E-ISSN:2456-3110

Case Report

Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 2 FEBRUARY
Publisherwww.maharshicharaka.in

Modest Ayurvedic interventions in the management of Ekakustha w.s.r to Psoriasis: A Case Series

Tiwari S1*, Biswas A2, Tiwari S3, Barik S4, Mukherjee P5
DOI:10.21760/jaims.10.2.48

1* Swadha Tiwari, Post Graduate Scholar, Department of Panchakarma, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Bengal, India.

2 Anupam Biswas, Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Bengal, India.

3 Shomya Tiwari, Post Graduate Scholar, Department of Roga Nidan Evam Vikriti Vijnana, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Bengal, India.

4 Shawan Barik, Assistant Professor, Department of Panchakarma, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Bengal, India.

5 Pallabi Mukherjee, Associate Professor and HOD, Department of Panchakarma, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Bengal, India.

Psoriasis is a non-contagious, long-lasting autoimmune and chronic inflammatory skin disorder clinically characterised by erythematous, sharply demarcated papules and rounded plaques, covered by silvery micaceous scale. As per Ayurvedic texts, Psoriasis can be co-related with Ekakustha which is Vata-Kapha transcendent Kshudra Kustha. The prevalence of Psoriasis is between 0.44% and 2.8% in India and affecting up to 1% of world’s population, with men twice as likely to be affected as women. It is most common in people in their 3rd or 4th decade of life. Ayurveda offers wide range of treatment option for this chronic disease under the broad heading Kustha. 5 patients of Ekakustha were selected from Panchakarma OPD. Classical Virechana Karma followed by Shamana Aushadhi (Mahamanjisthadi Kashayam, Arogyavardhini Vati, Gandhak Rasayan and Panchatiktaghrita Guggulu Vati), external application (Siddharthak Snan Churna and Brihat Marichyadi Taila) and lifestyle modification were prescribed for one month. After completion of treatment, marked improvement were noticed in subjective criteria, PASI score and pictorial representation. Follow up suggested no further progression of disease. Panchakarma therapy and Shamana Aushadhi along with lifestyle modification provides a safe and effective treatment option for Psoriasis, highlighting the potential of multi modal Ayurvedic interventions in Psoriasis.

Keywords: Psoriasis, Ekakustha, Twak-Vikar, Skin disorder, Autoimmune disease, Chronic skin condition, Virechana Karma, PASI Score

Corresponding Author How to Cite this Article To Browse
Swadha Tiwari, Post Graduate Scholar, Department of Panchakarma, Institute of Post Graduate Ayurvedic Education and Research at SVSP Hospital, Kolkata, West Bengal, India.
Email: 		Tiwari S, Biswas A, Tiwari S, Barik S, Mukherjee P, Modest Ayurvedic interventions in the management of Ekakustha w.s.r to Psoriasis: A Case Series. J Ayu Int Med Sci. 2025;10(2):332-339.
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https://jaims.in/jaims/article/view/4017/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-01-13 2025-01-25 2025-02-05 2025-02-15 2025-02-25
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© 2025by Tiwari S, Biswas A, Tiwari S, Barik S, Mukherjee P and 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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Download PDFBack To ArticleIntroductionMaterials and MethodsObservation and ResultsDiscussionConclusionReferences
Swadha T et al. Management of Ekakustha w.s.r to Psoriasis

Introduction

Skin, the largest organ of human body, protects the body against external factors, regulates body temperature, aids in the production of vitamin D, and facilitates the sensation of touch. It acts as a visible barrier, readily displaying signs of underlined health issues and serving as a key indicator for the diagnoses of various diseases through observable changes in its appearance, texture, colour, and lustre.

Ekakustha, a type of Kshudra Kustha is a Vata-Kapha predominant Tridoshaja Vyadhi primarily manifested in Twacha i.e., skin. Due to intake of Nidan such as Viruddha Ahara-Vihara (incompatible diet and regimen), Vegadharana (suppression of natural urges), Divaswapna (daytime sleep), disrespecting elders and teachers, Pap karma (sinful activity) etc., all the three Dosha (Vata, Pitta and Kapha) gets aggravated and vitiates Tvak, Rakta, Mamsa and Lasika dhatus. It is characterised by the appearance of well demarcated, erythematous plaques with silvery scales (Matsya Sakalopamam) and loss of perspiration (Aswedanam).


It tends to spread in a large surface area and is termed as ‘Mahavastu’ by Acharya Charak.[1] On the basis of clinical presentation it can be correlated to Psoriasis in contemporary science. Psoriasis is a chronic dermatitis with unpredictable remissions and relapses. It is characterised by well defined, erythematous, indurated papilla and plaques, surmounted by large, silvery scales.[2]

Psoriasis, affecting approximately 1% of global population and between 0.44 to 2.8% of Indian population, is a significant health concern.[3] Despite advances in contemporary medicine, many patients with psoriasis seek alternative treatments due to the limitations and side-effects of conventional treatments.

Materials and Methods

Case Reports

5 patients of Ekakustha were selected from Panchakarma OPD of I.P.G.A.E & R at S.V.S.P Hospital with complaint of Scaly lesions over different parts of the body mainly over the extremities.


Table 1: Inclusion and Exclusion Criteria

Inclusive criteriaExclusive criteria
Age between 18 to 70 yearsAge <18 years and >70 years
Subjects presenting with classical features of EkakusthaImmuno-compromised patients - HIV, HBV
Both male and femaleDiabetes mellitus, Congestive cardiac failure, Chronic kidney disease
History less than 3 years of originPregnant and Lactating mother

Patient’s information

Case 1Case 2Case 3Case 4Case 5
OPD No.3697437241378653947140251
NameJBSLRLBDBS
Age57 Yr35 Yr25 Yr42 Yr52 Yr
SexFemaleMaleMaleFemaleMale
ReligionIslamHinduismHinduismHinduismHinduism
OccupationHousewifeBusinessmanBusinessmanHousewifeDriver
Socio-economic statusLower MiddleLower MiddleLower MiddleMiddleLower Middle
Marital statusMarriedMarriedUnmarriedMarriedMarried
Past History
MedicalN.SN.SN.SN.SN.S
SurgicalN.SN.SN.SN.SN.S
FamilyN.SN.SN.SN.SN.S

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Swadha T et al. Management of Ekakustha w.s.r to Psoriasis

Personal history

Case 1Case 2Case 3Case 4Case 5
AppetitePoorPoorNormalNormalPoor
BowelConstipatedConstipatedUnsatisfactoryNormalConstipated
BladderNormalNormalNormalNormalNormal
SleepDisturbedDisturbedNormalDisturbedDisturbed
AddictionNo suchTobaccoNo suchNo suchNo such
DietaryMixMixMixMixMix
RasaAmla, Lavan, KatuAmla, LavanAmla, LavanAmla, KatuAmla, Lavan
GunaUshna, SnigdhaSnigdhaSnigdhaUshnaUshna, Snigdha
AgniMandagniVishamagniVishamagniMandagniMandagni
KosthaKruraKruraMadhyamMriduKrura

Clinical Findings

Baseline findings

Case 1Case 2Case 3Case 4Case 5
Aswedanam (no/reduce sweating)++++++++
Mahavastu (Area)+++++++++++++++
Matsya Sakalopam (scaling over patches)+++++++++++++++
Kandu (Itching)++++++++++++++
Rukshata (Dryness)+++++++++++++++
Twak Vaivarnyam
(Skin Discolouration)		+++++++++++++
PASI Score19.622.324.516.830.2

Treatment Assessment Parameters

  • Improvements in symptoms grading
  • Psoriasis Area and Severity Index (PASI) Score
  • Pictorial Changes

Timeline of therapeutic intervention

Shodhan KarmaDrug & DoseDuration
1.Deepana and PachanaPanchakola Churna 5 gm twice daily before meal with luke warm water (L.W.W)5 days
2.SnehapanaPanchatikta Ghrita
(D1-30, D2-60, D3-90, D4-120, D5-150)		5 days
3.Sarvanga AbhyangaNeem Taila (Q.S)3 days
4.Sarvanga Bashpa SwedanaAragwadhadi Kwath for 10 minutes3 days
5.Virechana KarmaTrivritavaleha 100 gm with L.W.W
No. of Vega		1 day
6.Samsarjana KramaAs per Classics, 12 Anna Kala5 days
Shamana Aushadhi
7.a. KwathaMahamanjisthadi Kashaya 20 ml twice daily after meal with L.W.W30 days
b. VatiGandhak Rasayan 250 mg twice daily after meal with L.W.W30 days
Panchatikta Ghrita Guggulu 500 mg twice daily after meal with L.W.W30 days
Arogyavardhini Vati 250 gm twice daily after meal30 days
c. External applicationBrihat Marichyadi Taila twice daily30 days
Siddharthak Snan Churna once daily30 days

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Observation and Results

No. of Vega
Case 117
Case 219
Case 318
Case 416
Case 513

AswedanamMahavastuMatsya SakalapamKanduRukshataTwak VaivarnamPASI Score
BTATBTATBTATBTATBTATBTATBTAT
Case 120303030303119.62.8
Case 220313030303022.32.6
Case 310303020302024.55.7
Case 420303030302016.82.7
Case 510313130313130.29.8

ParameternMean scoreMean differenceS.DS.Et value% of reliefp value
BTAT
Aswedanam51.601.60.540.246.66100 %0.001
Mahavastu530.42.60.540.2410.8373.33 %0.001
Matsya Sakalapam530.22.80.440.201493.33 %0.001
Kandu52.802.80.440.2014100 %0.001
Rukshata530.22.80.440.201493.33 %0.001
Twak Vaivarnam52.60.42.20.440.1911.5784.61 %0.001
PASI Score522.64.717.92.541.1315.8979.18 %0.001

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Figure 1: Pictorial Assessment of the Study


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jaims_4017_06.jpg
Graph Showing effect of treatment on Subjective parameters in Patients

Follow-Up and Outcome

After completion of treatment marked improvement were noticed in subjective criteria, PASI score and Pictorial representation. Follow up after one month showed no further disease progression. No ADR or symptom aggravation was found during and after treatment.

Discussion

Ekakustha is described as a Tridoshaja Vyadhi, resulting from the imbalance of Vata, Pitta and Kapha Doshas. Ayurveda offers a unique perspective on Ekakustha, emphasising the importance of diet, lifestyle, Shodhan Karma (purification therapy) and Shamana Karma (palliative treatment) in managing the condition. Acharya Charak has recommended repeated Shodhan Karma for the management of Kustha.[4]

In this case series, 5 cases fulfilling the inclusion criteria were randomly selected from the Panchakarma OPD. Percentage of relief for Aswedanam was 100%, for Mahavastu was 73.33%, for Matsya Saklopamam was 93.33%, for Kandu was 100%, fir Rukshata was 93.33% and for Twak Vaivarnata was 84.61%. PASI score before treatment was 22.6 and after treatment, it reduces to 4.6 . The p values of all the symptoms were 0.001, which shows highly significant result. Here, classical Virechana Karma was conducted before the administration of Shamana Aushadhi for the purpose of achieving Srotoshuddhi (cleansing the channel of circulation), nourishment of senses, lightness of body, rekindling of digestive fire and elimination of toxins from body.[5] Also, in absence of Srotarodha (obstruction of channel) optimum benefit of Shaman Aushadhi can be achieved.

Deepana-Pachana with Panchakola insures Kostha Laghuta (lightness of GI tract), proper functioning of Agni and digestion of ama (undigested product) with the help of Laghu, Ushna, Tikshna, Vishada, Ruksha, Suksma, Khara, Sara and Kathin properties. It also helps in mobilisation of Dosha from Sakha to Kostha.[6]

Snehapana with Mahatikta Ghrita was done in ascending dose. Mahatikta Ghrita contain ingredients like Chandana, Yasthimadhu, Sariba [drugs included in Varniya Mahakasaya); Kharida, Abhaya, Amlaki, Haridra, Saptaparna, Aragvadha [drugs included in Kusthaghna Mahakashaya]; Usheera, Sariva, Guduchi [drugs included in Dahaprasaman Mahakashaya]; Daruharidra, Musta [included in Kandughna Mahakashaya]. It is indicated in the management of Kustha, Visphota, Kandu, Pidaka etc.[7,8]

Snehapana insures Vata Anulomana (pacification of aggravated Vayu) and imparts Mriduta (softening of body). By breaking the Mala-Sanga (accumulation of excretory products), it helps in removing the Srotarodha (obstruction in the channel of circulation).[9] Sneha increases Apymsa (watery part) in the body due to Kledakarak Guna which ultimately leads to Klinnata or Utkleshavastha needed for Sodhan Karma.[10] Sarvanga Abhyanga and Svedana done during Vishram Kala and on the day of Virechana Karma helped in the liquefaction of Dosha and movement of Dosha from Sakha to Kostha.

Virechan Karma was done with the administration of Trivrit Avaleham. Trivrit being the main ingredient is included in the Bhedaniya, Vishaghna, and Asthapanapaga Mahakashaya.[8] This Virechan yoga by the virtue of its Ushna, Tikshna, Sukshma, Vyavayi, Vikasi Guna and Swavirya property reaches the Hridaya. From there, by means of Dhamanis (channel of circulation) it entered Suksma and Sthula Shrota (micro and macro channel of circulation) and acted over the vitiated Dosha. By virtue of Agniya Guna, it liquified the Dosha and by Tikshna Guna it disintegrated the Doshas which ultimately passed down to Kostha (GI tract). Due to predominance of Apa Mahabhuta, Prithvi Mahabhuta and Adhobhagahara Guna the vitiated Dosha were eliminated through the Gudabhaga (anus) by means of Virechana. And by this, it breaks the pathology of the disease by bringing the vitiated dosha and dhatus back to equilibrium state.[11]


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Since Madhyam Suddhi was observed in all the cases, Samsarjana Krama for 12 Anna Kala was adopted. Samsarjan Krama helped in restoration of Agni.[12]

After Samsarjana Krama, Shamana Aushadis (palliative medicines) were administered. Mahamanjisthadi Kashayam is indicated in the management of Kustha Roga. It contains several ingredients such as Manjistha, Musta,Kutaja, Guduchi, Kustha, Nimba, Katuki, Vidanga, Abhaya, Amlaki, Daruharidra, Khadira, Chandana etc., which are categorised under Kusthagna, Kandughna, Varnya, Deepaniya, Dahaprasamana and Vayasthana Mahakashaya. By the virtue of the above property Mahamanjisthadi Kashayam exerts it’s effect in pacifying the aggravated Dosha and also in improving the quality of the skin.[13]

Gandhak Rasayan consist of Suddha Gandhak, Tvak, Ela, Patra, Nagkesara, Haritaki, Amlaki, Vibhitaki, Sunthi etc. it’s chief ingredient Gandhak is Agnideepak, Amanasak, Vishahara, Soshaka and Kriminasak. Gandhak along with other ingredients ensures restoration of normal skin colour and pacifies the symptoms of Ekakustha.[14]

Panchatiktaghrita Guggulu mentioned in the management of Kustha Roga consist of ingredients belonging to Panchatikta Gana i.e., Neem, Guduchi, Vasa, Patol, Nidigdhka along with Ghrita and Guggulu. It has a dominance of Tikta Rasa, Laghu and Ruksha Guna. It possesses Kledhagna, Kandugna, Vranashodhak properties. It thereby rectifies the vitiation of Tvak, Rakta, Mamsa and Lasika Dhatu by exerting anti-inflammatory, anti-oxidative, anti-histaminic properties.[15]

Arogyavardhini Vati is indicated in the treatment of Kustha Roga due to the presence of Ingredients like Kutki, Shuddha Parada, Gandhak, Loha Bhasma, Abhrak Bhasma, Tamra Bhasma along with Triphala, Shilajita, Guggulu, Tikta, Chitrakamula and Neem Swaras Bhavana. Kutki being the main ingredient of Arogyavardhini consist of phyto active compounds like kutkin, kutkosides and picrosides etc. exhibiting anti-inflammatory, hyaluronidase inhibitory, anti-oxidative, immunomodulatory, anti-microbial etc. properties. The Lekhaniya and Bhedaniya property of the drug prohibits the accumulation of vitiated dosha whereas by means of Rechani Guna, it expels the vitiated Dosha and thereby minimises the symptoms of Ekakustha.[16]

Along with Shaman Aushadhi, topical application of Siddhartaka Snan Churna and Brihat Marichyadi Taila were advocated.

Siddhartaka Snan Churna is indicated in the management of Tvak Vikar, Kustha etc. and consist of ingredients such as Mustak, Madanaphala, Triphala, Karanja, Aragvadha, Indrayava, Daruharidra and Saptaparni. Musta exhibits anti-inflammatory and anti-hyperlipidemic activities. It relieves the symptoms of Ekakustha by its Kusthagna, Krimighna, Lekhaniya Gunas.[17] Madanphala acts on Tvak Vikar by exerting it’s anti-inflammatory, anti-helminthic, antibacterial, antifungal, carminative etc. properties.[18] The other ingredients of the drug is mentioned in Kandughna and Kusthagna Mahakashaya which aides them to act against the pathology of Ekakustha.

Topical application of Brihat Marichyadi Taila increases the flow of circulation of the area it is applied on, restores the mobility of soft tissues and also facilitates the drainage of the fluid into the lymph vessels.[19] The ingredients of the Tailam such as Chandana (Kandughna, Vishaghna, Varniya Mahakashaya), Haridra (Kusthagna, Vishaghna Mahakashaya), Saptaparna (Kusthagna Mahakashaya), Khadira (Kusthagna Mahakashaya) Guduchi (Dahaprasamana Mahakashaya), Daruharidra (Kandughna Mahakashaya), Sirish (Vishaghna Mahakashaya) etc.[8] have anti-inflammatory, anti-fungal, antiseptic properties and is used in the treatment of eczema, psoriasis and other dermatological conditions.[20] Katu Taila used as the base oil possesses Kusthagna property.[21] Gomutra exhibits anti-oxidative, anti-fungal, anti-pruritic, antimicrobial etc. properties and is indicated in the management of skin diseases.[22] Other component such as Haritala and Manashila exerts antimicrobial action attributed to its arsenic content and is helpful in relieving the symptoms of skin disease such as Ekakustha.

Conclusion

Ekakustha is a chronic and debilitating skin condition with significant challenges in contemporary medicine. This study provides evidence for the effectiveness of the multimodal Ayurvedic treatment approaches in managing Ekakustha.


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The incorporation of Sodhana, Shamana and Bahir Parimarjana Chikitsa offers a promising outcome in reducing symptoms, improving quality of life and promoting overall well-being in the patients with Ekakustha.

Limitation

  • Small sample size
  • Short follow-up period

Future direction

  • Large scale clinical trials
  • Comparative studies with conventional treatments

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