  • Sadhyo Virechana with Eranda Thaila 15 ml with milk
  • Siravyadha

Assessment Criteria for Sputana

Clinical featuresScore
Insignificant dryness at the foot0
Roughness is present when touching1
Excessive roughness presents and leads to itching2
Excessive roughness presents and leads to slight cracks3
Roughness leading to cracks and fissures4

Assessment Criteria for Vedana

Clinical featuresScore
No pain0
Mild pain of an easily bearable nature comes occasionally1
Moderate pain, but no difficulty in walking2
Appears frequently and requires some measures for relief3
Pain requires medication and may remain throughout the day4

Assessment Criteria for Itching

Clinical featuresScore
No itching0
Mild itching, occasional, annoying1
Moderate itching, frequent, disturbing2
Severe itching, constant, continuous3
Very severe itching, unbearable, disturbs day-to-day activities and sleep4

Observation Table

Clinical featuresBefore treatmentAfter treatment
Sputana 31
Ruja 20
Kandu 40

jaims_3806_01.JPG
Figure 1: Before treatment 7/4/2024

jaims_3806_02.JPG
Figure 2: After treatment 14/4/2024

jaims_3806_03.JPG
Figure 3: After treatment 28/4/2024

jaims_3806_04.JPG
Figure 4: After treatment 10/5/2024

Observation

Before treatment (fig: 1)

  • Patient had Cracks, Dryness, scaling, itching, pain, and bleeding in both sole

After treatment (figure:2)

  • After 7 days of treatment pain, scaling and bleeding were reduced

After treatment (figure: 3)

  • After 20 days of treatment cracks were reduced, and dryness and itching reduced

After treatment (figure: 4)


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Sambu S et al. Management of Vipadika Kushta w.s.r to Plantar Psoriasis
  • After 1 month of treatment complete scaling, dryness, bleeding and all other symptoms were reduced.

Result

After treatment symptoms are reduced, and follow-up medicine and proper diet are advised.

Discussion

Based on the symptoms of Vipadika Kushta it can be correlated to plantar psoriasis. Two sittings of Siravyadha were done over a gap of 7 days. As Kustha is a Raktha Pradhoshaja Vikara, Siravyadha does Raktha Shodhana by removing the Dhushitha Raktha and reducing symptoms like itching etc. Indukantham Kashaya was given for 10 days which has Poothika, and Dharu Dashamoola which corrects Agni and reduces Rooksha, Sputana and Ruja caused due by Vata, Aragwadadi Kashaya was given for 20 days which has a direct indication in Kushta, the drugs of the formulation reduce Kelda in Vaipadika Kushta hence reduce Kandu, and helps in healing of the cracks and along with Vatanulomana. virechana was given on the 10th day of treatment with eranda thaila as it does ama pachana as well as reduces Vata. Eternally Parisheka was done with Kashaya prepared with Aragwadha Twak does Shodhana of the lesion and reduces the symptoms, Eladi Kera was advised to apply externally as it reduces kapha and Vata, does Vrana Prasadana and reduces Kandu.

Conclusion

The present study concludes that Vipadika can be effectively treated with ayurvedic treatments like Sira Vyadha and Virechana.

References

1. Charaka Samhita, revised by Charaka and Dridhabala with the Ayurved-Dipika Commentary of Chakrapani Datta. In: Acharya JT, editor. Sutrasthana, 8/10. New Delhi: Chaukhamba Publications; 2018. p. 56.

2. Charaka Samhita, revised by Charaka and Dridhabala with the Ayurved-Dipika Commentary of Chakrapani Datta. In: Acharya JT, editor. Sutrasthana, 8/10. New Delhi: Chaukhamba Publications; 2018. p. 56.

3. Charaka Samhita, revised by Charaka and Dridhabala with the Ayurved-Dipika Commentary of Chakrapani Datta. In: Acharya JT, editor. Sutrasthana, 8/10. New Delhi: Chaukhamba Publications; 2018. p. 56.

4. Charaka Samhita, revised by Charaka and Dridhabala with the Ayurved-Dipika Commentary of Chakrapani Datta. In: Acharya JT, editor. Sutrasthana, 8/10. New Delhi: Chaukhamba Publications; 2018. p. 56.

5. Charaka Samhita, revised by Charaka and Dridhabala with the Ayurved-Dipika Commentary of Chakrapani Datta. In: Acharya JT, editor. Sutrasthana, 8/10. New Delhi: Chaukhamba Publications; 2018. p. 56.

6. Charaka Samhita, revised by Charaka and Dridhabala with the Ayurved-Dipika Commentary of Chakrapani Datta. In: Acharya JT, editor. Sutrasthana, 8/10. New Delhi: Chaukhamba Publications; 2018. p. 56.

7. Sushruta Samhita, Ayurveda Tatva Sandeepika Hindi Commentary by Kaviraj Ambikadatta Shastri. Varanasi: Chaukhamba Sanskrit Sansthan; Reprint Edition, 2010. Shareerasthana, Chapter 4.

8. Sushruta Samhita. Edited by Yadavji Trikamji Acharya. Reprinted. Varanasi: Chaukhamba Orientalia Academy; 2009. p. 143.

9. Acharya JT. Charaka Samhita of Agnivesha, Chikitsasthana; Kushtachikitsa Adhyaya, Chapter 7, Verses 31-32. 1st ed. Varanasi, India: Chowkhamba Prakashan; 2013. p. 451.

10. Shukla V, Tripathi RD, editors. Charaka Samhita of Agnivesha, ‘Vaidyamanorama’ Hindi Commentary. Chikitsa Sthana, Verses 7-22. Varanasi: Chaukhamba Sanskrit Pratishthan; Vol II; p. 184.

11. National Center for Biotechnology Information. Charaka Samhita. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448142/

12. Acharya JT. Charaka Samhita of Agnivesha, Chikitsasthana; Kushtachikitsa Adhyaya, Chapter 7, Verses 31-32. 1st ed. Varanasi, India: Chowkhamba Prakashan; 2013. p. 451.


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13. Acharya JT. Charaka Samhita of Agnivesha, Chikitsasthana; Kushtachikitsa Adhyaya, Chapter 7, Verses 31-32. 1st ed. Varanasi, India: Chowkhamba Prakashan; 2013. p. 4.

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