Introduction

Healthy skin is an important indicator of overall health and well-being. As the largest organ in the body, the skin is also considered a symbol of beauty in many cultures. When skin conditions arise, they can significantly impact both physical and mental health. Palmo-plantar psoriasis is a common, chronic, immune-mediated inflammatory skin condition that primarily affects individuals with a genetic predisposition, with environmental factors playing a significant role in its development. It accounts for approximately 3-4% of all psoriasis cases. According to the World Health Organization (WHO), the global prevalence of psoriasis is estimated to be between 2-3% as of April 2013. In India, the prevalence ranges from 0.44% to 2.88%. Although there are various treatment options, palmo-plantar psoriasis remains challenging to manage due to its chronic and recurrent nature.^[1] Modern medical treatments for psoriasis, such as PUVA therapy, corticosteroids, and immunomodulators, can be effective, but they often come with serious side effects like obesity, bone marrow suppression, kidney and liver failure, among others. This underscores the need to explore safer and more effective treatments for psoriasis, which is where Ayurveda may offer promising solutions. According to Acharya Charaka, all skin diseases, or Kushthas, are considered to be Tridoshaj in nature. While palmo-plantar psoriasis cannot be directly matched with any specific disease in Ayurveda, its symptoms show similarities to Vipadika, a form of Kshudrakushtha. This condition primarily involves an imbalance in the Vata and Kapha doshas, characterized by fissures on the palms and soles (Pani-pada Sphutan) and intense pain (Teevra Vedana).^[2] Acharya Vagbhat agrees with Acharya Charaka, adding that red patches on the palms and soles are also a feature of this condition.^[3] Charaka emphasized the importance of external applications (Lepa) following Shodhana Chikitsa (detoxification treatment) and also specifically recommended Vipadikahar for treating Vipadika. Leech application demonstrating the uniqueness of the evidence.^[4]

Case Report

A 44 year old Female patient, Hindu by religion, House wife by occupation, visited to the Shalya Tantra OPD of Sri Dharmasthala Manjunatheshwara college of Ayurveda and Hospital,

they underwent Abhyanga (oil massage) with Nalpamaradi Taila, followed by Sarvanga Parisheka using Dashmoola decoction for two days. Throughout this period, a light, warm, and liquid diet was provided.

2. Pradhana Karma

On the morning of the Virechana procedure, Abhyanga (oil massage) and Swedana (steam therapy) were performed. Vital parameters, including pulse, blood pressure, respiratory rate, and temperature, were recorded and monitored at regular intervals throughout the main procedure (Pradhan Karma).

The patient was kept on an empty stomach before the administration of the Virechana drug. The purgation therapy was carried out using 35grams of Avipattikar Choornam. After Kapha Kala i.e., 9:45 a.m. on empty stomach as mentioned in classics.

Number of motions after administration of Virechana drug were counted till the symptoms of proper purgation like stopping of purgation on its own, passing of stool with mucus in the last one or two motions, feeling of lightness of body. Patient had 15 Vegas and considered as Madhyama Shuddhi.

3. Paschat Karma

After completing the Virechana procedure, a regular diet should not be introduced immediately, as the digestive power (Agni) is weakened due to the cleansing process (Shodhana). To restore Agni to its normal state, the patient underwent Samsarjana Karma (a post-procedure dietary regimen) based on the classification of purification as Madhyama Shuddhi (moderate purification). The patient was advised to rest and was given thin rice gruel as the initial food, followed by a specially prescribed diet for three days.

Application of Leech Therapy

Initially, a leech was placed on the affected areas of the palm and sole and observed for two minutes to allow it to begin sucking blood. A damp cotton gauze was placed over the leech to maintain moisture. After approximately 15 minutes, the leech naturally detached after completing the blood sucking process. A cotton gauze with Haridra Choorna was then applied to the bite site to prevent further bleeding. This procedure was carried out without any complications.

Figure 3

During Jaloukavacharana (Leech Therapy)

Figure 4

Figure 5

After Treatment

Figure 6

In this particular case, Virechana Chikitsa (therapeutic purgation) yielded positive results when combined with Shamana Aushadhi (palliative medicines) and jaloukavacharana (leech therapy). The Virechana procedure effectively eliminated the vitiated Doshas from the body.

To enhance digestion and metabolism, Panchakola Phanta and Chitrakadi Vati was used for Deepana-Pachana (appetizer and digestive therapy), which also facilitated the smooth digestion of Sneha (medicated ghee). Panchatikta Ghrita, used during Snehapana (internal oleation), acted as a blood purifier (Raktashodhak) and supported the movement of vitiated Doshas from the peripheral tissues (Shakha) to the gastrointestinal tract (Koshtha). Due to its subtle (Sukshma) nature, Sneha can penetrate to the cellular level. The lipid-based formulation aids in the elimination of lipid-soluble toxins from the body.

After obtaining Samyak Snigdha Lakshanas patient was subjected to Abhyang and Swedana. Abhyang softens vitiated Dosha and localize them and Swedana liquefy the vitiated Doshas which are being situated in micro channel so they can easily reach from Shakha to Koshtha from where they can be easily removed from body.

Since the vitiated Pitta and Kapha Doshas, which are in a liquid (Drava) state, are directed toward the nearest route of elimination, the administration of a purgative through the anal pathway allows for their effective expulsion. This route also targets the large intestine (Pakwashaya), which is the primary seat of Vata Dosha, thereby aiding in its cleansing and regulation. This demonstrates that Virechana therapy is effective in balancing all three Doshas - Vata, Pitta, and Kapha.

After completing Virechana, the digestive fire (Agni) becomes weak due to the cleansing process, so normal food should not be introduced right away. The patient was advised to rest and was initially given a thin rice gruel as a light, easily digestible meal. A specially planned diet was continued for three days to gradually restore Agni to its normal function.

In view of the vitiation of Rakta (blood) and Pitta Dosha, and to provide quick symptomatic relief, Raktamokshana therapy using Jaloukavacharana (leech application) was carried out.^[5]