Management of Kitibha Kushta (Plaque Psoriasis) with Combination of Ayurvedic Modality-A Case Study

Skin diseases are commonly observed due to altered lifestyle, lack of physi-cal exercise, poor hygiene, mental stress and improper food habits. Kushta (Skin diseases) is divided into Maha Kushta (Major skin diseases) and Kshudra Kushta (Minor skin disease). Kitibha Kushta (Plaque Psoriasis) is included in Kshudra Kushta commonly found today, having sign and symptoms similar to Plaque psoriasis. Due to relapsing nature of Plaque psoriasis it needs long duration treatment. Ayurveda provides long lasting results by treating the disease and preventing reoccurrence. In this case study, a 43 years old male came to OPD of Kayachikitsa with chief complaint of Kandu (Itching), dry silvery white patches over left leg treated with Shodhana Chikitsa (Body puri(cid:976)ica-tion treatment) using Vaman Karma (Therapeutic Emesis) and Shaman Chikitsa (Alleviating treatment) using internally Gandhaka Rasayana , Panchatikta Ghrita and S-kin powder, Shabsoria Oil for external application for 1 month. The PASI score was 14.4. Before treatment, after 15 days it was 7.4 and after 30 days it was reduced to 0. Patient got relief in the symptoms. Better result achieved in this case using Shodhana Chikitsa and Shaman Chikitsa along with Bahirparimarjan Chikitsa (External application).

A Skin diseases are commonly observed due to altered lifestyle, lack of physical exercise, poor hygiene, mental stress and improper food habits. Kushta (Skin diseases) is divided into Maha Kushta (Major skin diseases) and Kshudra Kushta (Minor skin disease). Kitibha Kushta (Plaque Psoriasis) is included in Kshudra Kushta commonly found today, having sign and symptoms similar to Plaque psoriasis. Due to relapsing nature of Plaque psoriasis it needs long duration treatment. Ayurveda provides long lasting results by treating the disease and preventing reoccurrence. In this case study, a 43 years old male came to OPD of Kayachikitsa with chief complaint of Kandu (Itching), dry silvery white patches over left leg treated with Shodhana Chikitsa (Body puri ication treatment) using Vaman Karma (Therapeutic Emesis) and Shaman Chikitsa (Alleviating treatment) using internally Gandhaka Rasayana, Panchatikta Ghrita and S-kin powder, Shabsoria Oil for external application for 1 month. The PASI score was 14.4. Before treatment, after 15 days it was 7.4 and after 30 days it was reduced to 0. Patient got relief in the symptoms. Better result achieved in this case using Shodhana Chikitsa and Shaman Chikitsa along with Bahirparimarjan Chikitsa (External application).

INTRODUCTION
Psoriasis is a common long lasting auto-immune skin disease with prevalence of 0.44-2.8 percent in India. Psoriasis is typically present as erythematous plaque with silvery scales (Dogra and Yadav, 2010). Most common type of Psoriasis is Plaque Psoriasis in which each lesion separated from other lesions with diameter of millimetres to centimetres. Elbow, knees and lower back are commonly involved areas in Plaque Psoriasis while scalp, nails, lexures, palm are other site. After scraping the surface in plaque psoriasis lesions become red (Colledge et al., 2010).

Case Report
A 43 year old male patient approached with complaints of dry silvery white patches, rough similar to scar tissue over left leg with Kanduin them since 6 months.

Presenting complaints
A 43 year old male patient who was apparently normal before 6 months, then having complaint of itching over left leg followed by small redish patch which increased gradually and spread dry silvery white patches, rough scar tissue like appearance on left leg (Figure 1). He consulted all local allopathic and Homeopathic physicians before for same complaints, but he did not get satisfactory relief, so for further management he consulted in our hospital.
He had no family history and no past history regarding any skin diseases. No history of any type of allergy before. Due to itching sleep was disturbed. On examination Ashtavidha Pariksha within normal limit except Saam Jivha (Coated tongue) and Malbadhata (Constipation).

Treatment Plan given
Shodhana Chikitsa and Shamana Chikitsa was given to the patient.

Greading-PASI (Psoriasis Area Severity Index) Score
The severity of Psoriasis is estimated by three clinical signs: Severity parameters are measured from none to maximum within each area on the scale of 0 to 4 (Table 5).  KushthaghnaAntibacterial, Antiviral, Antimicrobial, Antifungal, Antiin lammatory,

Figure 2: Showing effect of combination of Ayurvedic modalities on KitibhaKushtha
The body is divided into four sections [Head (H) (0% of a Person's skin); Arms (A) (20%); Trunk (T) (30%); Legs (L) (40%)]. Each of this area is scored by itself, and then the four scores are combined into the inal PASI (Table 7). The percent of skin area involved is evaluated and then converted into a grade from 0 to 6 for each section (Table 6) (Hani et al., 2012).

DISCUSSION
Panchakarma treatment is a novel kind of treatment for different incessant immune system hormonal and degenerative disorders, whereas different kinds of medicines have no palatable answer too similarly helpful for the advancement and safeguarding of wellbeing. Any illness in Ayurveda is dealt with Shodhana, Shaman and Rasayana Chikitsa (Bhende and Parwe, 2020 Figure 2)
After SarwangaSnehana, SarwangaSwedana given in the form of NadiSwedan (Bramhananda, 2015). It removes Srotasaob struction. Due to Swedana, Doshas gets liqui ies and came from Shakha to Koshta for easy elimination with the help of Shodhana.
In Pradhan Karma Vaman was given (Table 4) with Madanphal Yoga (Vidyadhar and Dutt, 2019b). Followed by SamsarjanKarma. For diseases of Kapha-DoshaVamana is useful as it given in Samhitas. Due to predominance of KaphaDosha in KitibhaKushta, Vamana was given. Vamana puri ies body through there peutice mesis, increase Agni, prevents relapsing nature of disease by strengthening Immune system of body. SamsarjanaKramaworks on Agni Dipana.

Mode of action of Gandhaka Rasayana
Gandhaka Rasayana (Sashtri, 1983) is broad spectrum medicine useful in number of skin diseases like psoriasis, eczema, itching due to it's anti-microbial, anti-bacterial and anti-viral properties. Gandhaka Rasayana improves digestion and complexion of Skin. Main ingredient i.e. Puri ied Sulphur acts on skin and mucous membrane. With mercury puri ied Sulphur used in many diseases. Internal and external both route of puri ied Sulphur useful to treat skin disease.

Mode of action of Panchatikta Ghrita
Panchatikta Ghrita is explained in Bhaishajyaratnavali, In Kushtadhyaya.
Ingredients of it having Kushtaghna property. Goghritais Vata-pitta Shamaka, Twachya, useful in healing and has a "Samskarasya Anuvartanam" property (without losing own property, assimilates the properties of other substance with which it is processed). So Panchtikta Ghrita becomes more effective in psoriasis.

Mode of action of S-kin powder with Gomutra
It is very useful for topical skin infection and also a drug of choice to wash all over body. It treats  Lesion Score Sum (A) 0 9   Their idealist approach, faith in the science commit-ment toward work and anticipation made this work a success and it will always motivate me in future work.
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