E-ISSN:2456-3110

Case Report

Ekakushtha

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 1 JANUARY
Publisherwww.maharshicharaka.in

Therapeutic approaches and clinical outcomes in Ayurvedic management of Ekakushtha (Psoriasis) : A Case Report

Brahmbhatt S1*, Taviad K2, Kalsariya B3
DOI:10.21760/jaims.10.1.38

1* Saurav Brahmbhatt, Post Graduate Scholar, Upgraded Department of Rasashastra and Bhaishajya Kalpana, Government Ayurved College Hospital, Vadodara, Gujarat, India.

2 Krushnkumar Taviad, Assistant Professor, Upgraded Department of Rasashastra and Bhaishajya Kalpana, Government Ayurved College Hospital, Vadodara, Gujarat, India.

3 Bharat Kalsariya, Professor and Principal, Upgraded Department of Rasashastra and Bhaishajya Kalpana, Government Ayurved College Hospital, Vadodara, Gujarat, India.

Background: Ekakushtha, a type of Kshudra Kushtha attributed to Vata and Kapha Dosha imbalance, shares clinical similarities with psoriasis - a chronic, non-communicable condition causing significant morbidity and negatively impacting the quality of life.

Methods: A 64-years-old male presented with pruritic, dry, scaly lesions progressing to thick, erythematous patches across the abdomen, diagnosed as Ekakushtha at the OPD of Rasashastra and Bhaishajya Kalpana, Government Ayurved Hospital, Vadodara. The therapeutic approach involved oral ingestion of Panchatikta Ghrita Guggulu, Triphala Guggulu, Gandhaka Rasayana, and morning administration of a combination of Amalaki, Guduchi and Haridra Swarasa, alongside the local application of Gandhaka Malahara. The patient's response was assessed over eight weeks using the Auspitz sign, PASI score, symptom improvement, and patient-reported outcomes.

Results: Significant reduction in inflammation, itching, and scaling was observed, with substantial lesion improvement noted. The treatment regimen, administered for eight weeks with four weeks of follow-up, was well-tolerated without adverse effects. He was observed for twenty-four weeks after follow-up and no recurrence has been observed.

Conclusion: This case study demonstrates effective management of Ekakushtha using Ayurvedic therapies including Panchatikta Ghrita Guggulu, Triphala Guggulu, Gandhaka Rasayana, and Gandhaka Malahara, resulting in marked clinical improvement and no recurrence at twenty-four weeks post-treatment. Thus, it can be concluded that Ayurvedic treatments seem to be effective options in the management of Ekakushtha.

Keywords: Ayurved, Case report, Gandhaka Rasayana, Panchatikta Ghrita Guggulu, Rasashastra, Skin disease, Triphala Guggulu

Corresponding Author How to Cite this Article To Browse
Saurav Brahmbhatt, Post Graduate Scholar, Upgraded Department of Rasashastra and Bhaishajya Kalpana, Government Ayurved College Hospital, Vadodara, Gujarat, India.
Email: 		Brahmbhatt S, Taviad K, Kalsariya B, Therapeutic approaches and clinical outcomes in Ayurvedic management of Ekakushtha (Psoriasis) : A Case Report. J Ayu Int Med Sci. 2025;10(1):246-252.
Available From
https://jaims.in/jaims/article/view/3901

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-12-16 2024-12-26 2025-01-06 2025-01-16 2025-01-28
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Not required 12.54

© 2025by Brahmbhatt S, Taviad K, Kalsariya Band 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 2025;10(1)246
Download PDFBack To ArticleIntroductionCase ReportResultDiscussionConclusionReferences
Saurav Brahmbhatt et al. Ayurvedic management of Ekakushtha (Psoriasis)

Introduction

All skin conditions are grouped under Kushtha Roga category in Ayurvedic classics. The word Kushtha itself suggests, a disease that causes marked disfigurement or deformity of skin.[1] It is classified into two main categories: Mahakushtha (major skin diseases) and Kshudra Kushtha (minor skin diseases). Among the 18 types of Kushtha, seven belong to Mahakushtha and eleven are classified as Kshudra Kushtha. It is a disorder influenced by all three Dosha[2], commonly found in individuals who lead an unhealthy lifestyle. It is categorized within Ashtamahagadavyadhi, a group of eight serious disorders.[3] Ekakushtha is a type of Kshudra Kushtha attributed to Vata and Kapha Dosha imbalance. It manifests with symptoms including Aswedanam (Anhidrosis), Mahavastu (extensive lesions), Matsyashakalalopamam (skin scaling resembling fish scales), and Aruna Varna (skin discolouration) [4]. It exhibits clinical similarities to psoriasis - a chronic, non-communicable condition that significantly impacts quality of life.[5]

Psoriasis affects between 0.09% to 11.4% of global population. In India, psoriasis affects between 0.44% to 2.8% of population, with a prevalence twice as high in males compared to females. The majority of patients first present with condition during their third or fourth decade of life. [6] Thus, psoriasis is a widespread skin disorder with its exact cause remaining unknown. However, it is believed that genetic, environmental, dietary, and lifestyle factors may play a role in its onset. The condition worsens due to factors such as disrupted gut flora, physical injury, and emotional stress.[7] It is a persistent inflammatory skin condition marked by well-defined, red, scaly plaques, commonly found on extensor surfaces, scalp and nails. Some of most common medicines being used in management of psoriasis are Cortico-steroids (betamethasone, clobetasol, prednisolone etc.), Salicylic acids, methotrexate, cyclosporin and anti-fungal drugs (Fluconazole, ketoconazole, itraconazole etc).[8]

Modern medicine offers limited therapeutic options due to its recurrent nature.[9] Ayurveda, however, provides a holistic approach focusing on balancing Dosha. In Ekakushtha, treatment involves addressing seven Dushya [10] (Saptako Dravya Samgraha - Tridosha, Rakta, Mamsa, Twak & Ambu) through Shodhana & Shamana Chikitsa therapies.

Present case report aims to assess therapeutic approaches & clinical outcomes of Ayurvedic management in treating Ekakushtha, offering detailed case report to guide future research & clinical practice.

Case Report

Case Presentation

On 27 September 2023, 64-years-old married male presented with OPD no. 22338 came to outpatient department of Rasashastra & Bhaishajya Kalpana at Government Ayurved Hospital, Vadodara, Gujarat, India. Patient was of lower middle-class socio-economic status, resides with his family in Vadodara & works in rural farming environment. He reported pruritic, dry, scaly lesions that had evolved into thick, red erythematous patches covering his abdomen, with chronicity of more than two years (Figure - 1). Upon clinical examination & evaluation, he was diagnosed with Ekakushtha. As he was farmer, he was not convinced of Shodhana (purification therapy), So, Shamana Chikitsa was given to him (palliative treatment).

Treatment History

The patient underwent specific therapy for Ekakushtha (psoriasis) and had a history of allopathic treatments, including prednisolone 5 mg BD, fluconazole 150 mg OD, and ketoconazole ointment for four weeks, which provided symptomatic relief. However, symptoms recurred after discontinuation of these medications. The patient presented with pruritic, dry, scaly lesions that progressed to thick, erythematous patches on abdomen. Condition had been chronic for over two years. There were no known coexisting conditions (K/C/O). The patient reported a history of excessive consumption of spicy and sour foods and significant sun exposure. No relevant family history of psoriasis or similar dermatological conditions was identified.

Examinations and measures

The Patient was firstly assessed with general examinations such as physical examination, Dashavidha Pariksha, and Ashtavidha Pariksha. Specific examinations were done and assessed using criteria such as Matsyashakalopama (scaling), Krishna-Arunavarna (discoloration), Aswedana (absence of perspiration), Mahavastu (lesion extent), Daha (burning sensation), Kandu (itching),


J Ayu Int Med Sci 2025;10(1)247
Saurav Brahmbhatt et al. Ayurvedic management of Ekakushtha (Psoriasis)

Auspitz sign and PASI score (Psoriasis Area Severity Index). After examinations and assessments, patient was diagnosed with Ekakushtha (Psoriasis).

General Examination

The patient had a pulse rate of 72/min, blood pressure of 130/80 mm/Hg, a temperature of 98.8°F, and a respiratory rate of 20/min; his height was 168 cm, weight was 67 kg, and BMI was 23.7 kg/m², with clear conjunctiva, a white-coated tongue with no oedema in any part of the body.

Dashavidha Pariksha

The Dashavidha Pariksha revealed following findings for patient: Prakriti (constitutional type) was identified as Vata Kapha. The Vikriti (disease state) was characterized by Saptako Dravya Samgraha (Tridosha, Rakta, Mamsa, Twak and Ambu). Sara (tissue quality) was Medasara. Samhanana (body structure) was assessed as Madhyama. Pramana (body measurement) was considered Madhyama. Satmya (adaptability to diet and environment) was Pravara. Satva (mental strength) was categorized as Madhyama. Ahara Shakti (digestive strength) was Madhyama, while Vyayama Shakti (exercise capacity) was noted as Pravara. Vaya (age) was also evaluated as Pravara.

Ashtavidha Pariksha

The Ashtavidha Pariksha findings were as follows: Nadi (pulse) was Vata Kapha. Urine output was 4-5 times per day and 0-1 time per night. Stool was described as Baddha (constipated). The tongue was coated white. The voice was clear. The skin was noted as Sheeta (cool to touch). Vision was normal. The overall body structure (Akriti) was normal.

Criteria of Assessment with scoring
1. Matsyashakalopama (Scaling)

Table 1: Assessment of Matsyashakalopama (Scaling) with scoring

SNCriteriaScoring patternScore on screening day
1.No Scaling02
2.Mild scaling by rubbing/by itching (scaling from some lesion)1
3.Moderate scaling by rubbing/by itching (from all lesions)2
4.Severe scaling by rubbing / by itching (from all lesions)3
5.Scaling without rubbing / by itching (from all lesions)4

2. Krishna-Arunavarna (Discoloration)

Table 2: Assessment of Krishna-Arunavarna (Discoloration) with scoring

SNCriteriaScoring patternScore on screening day
1.Normal coloration02
2.Near to normal which looks like normal colour to a distant observer1
3.Reddish colouration2
4.Slight black reddish discolouration3
5.Dark black coloured discolouration4

3. Aswedana (Absence of perspiration)

Table 3: Assessment of Aswedana (Absence of perspiration) with scoring

SNCriteriaScoring patternScore on screening day
1.Normal04
2.Improvement1
3.Present in a few lesions2
4.Present in all lesions3
5.Absence of sweat in the lesion and uninvolved skin4

4. Mahavastu (Extensive location)

Table 4: Assessment of Mahavastu (Extensive location) with scoring

SNCriteriaScoring patternScore on screening day
1.No lesions on Mahasthanama 02
2.Lesion on partial part of hand, leg, neck, scalp, trunk, back, abdomen1
3.Lesions on most of hand, leg, neck, scalp, trunk, back, abdomen2
4.Lesions on the whole part of Mahasthanama (Vast area)3

5. Mandala (circular lesion)

Table 5: Assessment of Mandala (circular lesion) with scoring

SNCriteriaScoring patternScore on screening day
1.No circular lesion04
2.Few circular lesions and smaller than a coin1
3.Few circular lesions and big (larger) coin2
4.More circular lesions and smaller than a coin3
5.More circular lesions and bigger than a coin4

J Ayu Int Med Sci 2025;10(1)248
Saurav Brahmbhatt et al. Ayurvedic management of Ekakushtha (Psoriasis)

6. Daha (Burning sensation)

Table 6: Assessment of Daha (Burning sensation) with scoring

SNCriteriaScoring patternScore on screening day
1.No burning Sensation01
2.Mild burning Sensation1
3.Moderate burning Sensation2
4.Severe burning Sensation3
5.Very severe burning Sensation4

7. Kandu (Itching)

Table 7: Assessment of Kandu (Itching) with scoring

SNCriteriaScoring patternScore on screening day
1.No Itching03
2.Mild Itching1
3.Moderate Itching2
4.Severe Itching3
5.Very severe Itching4

8. Auspitz sign

Table 8: Assessment of Auspitz sign with scoring

SNCriteriaScoring patternScore on screening day
1.Absent01
2.Less often bleeding1
3.Often bleeding but in less amount2
4.Often bleeding and excessive3

9. PASI score (Psoriasis Area Severity Index)

Treatment Protocol

A. Nidana Parivarjana: The patient was advised to avoid dietary substances that aggravate Dosha and induce symptoms.

This included abstinence from consuming heavy foods, incompatible food combinations, acidic foods, sesame, jaggery, excessive dairy products, etc.

B. Shamana Chikitsa

Table 9: Details of given drugs during treatment

SNDrugDoseDuration of treatmentDuration of follow-upAnupanaKala
1.Combination of Amalaki, Guduchi and Haridra Swarasa20 mleight weeksfour weeks-Empty Stomach- morning
2.Panchatiktaghrita Guggulu5 tab. Onceeight weeksfour weeksLuke warm waterEmpty Stomach- morning
3.Gandhaka Rasayana2 tab. Thriceeight weeksfour weeksLuke warm waterAfter meal
4.Triphala Guggulu2 tab. Thriceeight weeksfour weeksLuke warm waterAfter meal
5.Gandhaka MalaharaOnceeight weeksfour weeksExternal applicationAt night
6.Haritaki Churna for Koshtha Shuddhi4 geight weeksfour weeksLuke warm waterAt night

Result

Table 10: Details of the score of symptoms before and after treatment with follow-up

SNComplaintsBT (0 week)After Treatment (8 weeks)Follow up(4 weeks)
1.Matsyashakalopamam200
2.Krishna-Arunavarna200
3.Aswedana400
4.Mahavastu200
5.Mandala400
6.Daha100
7.Kandu300
8.Auspitz sign100
9.PASI score700

Discussion

Ekakushtha, an Ayurvedic classification for skin disorders resembling psoriasis, exhibits symptoms such as scaling, redness, and discomfort. Psoriasis affects a significant portion of the global population, with varying prevalence across regions, and its exact cause remains elusive.


J Ayu Int Med Sci 2025;10(1)249
Saurav Brahmbhatt et al. Ayurvedic management of Ekakushtha (Psoriasis)

Treatments often provide limited long-term relief due to recurrent nature. Ayurveda approaches Ekakushtha by focusing on balancing Dosha - particularly Vata and Kapha. The Ayurvedic approach to managing Ekakushtha focuses on restoring Dosha balance through detoxification and nourishing therapies. The comprehensive case presentation covers patient demographics, clinical history, symptoms, and prior allopathic treatments. This detailed account provides a thorough understanding of the patient's condition and treatment journey. The effectiveness of combined herbal and herbo-mineral formulations in alleviating psoriasis symptoms is demonstrated. The patient, a 64-year-old male with chronic, pruritic, scaly lesions, had previously experienced symptom relief with allopathic medications, but recurrence was observed. The Ayurvedic treatment protocol was meticulously outlined, specifying the use of remedies such as Panchatiktaghrita Guggulu, Triphala Guggulu, Gandhaka Rasayana and Haritaki Churna complemented by dietary adjustments (with proper Deepana-Pachana) and external applications (Gandhaka Malahara). Each treatment choice is justified about Ayurvedic principles of Dosha equilibrium and immune enhancement.

Probable mode of action of drugs

A combination of Amalaki, Guduchi and Haridra Swarasa, Guduchi and Amalaki was given in morning on an empty stomach. These herbs were chosen for their rejuvenating and immunomodulatory properties. Amalaki and Guduchi act as Rasayana and improve immune response of body.[11] Guduchi acts as Deepana, Vata-Kaphahara and Raktadoshaghna. Niraj Mendpara et. al concluded significant action of Guduchi in management of Ekakushtha.[12] Haridra possesses properties like Shothahara, Kushthaghna, Varnya, Vranahara and Pramehahara.[13] It has been proven that turmeric possesses antioxidant, antifungal, antibacterial, anti-inflammatory and immune-modulatory properties.[14] Fresh juice of Amalaki, Guduchi and Haridra Swarasa acts more beneficially as it retains all phytoconstituents and properties. So, this combination may help in fast acting, blood purification, and early healing of plaques and also reduces risk of recurrence and adverse drug reactions. Panchtiktaghrita Guggulu was selected for Shamana therapy because it is indicated in classes for Kushtha.

It contains Panchatikita herbs like Patola (Trichosanthes dioica Roxb.), Nimba (Azadirachta indica A. Juss), Vasa (Adhatoda vasica Linn Nees), Kantakari (Solanum virginianum Linn.) and Guduchi (Tinospora cordifolia Willd.) which are recognized for their strong anti-inflammatory properties. These ingredients are also effective in diminishing the inflammation linked with psoriatic lesions. It is widely used in the treatment of psoriasis, eczema and ulcers. Research shows that it is beneficial in skin disorders of Vata and Kapha predominance.[15] The impacts of Vata and Kapha Dosha are lessened by Gandhaka Rasayana because of its Kushthaghna, Kandughna and Vata-Kaphaghna properties.[16] Triphala Guggulu is mentioned in Sharangdhara Samhita which possesses Shothahara (reduction in swelling or inflammation), Vrana Shodhana (wound cleansing) and Vrana Ropana (wound healing) properties.[17,18] Gandhaka, the primary constituent of Gandhaka Malahara, plays a crucial role in promoting the healing and regeneration of skin tissues. This property is essential for effectively managing lesions associated with Ekakushtha.[19] Haritaki Churna given to the patient has a purgation effect. It cleanses Koshtha (Gastrointestinal Tract) and pacifies the Pitta Dosha of the body.

Follow-Up: The patient was followed up weekly for four weeks to monitor progress and adjust treatment as needed. After follow-up patient was observed for six months and no recurrence has been seen.

Clinical Outcomes: At the end of the eight-week treatment period, the patient reported a significant reduction in all the symptoms. Assessment of treatment outcomes includes both subjective (patient-reported symptoms) and objective measures (PASI score, Auspitz sign), providing a comprehensive evaluation. Remarkable improvements in symptoms and the absence of recurrence during the 6-month follow-up period underscore the efficacy of the treatment approach.

Conclusion

This case report highlights the effectiveness of traditional Ayurvedic therapies in managing chronic skin conditions like Ekakushtha (Psoriasis). It underscores the potential of Ayurvedic principles to address complex dermatological issues and provides a basis for further research and clinical application in treating Ekakushtha and similar conditions.


J Ayu Int Med Sci 2025;10(1)250
Saurav Brahmbhatt et al. Ayurvedic management of Ekakushtha (Psoriasis)

Consent: The patient's consent was received for publishing this case report.

Source of Support: Nil

Conflict of Interest: None declared

References

1. Acharya Charaka. Charaka Samhita, Vidhyotini Tika by Kashinath Shastri. Reprint edition. Varanasi: Chaukhambha Bharti Academy; 2017. Chikitsasthana, 7/1; p. 247 [Crossref][PubMed][Google Scholar]

2. Acharya Charaka. Charaka Samhita, Vidhyotini Tika by Kashinath Shastri. Reprint edition. Varanasi: Chaukhambha Bharti Academy; 2017. Chikitsasthana, 7/9; p. 248 [Crossref][PubMed][Google Scholar]

3. Acharya Sushruta. Sushruta Samhita, Sharma AR. Sutrasthana, 33/6. Varanasi: Chaukhamba Surbharati Prakasan; 2017. p. 259 [Crossref][PubMed][Google Scholar]

4. Acharya Charaka. Charaka Samhita, Vidhyotini Tika by Kashinath Shastri. Reprint edition. Varanasi: Chaukhambha Bharti Academy; 2017. Chikitsasthana, 7/21; p. 253 [Crossref][PubMed][Google Scholar]

5. Langley RGB, Krueger GG, Griffiths CEM. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64(Suppl II):ii18-ii23. doi:10.1136/ard.2004.033217. Published 2024 Aug 12 [Crossref][PubMed][Google Scholar]

6. Dogra S, Yadav S, et al. Psoriasis in India: Prevalence and pattern. Indian J Dermatol Venereol Leprol. 2010;76(6):595-601. [Crossref][PubMed][Google Scholar]

7. World Health Organization. Global report on psoriasis. WHO Library Cataloguing-in-Publication Data. ISBN 978 924156518 9. [Crossref][PubMed][Google Scholar]

8. Medscape. Emedicine Guidelines for Psoriasis. Available from: https://emedicine. medscape. com/article/1943419-guidelines?form=fpf#g2 [Crossref][PubMed][Google Scholar]

9. Langley RGB, Krueger GG, Griffiths CEM. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64(Suppl II):ii18-ii23. doi:10.1136/ard.2004.033217. Published 2024 Aug 12 [Crossref][PubMed][Google Scholar]

10. Acharya Charaka. Charaka Samhita, Vidhyotini Tika by Kashinath Shastri. Reprint edition. Varanasi: Chaukhambha Bharti Academy; 2017. Chikitsasthana, 7/9; p. 248 [Crossref][PubMed][Google Scholar]

11. Bhat PM, Shah RS, Patel BS, et al. Amalaki: A review on functional and pharmacological activities. J Pharmacogn Phytochem. 2019;8(3):4378-4382. [Crossref][PubMed][Google Scholar]

12. Mendpara N, et al. Dissertation work. Assessment of different processes of Guduchi (Tinospora cordifolia Willd. ) through berberine quantification and their clinical efficacy on Ekakushtha (Psoriasis). Vadodara: Government Ayurved College and Hospital, Gujarat Ayurved University; 2024 [Crossref][PubMed][Google Scholar]

13. Chakraborty S, Das S, et al. A classical Ayurveda review on Haridra. AYUSHDHARA. 2020;7(Suppl. 1):85-92 [Crossref][PubMed][Google Scholar]

14. Jyotirmayee B, et al. A review on selected pharmacological activities of Curcuma longa L. Int J Food Prop. 2022;25(1):1377–1398. [Crossref][PubMed][Google Scholar]

15. Barvalia R, et al. Dissertation work. A comparative pharmaco-clinical study of Panchatikta Ghrita prepared by different methods in Ekakustha (Psoriasis). Jamnagar: IPGT&RA; 2000. [Crossref][PubMed][Google Scholar]

16. Yogaratnakar. Kushtha Chikitsa. In: Dr. Indradeva, editor. Varanasi: Krishnadas Academy; 1998. p. 644 [Crossref][PubMed][Google Scholar]

17. Acharya Sharangadhara. Sharangadhara Samhita with Deepika Hindi Commentary by Dr. Brahmanand Tripathi. Reprint Edition. Varanasi: Chaukhambha Surbharti Prakashan; 2020. Madhyama Khanda, 7/82-83; p. 242 [Crossref][PubMed][Google Scholar]


J Ayu Int Med Sci 2025;10(1)251
Saurav Brahmbhatt et al. Ayurvedic management of Ekakushtha (Psoriasis)

18. Rawat N, et al. Anti-inflammatory and anti-microbial action of Triphala Guggulu: a review. Int J Res Ayurveda Pharm. 2022;13(4):153-160. [Crossref][PubMed][Google Scholar]

19. Thakur N. Rasatantra Saar evum Siddha Prayoga Samgraha. Kaleda: Krushn Gopal Ayurved Bhavan; 2019. Part-2; p. 238 [Crossref][PubMed][Google Scholar]

Disclaimer / Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of Journals and/or the editor(s). Journals and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.


J Ayu Int Med Sci 2025;10(1)252