Introduction

The skin serves as a protective shield, guarding the body against various external threats. Skin diseases are among the most prevalent health issues globally, carrying a significant burden. Chronic, incurable skin conditions such as psoriasis and eczema result in considerable morbidity, causing physical discomfort and diminishing the quality of life for affected individuals^[2] It is a readily observable organ, visible to the naked eye, and is the largest organ of the body, making it susceptible to diseases and injuries. Several interconnected factors, including nutrition, hygiene, blood circulation, age, immunity, genetic traits, psychological state, and medication use influence the health of the skin.^[3] Psoriasis is a prevalent, long-lasting (chronic) skin condition. In India, its prevalence ranges from 0.44% to 2.8%. The condition typically begins during the second to fourth decades of life. Psoriasis is a chronic disorder characterized by episodes of remission and flare-ups. Remission periods can last anywhere from a week to several years. The disease is marked by the formation of erythematous, well-defined, dry, scaly papules and plaques, which can vary in size from a pinhead to palm-sized or larger.^[4]

In Ayurveda, the skin is referred to as ‘Twacha’ or ‘Charma’. The term Twacha is derived from the root word Twach Samvarne, meaning "the covering of the body." In Ayurvedic texts, all skin-related conditions are broadly categorized under Kushta. According to Amarakosa - Kushta causes destruction of skin and various other parts of the body (Subsequently). Twacha is considered the seat of Sparshajnanendriya (the sense of touch), one of the domains of Vata. However, in modern times, lifestyle changes have significantly contributed to Raktadushti (vitiation of blood) and Dosha Vrudhhi (aggravation of Doshas), which are key factors in the development of skin disorders, particularly Kushta. In Ayurvedic texts, most skin diseases are broadly categorized under the term Kushta.^[5]

Sannikrishta Nidana - Saptko Dravya Sangraha i.e., seven Dravyas or factors involved in the pathogenesis of Kushtha are considered as Sannikrishta Nidana. The Sapta Dravya includes three Doshas viz. Vata, Pitta and Kapha and four Dushyas viz. Tvaka (Rasa), Rakta, Mansa and Ambu or Lasika.^[6]

History of previous illness

He has no history of hypertension (HTN), diabetes mellitus (DM), or other pathological conditions.

Family history

No family history of psoriasis or other dermatological conditions.

Personal history

Appetite - decreased
Bowel - irregular
Micturition – With in normal limits (1 times /night)
Sleep - disturbed
Addiction - Alcohol occasionally
Diet - Mixed

General examination

Pallor - Absent
Icterus - Absent
Cyanosis - Absent
Clubbing - Absent
Lymph node - not palpable
Oedema - Absent
BP - 134/92 mmHg
Pulse - 80 bpm
Respiratory rate - 18/min
Temperature - 98°F

Ashtasthana Pariksha

Nadi - Vata Kapha
Mala - Vibhanda
Mutra - Prakruta
Jihva - Alipta
Drik - Prakruta
Shabdha - Prakruta
Sparsha - Khara Sparsha
Aakriti - Madhyama

Dashavidha Pariksha

Prakriti - Kaphapitha
Vikriti - Kapha Vata
Satva - Madhyama
Sathmya - Madura
Ahara Shakti - Madhyama
Vyayama Shakti - Madhyama
Sara - Meda
Samhanana - Madhyama

Samprapti Ghataka

Dosha - Vata Pradana Thridosha
Dhatu - Rasa (Toda, Vaivarnya), Rakta (Sweda),

This leads to Sanghatmak Vikruti (pathological changes) in Swedavaha Srotas (sweat channels). The Prakupita (vitiated) Doshas enter Rasaraktadi Paribhamana (systemic circulation), particularly affecting Sanchara (movement) in Tiryak Sira (veins). These Doshas eventually localize in Bahya Roga Marga (external pathways, i.e., skin), resulting in formation of Kushta (skin lesions).

Treatment

• Additionally, a light diet consisting of [rice gruel] was recommended to support the digestive process.

As lesions are extremely dry and dryness increases itching. So, to increase unctuousness Kayaseka advocated. Parisheka involves the continuous pouring of medicated liquid from a specific height over the entire body or the affected area. It is also referred to as Kaya Seka or Dhaara. Parisheka aid in enhancing local blood circulation and restoring imbalanced Doshas to their normal state. Parisheka may facilitate the penetration of active principles into the Twakgata Dhamanis. These active principles are absorbed and transferred to deeper layers with the assistance of Bhrajaka Pitta. Abhyantara Snehapana (internal oleation) with Mahatiktaka Ghrita for five days to pacify Vata Dosha. The patient of Kushta should be treated with Snehapana first.^[15] In Vata predominant Kushta condition, ghee should be administered first. Mahatiktaka Ghrita is specially indicated for this purpose. Mahatiktaka Ghrita is greater in properties than Tiktaka Ghrita.^[16] These two drugs are specially mentioned in Kushta Chikitsa context. It alleviates burning sensation, itching, discolouration. Patients of Kushta should be treated with Snehana during intervals. If not given, Vata Dosha increases in body.^[17]

Before performing Virechana Karma, Abhyanga was carried out using Marichadi Taila, which helps reduce dryness, enhances blood circulation, and alleviates itching. This was followed by Sarvanga Swedana, which facilitates Dosha Vilayana (liquefaction of Doshas) and mobilizes Shakhagata Doshas (Doshas lodged in the peripheral tissues) toward the Koshtha for elimination. This process effectively achieves Srotoshodhana (cleansing of channels).

Pradhanakarma

Acharya Charaka emphasizes the importance of Panchakarma therapy, stating that diseases treated with Shodhana (purification therapy) rarely recur, whereas those managed with Shamana (palliative therapy) may relapse over time. Among the Shodhana procedures, Virechana Karma is advocated here. Amongst the Shodhana, Virechana is the best Chikitsa for the Kushtha as it eliminates the Pitta and Kapha Dosha from the body. Virechana (therapeutic purgation) was administered using Trivrut Lehyam to eliminate aggravated Doshas.