Approach Towards Kushta (Psoriasis) With Ayurveda-A Case Study

Sourabh G Deshmukh*1, Trupti I. Thakre2 1Department of Kayachikitsa, Mahatma Gandhi Ayurved College, Hospital & Research Centre, Constituent College of Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India – 442001 2Department of Kaumarabhritya, Mahatma Gandhi Ayurved College, Hospital & Research Centre, Constituent College of Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India – 442001


INTRODUCTION
Chronic Plaque Psoriasis is a chronic, recurrent in lammatory disease of the skin of unknown origin, characterized by well-circumscribed erythematous, dry plaques of various sized, covered with mica like scales (Walter, 2010). Psychological stress is one of the major triggering factors in the exacerbation of the disease. The worldwide burden of psoriasis is 2%, and the prevalence of psoriasis in India ranges from 0.44% to 2.8% (Dogra and Yadav, 2010). In Ayurveda, all skin disorders are described under the term Kushtha. Acharya Charak included it in Ashtamahagad (Trikamji, 2004a) (dif icult to treat). In Kushta-Rogadikhar of Charak Samhita, Kushtha is classi ied into two major types like Maha-Kushta and Kshudra Kushta (Sharma, 2009a). Eka Kushtha is one of the types of Kshudra Kushtha. The Eka Kushtha has symptoms like Aswedanam (Absence of perspiration.), Mastyasakalopamam (Skin resembles scales of ish), Mahavasthuvam (spread on a large area of the body) which has close resembles with psoriasis (Sharma, 2009b). Eka Kushtha has Vata Kapha dominance where Vata results in dry reddish-black patches, whereas itching is due to Kapha dosha.
In Samhitas Shodhan and Shaman Chikitsa is described for Kushtha according to Bala, Dosha and Vyadhi Avastha. All Acharyas emphasized on Shodhana Chikitsa due to Bahu Dosha Avastha of Kushtha. Acharya Charaka has emphasized on Shodhana Chikitsa by stating that the Vyadhi treated by Shodhana will never recur. In contrast, the treatment with Shamana therapy may recur in due course of time (Vaidya, 2000). Due to Bahu doshavastha repeated Shodhana is indicated in Kushtha to eliminate aggravated Doshas which helps to treat the root cause of disease (Kushwaha, 2009

CASE REPORT
A 41 years old female patient came with complaints of whitish silvery scales all over the body with itching, powdery discharge, burning sensation and scaling for one year.

History of present illness
The patient was alright before one year, and then whitish silvery scales appeared on both upper and lower limbs with itching, powdery discharge and burning sensation. After that, the patches spread on trunk and back region. Then the thickness of patches increased and slowly turns to blackish. Gradually severity of itching increased with a scaling of patches. The patient took Allopathic and Homeopathy medicines for the above complaints. But she couldn't get any relief from the symptoms. Later she consulted our hospital OPD for further treatment.
The patient had no signi icant history. No family history was present regarding psoriasis, allergy or any dermatological disorder. Sleep was disturbed due to itching. On examination, vitals of patients was within normal limits as shown in Table 1.

Shodhan Chikitsa
In Shodhan Chikitsa Vamana procedure was done (Month of Dec. 2018) and Virechana procedure was done (Month of Jan. 2019) in a sequence of Purva Karma (Table 2 and Table 4) Pradhan Karma (Table 3 and Table 5) and Paschayat Karma: After obtaining Samyaka Vamana Lakshana and Samyaka Virechana Lakshana Dhoomapan was given with stick made of Aguru for 5 minutes by each nostril (Trikamji, 2004b). Then the patient was advised to follow the Sansarjana Karma for ive days. Sansarjana Karma was given in the form of Peya, Vilepi, Akrita Mudga Yusha, Krita Mudga Yusha for ive days (kunnte, 2010).

Shaman Chikitsa
Shamana chikitsa was given by formulation shown in Table 7.

Grading-PASI (Psoriasis Area Severity Index) Score
In each area, the severity is estimated by three clinical signs: Severity parameters are measured on a scale of 0 to 4, from none to the maximum. The body is divided into four sections (head (H) (10% of a person's skin); arms (A) (20%); trunk (T) (30%); legs (L) (40%) Table 9 . Each of these areas is scored by itself, and then the four scores are combined into the inal PASI. For each section, the per cent of the area of skin involved is estimated and then transformed into a grade from 0 to 6. (Hani, 2012)

Discussion
Eka Kushtha is a Vyadhi of Raktavaha Strotas. The Samprapti Ghataka of Kushtha is Kapha   Table 6 Trikatu is the best Deepan Pachan drug hence it was given for three days (AFI, 2020a). After Deepan Pachan, Panchtiktagrita was given in increasing dose Table 4 for Abhyantar Snehana. It mainly helps in Vata Shaman and Daha Shamana (AFI, 2020b). Marichyadi tail was used for Abhyanga that is Bahya Snehana. It helps in reducing dryness; scaling and increases blood circulation. Sarvanga Sweda causes Dosha Vilayana (liqui ication) and brings Doshas from Shakha to Koshtha that is Amashaya, for their elimination. It also helps in removing obstruction of Strotasa  Table 7. All this Shodhan and Shaman Chikitsa equally help to reduce the signs and symptoms of psoriasis. (Table 10,   Table 11 and Figure 1)

The action of Snehapan with Panchtiktaghrita
Panchtiktaghrita contains Panchtiktagana dravays like Patol (Luffa acutangula), Neem (Azardirachta indica), Guduchi ( Tinospora cordifolia), Vasa ( Adhatoda vasica), Vyaghari (Solanum xanthocarpum) and ghee (Sharma, 1994 (itching), reddishblack discolouration and scaling. Ghrita used in formulation has lipophilic action which helps in carrying drugs to a target organ. This lipophilic nature of Ghrita facilitates entry of drugs into the cell and its delivery to mitochondria and nuclear membrane; it also helps in restoring the natural texture of skin (Sharma, 2009d).

Bahya snehana -Marichyadi tail
Marichyadi Tail (Jully, 2013). Sukshmagamitva nature of the tail helps in the absorption of drugs. These dravyas have Kashaya rasa, which helps in reducing Kleda. It has anti-fungal, antiseptic, anti-in lammatory and immune modulator property. Due to all these properties, local application of Marichyadi tail helps in reducing Lakshana of Eka Kushtha Mishra (2006).

Mode of action of Avipattikar Churna
Churna is a famous Ayurvedic herbal powder, used in the treatment of Pitta imbalance disorders.

Mode of action of Vetapalai Oil
All the are mentioned in Vetapalai Oil drugs are having Kushthaghna, antibacterial, antiviral antiin lammatory, anti-fungal and antimicrobial properties. It is useful in the treatment of skin diseases, itching, pruritus, psoriasis. It will help to improve the digestion and skin complexion, ef icient wound healer and pain reliever. All the ingredients are Vata Pitta Kapha Shamaka (pacifying Vata, Pitta, Kapha), Tvachya (improves appearance) and have a remarkable property to moisturizes the skin.

Mode of action of S-kin Powder
Manjistha ( Figure  No. 1) can be achieved when Shodhana Chikitsa is combined with Shaman Aushadhi. This is a single case study hence to prove the effectiveness of these treatment modalities it is recommended to conduct the research study on more number of patients for a longer duration of time.

ACKNOWLEDGEMENT
I acknowledge the full cooperation and encouragement of my wife, Dr Trupti Thakre Assistant Professor, Department of Kaumarbhritya, MGAC for sparing her precious time. The endless support she has bestowed upon me has been the guiding force behind me. Her perfectionist approach and faith in the science, dedication to work and amazing foresight made this work a success, and it will always inspire me in all my future endeavours. We declare that the manuscript is original and has not published before and is not currently being considered for publication elsewhere.

Funding Support
We know of no con licts of interest associated with this publication and there has been no signi icant inancial support for this work that could in luenced the outcome. As the corresponding author, I con irm that the manuscript has been read and approved for the submission by the named authors.