Journal of Ayurveda and Integrated Medical Sciences

Introduction

Psoriasis is a chronic, immune-mediated inflammatory disorder primarily affecting the skin and occasionally the joints, as in psoriatic arthritis.^[1] It is characterized by the hyperproliferation of keratinocytes, resulting in erythematous plaques with silvery scales. The global prevalence of psoriasis is approximately 2–3%, and its impact extends beyond physical symptoms, affecting patient’s psychological and social well-being. The aetiology is multifactorial, involving genetic predisposition, immune dysregulation and environmental triggers such as infections, stress and trauma. Conventional treatments include topical corticosteroids, systemic therapies like methotrexate & cyclosporine and biologics targeting cytokines such as TNF-α and IL-17.^[2] While these therapies provide relief, their limitations include potential side effects, high costs and inconsistent long-term efficacy.

In classical Ayurveda, chronic plaque psoriasis aligns closely with "Kitibha," categorized under "Kshudra Kushtha," a type of skin disorder. The condition's pathogenesis or Samprapti Ghataka, indicates a disruption primarily of the Vata and Kaphadoshas, alongside an involvement of Rakta (blood tissue). The vitiated doshas and contaminated blood together manifest characteristics on the skin commonly associated with psoriasis.

The pathogenesis details the following components: Dominant disturbed doshas are Vata, contributing to the dryness, roughness, scaling and Kapha, which adds itchiness, thickness, and a notable silvery scaling. The Dushyas involved include Twacha (skin), Rakta (blood), and occasionally Mamsa (muscles), where the imbalances and toxins express as patchy, scaly skin lesions. The affected channels or Srotas, particularly the Raktavaha (carrying blood) and Twakvaha (carrying therapeutic substances to skin), become blocked or misdirected primarily due to the accumulation of Ama (toxins) stemming from poor diet and lifestyle choices.

Typical causative factors or Nidana, such as cold and dry climates, consumption of incompatible foods, irregular lifestyles and psychological stress, further exacerbates the condition. Treatment in Ayurveda focuses on diet and lifestyle to pacify the aggravated doshas,

The affected areas were thickened, with well-defined borders and occasional mild tenderness. Her PASI (Psoriasis Area and Severity Index) score was calculated to be 15, indicating moderate severity of the disease. In this case study, the Pruritus Severity Scale (PSS) was used to assess the impact of pruritus on the patient’s quality of life. The initial PSS score was 16/18, indicating severe pruritus. The breakdown of the score revealed moderate intensity (2), frequent duration (2), widespread distribution (3), significant sleep disturbances (3), interference with daily activities (3) and a severe psychosocial impact (3). This high score highlighted the profound effect of pruritus on the patient’s physical, emotional, and social well-being.

In addition to her physical symptoms, the patient exhibited significant psychological distress, characterized by heightened anxiety, irritability and a pervasive sense of mental fatigue. These psychological factors, compounded by her poor sleep quality, appeared to contribute to the chronicity and severity of her condition. Her quality of life is notably impaired, with the disease affecting both her physical and mental well-being.

Dietary history:Her dietary habits were irregular and she frequently consumed incompatible foods, further aggravating her symptoms.

Lifestyle history: The patient described her lifestyle as sedentary, with minimal physical activity and high levels of stress due to professional and personal challenges. She experienced a disturbed appetite, often accompanied by acidity, bloating and constipation. Sleep disturbances was a persistent issue, characterized by difficulty falling asleep and poor sleep quality, which she attributed to her heightened anxiety and irritability.

Family history: No any family history.

Menstrual history: Had Normal Vaginal Delivery 11 months ago. LMP – 20^th Oct 2024.

No Significant Medical and Surgical History

Table 1: Vital Parameters

• 4–6: Moderate itching (frequent but not constant, impacts daily activities).
• 7–10: Severe itching (persistent, disrupts daily life and sleep).

2. Frequency of Itching Episodes

Score based on the number of itching episodes per day:

• 0: No episodes.
• 1: Occasional episodes (less than once per day).
• 2: Frequent episodes (1–5 times per day).
• 3: Constant or almost constant itching (>5 times per day).

3. Duration of Itching

Evaluates how long the itching lasts in a single episode:

• 0: No itching.
• 1: Episodes last <5 minutes.
• 2: Episodes last 5–30 minutes.
• 3: Episodes last >30 minutes.

4. Impact on Daily Activities

Assessed how pruritus interferes with personal, social or work life:

• 0: No interference.
• 1: Mild interference (minimal disruption).
• 2: Moderate interference (requires temporary adjustments in activities).
• 3: Severe interference (unable to complete routine activities).

5. Impact on Sleep

Evaluated how itching affects sleep quality and continuity:

• 0: No impact on sleep.
• 1: Occasional disruption (once or twice a week).
• 2: Frequent disruption (3–5 times a week).
• 3: Persistent disruption (6 or more nights a week).

Total Score Interpretation

• 0–3: Mild pruritus.
• 4–7: Moderate pruritus.
• 8–12: Severe pruritus.

Severity Score = (Erythema + Induration + Scaling) × Area Score \ text{Severity Score} = (Erythema + Induration + Scaling) \times \text{Area Score}

4. Weight Each Region

The regional score is multiplied by its weight:

• Head (H): Multiply by 0.1
• Upper Limbs (UL): Multiply by 0.2
• Trunk (T): Multiply by 0.3
• Lower Limbs (LL): Multiply by 0.4

5. Sum the Weighted Regional Scores

The total PASI score is the sum of the weighted regional scores, ranging from 0 (no disease) to 72 (maximal disease severity).

Interpretation of PASI Score

• 0: No disease
• <10: Mild psoriasis
• 10–20: Moderate psoriasis
• >20: Severe psoriasis

PASI is a gold standard for assessing psoriasis severity in both clinical and research settings, guiding treatment efficacy and patient management.

Treatment Plan

I. Diet Plan:^[21]

The dietary guidelines provided by Jeena Sikho Lifecare Limited Clinic, Sangrur includes the following key commendations:

A. Foods to be avoided:

• Do not consume wheat, refined food, milk and milk products, coffee and tea and packed food.
• Avoid eating after 8 PM.
• During solid consume as small bite and chew 32 times.

B. Hydration:

• During water intake, take sip by sip and drink slowly to ensure the amount of water intake each time.
• Drink about 1 liter of alkaline water 3 to 4 times throughout the day.
• Include herbal tea, living water, and turmeric-infused water part of your daily routine.

II. Lifestyle Recommendations were-

A) Include meditation for relaxation.
B) Practice barefoot brisk walk for 30 minutes.
C) Ensure 6-8 hours of quality sleep each night.
D) Adhere to a structured daily routine.

Medicines Given:

First month - August 2024

1. Oral Medications

• Divya Shakti Powder (1/2 teaspoon HS Adhobhakta (After food) with Lukewarm water)
• Charamroghar Powder (1 teaspoon BD Adhobhakta (After food) with Lukewarm water)
• Bramhi Vati (1 tablet BD Adhobhakta (After food) with Lukewarm water)
• Arogya Vati (1 tablet BD Adhobhakta (After food) with Lukewarm water)
• Psoro Tab (1 tablet BD Adhobhakta (After food) with Lukewarm water)
• Amlapittahar Cap (1 Capsule BD Pragbhakta (Before food) with Lukewarm water)
• Panchtiktaghrita Guggulu (1 tab once in the morning (Empty stomach) with Lukewarm water)
• Raktchap Vati (1-tab BD Adhobhakta (After food) with Lukewarm water)

2. Topical Applications

• Psoro Oil for local application in the Day time
• Psoro Ointment for local application in the Nighttime

3. Liquid preparation

• Blood purifier syrup 15 ml twice daily (Adhobhakta) with equal amount of lukewarm water

Second Month - September 2024

1. Oral Medications

• Psoro Tab (1 tablet BD Adhobhakta (After food) with Lukewarm water)
• Amlapittahar Cap (1 Capsule BD Pragbhakta (Before food) with Lukewarm water)
• Panchtiktaghrita Guggulu (1 tab once in the morning (Empty stomach) with Lukewarm water)

After three months of Ayurvedic treatment, there was a significant reduction in the PSS score to 4/18, indicating mild pruritus. Improvement were observed across all dimensions of the scale.

Image 1: Before Treatment

Image 2: After Treatment

Discussion

Psoriasis is a chronic autoimmune skin disorder characterized by keratinocyte hyperproliferation, inflammation, and systemic immune dysregulation.

These formulations are known to enhance digestive function and facilitate detoxification.^[14],[15] Immunomodulatory and antihistaminic interventions, including Jeevan Amrit Syrup contributed to reduced pruritus and systemic inflammation.^[16] Mental health, an important factor in psoriasis management, was addressed with Brahmi Vati and Raktachap Vati, which significantly alleviated stress and improved sleep quality, as supported by its neuroprotective and adaptogenic properties.^[17],[18]

By the second month, the patient demonstrated significant improvement, with a reduction in the PASI score from 15 to 5, reflecting decreased erythema, scaling and plaque thickness. A transient increase in itching during the second month could be attributed to the body’s detoxification response as described in Ayurvedic Kriyakrama protocols. Weight gain and musculoskeletal symptoms were effectively managed with the introduction of Slimite Capsules, Sandhi Arogya and Arthri Capsules in the third month. These formulations are known to regulate metabolism and reduce joint inflammation, providing comprehensive systemic relief.^[19],[20]

The case highlights the multi-dimensional nature of Ayurveda in managing psoriasis, emphasizing the correction of underlying systemic imbalances rather than focusing solely on symptomatic control. The marked improvement in the patient’s skin lesions, psychological well-being and overall quality of life underscores the efficacy of this integrative approach.

Mechanism of Action

The Ayurvedic interventions targeted psoriasis through systemic detoxification, immune modulation and the restoration of Agni (digestive fire), with a focus on pacifying Tridoshas (Vata, Pitta, and Kapha).

1. The Divya Shakti Powder contains Trikatu, Triphala, Nagarmotha (Cyperusrotundus), Vay Vidang (Embelia ribes), Chhoti Elaichi (Elettaria cardamomum), Tej Patta (Cinnamomum tamala), Laung (Syzygium aromaticum), Nishoth (Operculina turpethum), Sendha Namak, Dhaniya (Coriandrum sativum), Pippali Mool (Piper longum root), Jeera (Cuminum cyminum), Nagkesar (Mesua ferrea), Amarvati (Achyranthes aspera), Anardana (Punica granatum), Badi Elaichi (Amomum subulatum), Hing (Ferula assafoetida), Kachnar (Bauhinia variegata),

Abhrak Bhasma and Vang Bhasma supports cellular rejuvenation and strengthens the body's natural defences, promoting healthy skin regeneration.

4. Arogya Vati, formulated with Kajjali, Loh Bhasma, Abhrak Bhasma, Tamra Bhasma, Amalaki, Vibhitaki, Haritaki, Chitrak, Katuka and Nimba Patra, acts holistically to manage psoriasis by addressing the root causes of the disease. The combination of Kajjali, Loh Bhasma, Abhrak Bhasma and Tamra Bhasma enhances detoxification, supports blood purification, and improves tissue regeneration, essential for healing psoriatic skin lesions. Amalaki, Vibhitaki, and Haritaki as components of Triphala, aids in digestion, eliminates toxins (Ama) and rejuvenate tissues, maintaining a healthy gut-skin axis. Chitrak and Katuka stimulates digestion and liver function, promoting the breakdown of toxins and balancing aggravated Doshas, particularly Pitta and Kapha. Nimba Patra, with its potent anti-inflammatory and antimicrobial properties, soothes skin irritation and supports immune modulation.

5. Psoro Tab, composed of Neem Panchang, Pawad Beej, Ushba, Bawachi, Akash Bel, Bakayanfal, Manjistha, Gandhak Rasayan and Gum Acacia, works synergistically to manage psoriasis by targeting its root causes. Neem Panchang and Manjistha are powerful blood purifiers and anti-inflammatory agents that helps to detoxify the body and reduce inflammation in psoriatic lesions. Pawad Beej and Bawachi are known for their immunomodulatory and skin-rejuvenating properties, aiding in the repair and regeneration of damaged skin. Ushba, a well-known anti-inflammatory and anti-allergic herb, soothes chronic skin conditions by addressing aggravated Pitta and Kapha Doshas. Akash Bel and Bakayanfal helps in reducing toxins (Ama) and balancing metabolic functions that contribute to skin disorders. Gandhak Rasayan, with its sulphur-based composition, has antimicrobial, detoxifying and tissue-healing properties that improves skin health. Gum Acacia acts as a stabilizing agent and supports the gastrointestinal system by aiding digestion and absorption.

6. Panchatikta Ghrita Guggulu containing Cow Ghrita 8 parts, Vacha 1 part, Bhallatak 1 part, Pathha 1 part, Vidang 1 part, Ativisha 1 part, Pippalimoola 1 part, Deodar 1 part, Gajapippali 1 part, Haritaki 1 part, Shatpushpa 1 part, Yavakshar 1 part, Sajjikshar 1 part, Bibhitak 1 part,

Finally, Shankh Bhasma calms the digestive system and supports the absorption of nutrients, further enhancing skin and immune system health.

9. Psoro Oil (Day), formulated with Anant Mool, Bawchi, Aloe Vera, Mulethi (Licorice), Ratan Jot, Neem Panchang, Karanj Patra, Kali Mirch (Black Pepper), Mustard Oil and Nariyal Tailum (Coconut Oil), is designed for local application to manage psoriasis and soothe skin inflammation. Anant Mool and Bawchi possess potent anti-inflammatory and antimicrobial properties, reduces redness, swelling and infection commonly seen in psoriatic lesions. Aloe Vera is known for its cooling and moisturizing effects, helping to hydrate dry, flaky skin while reducing itching and irritation. Mulethi and Ratan Jot provides additional anti-inflammatory and skin-healing properties, promoting tissue repair and reducing scarring. Neem Panchang has antibacterial and antifungal properties, which helps to prevent secondary infections in the skin lesions and purifies the blood, addressing one of the underlying causes of psoriasis. Karanj Patra and Kali Mirch have strong analgesic and anti-inflammatory effects, easing discomfort and reducing redness. Mustard Oil and Coconut Oil are used as carrier oils, enhancing the absorption of the active ingredients while providing lubrication and nourishment to the skin.

10. Psorin Ointment, formulated with ingredients like Maricha, Musta, Jatamansi, Haldi (Turmeric), Madar, Daruhaldi, Devdaru, Kutha, Kutaja, Durva, Gomutra, ShudhHartala, Coconut Oil and Manashila, works effectively for the topical management of psoriasis, especially in the night. Maricha, Musta and Jatamansi are known for their anti-inflammatory and soothing properties, reducing redness, itching and irritation. Haldi and Daruhaldi possess powerful antioxidant and anti-inflammatory effects, aiding in skin healing and reducing psoriatic flare-ups. Madar and Kutha acts as detoxifying agents, helps to cleanse the skin and reduce the accumulation of toxins that can worsen psoriasis. Kutaja helps to regulate bowel movements, clearing toxins from the body, which can support skin health. Durva has antibacterial and anti-inflammatory properties, assisting in the prevention of secondary infections in damaged skin. Gomutr a (cow urine) is considered as a purifying agent that helps in detoxification, enhancing overall skin health. Shudh Hartala (purified orpiment) has astringent properties, helps to reduce inflammation and promotes the regeneration of skin tissues.

7. Ashtanga Hridaya, Nidanasthana 14/3. Translated by Murthy KRS. Varanasi: Krishnadas Academy; 2002.

8. Sharma PV. Dravyaguna Vijnana. Vol. II. Varanasi: Chaukhamba Bharati Academy; 2011.

9. Dash B, Sharma RK. Caraka Samhita: Text with English Translation. Vol. 1. Varanasi: Chaukhambha Orientalia; 2009.

10. Patgiri BJ, Galib R. Panchatikta Ghrita: An Ayurvedic medicated ghee for skin diseases. Ayu. 2011;32(4):543-548.

11. Shrivastava R, et al. Role of Panchatikta Kashaya in psoriasis: A clinical evaluation. Ayu. 2015;36(2):124-129.

12. Singh R, et al. Clinical efficacy of Charamrogha Powder in chronic skin diseases: A pilot study. Int J Res Ayurveda Pharm. 2019;10(4):561-565.

13. Pandya SK. Clinical efficacy of Psoro Oil in the management of psoriasis. Ayu. 2010;31(3):335-338.

14. Hebbar N, et al. Clinical study on the role of Amlapittahar Rasa in gastrointestinal disturbances associated with psoriasis. Ayush Sci J. 2018;5(2):87-94.

15. Kumar A, et al. Jeevan Amrit Syrup: A clinical assessment in improving immunity and managing autoimmune conditions. J Tradit Med Res. 2021;10(2):134-140.

16. Gupta S, et al. Anti-allergy Ayurvedic formulations for chronic inflammatory skin conditions: A review. Int J Ayurveda Pharm. 2021;12(1):23-31.