A case study of Ayurvedic management of Kitibha Kushtha with special reference to Palmoplantar Psoriasis

Psoriasis is a long-lasting skin disease that causes inflammation and excessive cell growth. It has clear, red, scaly plaques that mostly show up on the extensor surface, scalp, and nails. It generally goes through a relapsing-remitting course. It happens to people of both sexes and all ages. Children younger than 5 years old don't get it very often, but more than half of those who do get it do so before they turn 30.(1) Psoriasis is a long-lasting, painful, disfiguring, and disabling disease that can't be spread. There is no cure for it, and it has a big effect on the quality of life (QoL) of people who have it. Psoriasis is a major problem around the world; the number of people who have it varies from 0.09% to 11.4%. The cause of psoriasis is still unknown, but there is proof that some people are more likely to get it than others. A lot of study is also being done on the immune system and how it affects psoriasis. Psoriasis can also be brought on by things inside and outside the body, such as slight trauma, sunburn, infections, systemic drugs, and stress.(2) Up to 2% of the world's population has psoriasis, making it one of the most common skin diseases. It shows up on the skin as red, clearly defined papules and round plaques covered in a white micaceous scale. The Koebner or isomorphic phenomenon says that psoriasis lesions often appear in places that have been traumatised. Other outside factors, like infections, worry, and medicines (like lithium, beta blockers, and anti-malarial drugs), can also make psoriasis worse. The type of psoriasis that most people have is called plaque-type. People who have plaque-type psoriasis have steady plaques that get bigger over time but don't change much over time. The elbows, knees, gluteal cleft, and head are the most common places where this happens. Involvement is usually even on both sides. It often spreads to the head, palms, and soles of the feet.(3)

Kitibha Kushtha shows up when the Tridosha gets out of hand, especially when Vata and Kaphaa are in charge. Mithya Ahara and Vihara make Tridosha weak, which makes Rasa, Rakta, Mamsa, and Lasika suffer and get worse. There is no Kushtha that shows up because of one Dosha being upset.(4)

श्यावं किणखरस्पर्श परुषं किटिभं मतम् । ch. ch. ७/२२

Predominance of Vata can be elicited with symptoms like blackish discoloration hardness, dryness and roughness to touch. Kaphaa predominance can be appreciated with the presence of severe itching as a cardinal symptom. (5)

Modern science treats Psoriasis with Retinoids, Methotrexate and Corticosteroids. But the disease recurrences and causes serious side effects like liver, kidney failure and bone marrow depletion. Hence Ayurveda plays important role. Present study is undertaken to provide safe and effective remedy for Psoriasis.

Action of Snehapana –

Mahatiktaghrit(6) - Mahatikta is made up of tikta rasa, ruksha, and laghu guna. It mostly affects kled, meda, lasika, rakta, pitta, and kapha, which helps balance the dosha and dhatu that are out of balance. It possesses the traits of Deepan, Pachan, Strotoshodhak, and Raktashodhak. Ravi Shankara, Kushtaghna, Kandughna, and Varnya. Ghrit is lipophilic, which helps get drugs to the right places. It enters cells and delivers drugs to the mitochondria and nuclear membrane. It keeps the skin's normal structure.

Gandhak Rasayana –

It acts well on skin problems like Psoriasis with madhur amla and kashaya ras (7) and properties like Kushtaghna, Kandughna, Dahaprashaman, Raktashodhak, Vranaropak, Twachya, and Krumighna. It has antibacterial, antiviral, and antimicrobial Properties. Sulphur that has been refined can be used to treat many kinds of skin conditions. It lessens infection and irritation, benefits digestion and the appearance of the skin. It can be applied both internally and externally to treat skin conditions.(8)

Arogyavardhini Vati -

From a pathological point of view, we can see that Grahani Vikruti is the main cause of Kushtha. When Grahani doesn't work right, Malavrodha happens. When Vata Dosha between Grahani and Pakwashaya gets weak, Malavrodha and Grahani's general ability to move and move things around becomes flawed. Because of this, some organic toxins were made and then consumed, which led to Dhatu Dushti and then Kushtha Vyadhi. In general, Arogyavardhini works on Grahani and Pakwashaya to make them work better and more smoothly.(9)

Sariva -

As Daha and Vaivarnya is one of the symptoms and sign respectively of Kushtha Vyadhi. Charak has described Sariva in Dahaprasahamana(10)(Refrigerants) and Varnya (complexion promoting) Mahakashaya. It also works as Raktapachaka as described by Charak.

Manjishta –

Manjishtha is talked about by Charak in the Varnya(11) and Vishaghna(12) Mahakashayas and by Sushrut in the Pitta Shamana Mahakashayas. It works as Kaphapittashamaka because it has Tikta Kashaya Madhura Rasa. This gets mixed up in Kitibha Kushtha and Kushthaghna as well. It has the power of Krumighna in Pachansansthan.

Guduchi –

Guduchi have tikta ras and madhur vipak, which is useful to pacify the pitta dosha in rakta. Charak has described Guduchi in Dahaprashamana (10)  . It also helps in sarva dhatu vardhan and acts as Rasayana.

Khadira –

Khadira has kushtaghna (12) property according to charak . Also it’s tikta, kashay, shit virya makes it pitta kaphaghna and kandughna . It work great in kushtha disease.

1. Davidson’s Principles and Practice of medicine 23rd Edition. Edited by Stuart H. Ralston, Lan D. Penman, Mark W. J. Strachan, Richard P. Hobson, dermatology pg no. 1247
2. WHO Library Cataloguing-in-Publication Data Global report on psoriasis. Psoriasis – epidemiology. Pg no. 4
3. Harrison’s Principles of internal Medicine, 19th Edition, KASPER, FAUCI, HAUSER, LONGO, JAMESON, LOSCALZO editor,chapter 71 Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorder pg no. 347
4. Vd Vijay Shankar kale, Charak Samhita vol 2, Chaukhamba publication 2016 Delhi, Chikitsasthana kushtha chikitsa Adhyay Sutra No9,10
5. Vd Vijay Shankar kale, Charak Samhita vol 2, Chaukhamba publication 2016 Delhi, Chikitsasthana Kushtha Chikitsa Adhyay sutra No. 22
6. Vd Vijay Shankar kale, Charak samhita vol 2, Chaukhamba publication 2016 Delhi, chikitsa sthana kushtha chikitsa adhyaya Sutra 150
7. Wijayanthamala, *M.V.R., Kumar,S. Kumarsing, S, & Meena, B. 2016. PHARMACEUTICO- ANALYTICAL STUDY OF GANDHAK RASAYAN. International Journal Of Ayurveda And Pharma Research;4(7).
8. Saokar R, Et Al. Screening Of Antibacterial And Antifungal Activity Of Gandhaka Asayana- An Ayurvedic Formulation. Int J Recent Trends Sci Technol, ISSN 2277-2812 E-ISSN 2249-8109;8(2), 2013:134-7).
9.   Ayurvediy Aushadhigunadharmshastra, Vaidya Gune shastri, edition 2008,page no 208.
10. Vd Vijay Shankar kale, Charak Samhita vol 1, Chaukhamba publication 2016 Delhi, Sutrasthana shadvirechanasatashritiyadhyay sutra 17
11. Vd Vijay Shankar kale, Charak Samhita vol 1, Chaukhamba publication 2016 Delhi, Sutrasthana shadvirechanasatashritiyadhyay sutra 10
12. Vd Vijay Shankar kale, Charak Samhita vol 1, Chaukhamba publication 2016 Delhi, Sutrasthana shadvirechanasatashritiyadhyay sutra 11