Management of Ekakushtha with Shamana Chikitsa with Specific Reference to Psoriasis: A Case Report

About Author

Correspondence Address

Dr.Omprakash J. Patil
PG Scholar, Department of Kayachikitsa,
Shree Ayurved Mahavidyalay, Nagpur
Mobile No. 7387746431
E-Mail: omprakashpatil145@gmail.com

Contact No. : 7387746431 , Email : omprakashpatil145@gmail.com

Date of Acceptance : 02 Jun 2023

Date of Publication : 10 Aug 2023

Article ID : SD-IJAY_027

How to cite this article : Omprakash J. Patil,Archana S. Dachewar. Management of Ekakushtha with ShamanChikitsa with Specific Reference to Psoriasis: A Case Report. Sanjivani Darshan National Journal of Ayurveda & Yoga 2023;1(1):5-14 http://doi.org/10.55552/SDNJAY.2023.1102

Abstract

Diseases of skin are increases in recent years due to life style changes and unhealthy foods. Peoples of today’s era are cautious about the skin problems because of skin is the mirror image which reflects the functions of internal body organs. Psoriasis is non-infectious chronic inflammatory disease of skin. It is characterized by well-defined erythematous plaques with silvery scale which have a predilection for extensor surface and scalp and by chronic fluctuating course. According to W.H.O. the world-wide prevalence of Psoriasis is 2-3%. In India prevalence of Psoriasis varies about 0.44% to 2.88%. In Ayurveda all skin diseases are described under KushthaVyadhi. Ekakushtha is type of KshudraKustha which is mentioned in ancient samhitas.Ekakushtha is described as Vat - Kaphaj disease in CharakSamhita Chikitsasthan. Ekakushtha has clinical features like Asvedanam (absence of sweating), Mahavastu (big size lesions) and Matsyashakalopamam (scaling) which can be compared with Psoriasis. Due to highly recurrent nature the disease has remained a great problem. Here efforts were made to treat a sixty-six years old male diagnosed case of Plaque Psoriasis by combined Ayurvedic regimen. The diagnosis is considered as Ekakushtha in perspective of Ayurveda which is a Vata-Kaphaj predominant  Kshudra-Kushtha. All types of Kushtha will be treated with Shodhana and ShamanaChikitsa. ShamanaChikitsa was preferably given for 30 days. PASI (Psoriasis area severity index) score was taken for assessment criteria. PASI score before starting the treatment was found to be 5.6 which decreased to 0.6 at the end of treatment. Also, significant improvements in subjective parameters were observed. This case report showed that combined Ayurvedic modalities resulted in great improvement in overall condition of the patient with no recurrence in five months follow-up. Ayurvedic treatment regimen can be very useful in the management of Psoriasis and betterment of mankind.

Introduction

Due to unhealthy dietary habits and devoid of Dinacharya and Ritucharya, People have to face many skin diseases, life style diseases and autoimmune diseases. Psoriasis is one of them which is common dermatologic disease, affecting approximately 1.5 to 3% of Caucasians but less common in Asian.^[1] Both males and females suffering equally.^[2] Psoriasis is a non- infectious, chronic inflammatory disease of skin. It is characterized by well-defined erythematous plaques with silvery white scale appearance.^[3]

All types of skin diseases are included under the heading of Kushtha. Charakacharya included in one of the Ashtamahagad.^[4] AcharyaCharak described KushthaRogadhikar in which he classified Kushtha in to two major types; Maha-Kushtha and KshudraKushtha.^[5]  Amongst  various types  of Kustha,  Eka-Kustha is  one of them which having a symptoms like Asvedanam (Absence of perspiration), Mahavadstu, Matsyashakalopam (Look like  fish  scale).^[6] According to the Dosha-Dushya and VyadhiAvastha (Disease condition) and Bala (Strength),Shodhan and ShamanChikitsa is described for  the  Kushtha in Ayurvedic literature. Repeated Shodhan is required in Kushtha due to BahuDoshavastha, to eliminate the aggravated Doshas which helps to treat the root cause of disease.But due to covid pandemic, ShamanaChikitsa was preferably given for 30 days.

Psoriasisis abnormal differentiation and keratinocyte hyperproliferation due to excessive multiplication of cells in the basal layers. The transit time of keratinocyte is shortened from approximately 28 to 5 days so that immature cells reach the stratum corneum prematurely.^[7] Even though the etiology is unknown, the factors involved are genetic, biochemical, immune-pathological and environmental.^[8] Precipitating factors like trauma, infections, sunlight, some drugs and emotions may flare up the disease.^[1] As there is no available cure for the disease it has remained a great problem for the patients.^[9] Patients not only suffer from physical problems, but also mental distress and social stigma.

Diagnosis of the Psoriasis is made mainly on the basis of clinical features that is ^[10]

1. Erythematous plaques, covered with silvery white scales appearance.
2. Extensor surface primarily involved.
3. Koebner’s phenomenon present in the active phase of the disease.
4. Worn off’s ring often present in the healing phase of the disease.
5. Auspitz and candle grease signs are another classical feature of the disease.

The main goal of management is to alleviate symptoms and prevent relapse. In modern medicine, systemic treatment commonly used is photo chemotherapy with PUVA, retinoids, methotrexate and cyclosporine-A and corticosteroids. Locally coal tar preparations, calcipotriol, retinoid, corticosteroids and ultraviolet radiations are used to manage Psoriasis. ^[11] These medicines usually provide good symptomatic benefits, but in long term use causes number of side effects.

There are different types of Psoriasis which can be corelated to certain types of Kustha described in Samhitas. The description of Kushtha  is present since Vedic period, Ekakushtha is described in GarudaPurana^[12]and almost all Ayurvedic classics after that period i.e., Brihattrayi, Laghutrayiand all texts afterwards. Ekakushtha is mentioned in all Ayurvedic classics under KshudraKushtha and has predominance of Kapha and VataDosha.^[13]AharajHetu like ViruddhaAahara, excessive consumption of Drava, Snigdha, Guru Aahar, Navannapan aand Viharaj Hetu like VegaDharana specially of urge of vomiting are major aetiologies. Sinful act and ill Manovritti(negative mentality) are associated mental factor for causing the Kushtha. ^[14]

Charaka has depicted classical features of Ekakushtha as Aswedanam, Mahavastu, and Matsyashakalopamam ^[15]and Sushruta described its symptoms as Krishna- ArunaVarnata.^[16]Hetusevan leads to vitiation of Tridosha especially Vata and Kapha. These Dosha through TiryakvahiniSiras proceed to BahyaRogamarga i.e., Twacha, Rakta, Mamsa, and Lasika and leads to variety of Kustha..^[17] Repeated Shodhana along with Shamana is main line of treatment.^[18] Both AntahParimarjan and Bahiparimarjan therapies has been indicated in KushthaRoga. The present Allopathic treatment part is not sufficient to deal with the psoriasis. So, the Ayurveda has potential to deal with such kind of diseases.

Aim and Objective - To evaluate the role of Shamana Chikitsa in the management of Psoriasis.

Place of study - The present case study was done in the Department of Kayachikitsa, Shree Ayurved College and Pakwasa Hopsital, Nagpur

CASE REPORT:

Basic information of the patient

 Age -66 years male    Religion–Hindu

 Socioeconomic status- Lower Middleclass

 He was Security Guard and has mixed diet pattern. Patient has habit of chewing  

Gutkha(1 packet daily) since last 40 years

PradhanVedana(Chief complaints)

 Erythematous rashes on both hands, and both legs in the last 1 years.

 Itching in rashes, with scaling on scratching.

 Sometimes burning sensation

Vartaman Vyadhivritta(History of present illness)

The patient was asymptomatic before 1 year. After that he has developed complaint of scaly rashes on his both palm and on both legs which gradually progressed. There is severe itching in the rashes along with burning sensation, and scaling after scratching. On enquiry he said that lesions and symptoms was get aggravated on stress and having no relation to seasonal variation and remained constant for whole year. He took modern medication for about 6 months which provided symptomatic relief till treatment continues; on discontinuity of the treatment again the symptoms were exaggerated.

Purva Vyadhivritta(History of past illness)

Known case of hypertension since last 1 years on regular medication- Amlodipine 5mg once a day. Patient has no past history of any other chronic illness, burn, trauma.

KulajaVritta(Family history)

Not specific.

Vaiyaktikavritta(Personal history)

Appetite wasreduced. Predominant Rasa in Aharawas Madhura and Lavna Rasa. Sleep not regular due night shift, Habit of Divaswap, habit of constipation.                

OnExamination

General condition was fair andafebrile.

Vitals werenormal.

Cardiovascular system, respiratory system and per abdomen examinations had  

shown no deformity.

Prakriti(constitution) wasKapha-Pittaja.

Ashtavidha Pariksha

Nadi(pulse) was Kaphadhika-Tridoshaja.

Frequency and colour of Mutra (urine) were normal with no Daha.

Mala (stool) was constipated and feeling of incomplete evacuation of bowel.

Jihvawas Sama(coated), suggesting improper digestion.

Shabda(Speech) was clear and fluent.

Sparsha(touch) was Ruksha.

Drik(eyes) were normal.

Aakriti(appearance) was average built

Local Examination- Lesions were scaly erythematous plaque, present on both upper and lower limb. Lesions were symmetrical and well defined.

Auspitz sign – present      koebner phenomenon– Present

Diagnosis- On the basis of clinical history and examination the condition was diagnosed             

as Plaque Psoriasis.

Treatment protocol-

Total duration-30 days

Table no 1 - Showing Treatment Protocol

PASI Score [19] - The current gold standard for assessment of extensive Psoriasis has been the Psoriasis area severity index (PASI). PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). The PASI is a measure of the average redness, thickness and scaling of the lesions (each graded on a 0-4 scale), weighted by the area of involvement.

Steps in generating PASI score

• Divide body into four areas: head, arms, trunk to groin and legs to top of buttocks.

 Generate a percentage for skin covered with psoriatic plaques for each area and convert that to 0-6 scale as bellow.

Table no 2 showing Rating Scale for Percentage of Area Involved.

1. Generate an average score for the erythema, thickness and scale for each of the areas.
2. Sum the score of erythema, thickness and scale for each of the areas.
3. Multiply item (c) and (d) for each area and multiply that by 0.1, 0.2, 0.3 and 0.4 for head, arms, trunk and legs respectively.
4. Add these scores to get the PASI score.

 Assessment criteria:

The improvement of condition of the patient was assessed on the basis of PASI scale                                                                                                                    

Table no 3- PASI Score (Before treatment)

Table no 4-PASI Score (After Treatment)

Observation:

Picture no. 1:  Showing before treatment and after treatment.

RESULT:
Here, significant improvements in the subjective parameters of the patient were seen. Also, the considerable reduction in the PASI score from 5.6 to 0.6 was observed.

Discussion

Here a case of Plaque Psoriasis which is correlated to EkakushthahavingVata- Kapha dominance can be evident from its signs and symptoms. The vitiated Doshasreaches to ShithilaDushyalike Twaka, Rakta, Lasika and Mamsa which results into SthanaSamshraya Avastha and then produces symptoms of Ekakushtha.

AstangHrudayaSamhita denot that, Shithilta in Kustha were in whole Tvaka, while the lesions are produced at the site of Sthanasanshray of Doshas. ^[20] As a part of  treatment mentioned in Ayurvedic classics for KushthaRoga are NidanaParivarjana, Snehana, Swedana, Shodhana, Raktamokshana, PrakritiVighatana, Shamana, Lepana etc. As Ekakushtha is mostly chronic and Bahu-Doshajanya, both repeated Shodhana and Shamana therapies has to be followed to provide long lasting results and for good control of disease. Psoriasis is BahyaRogamarga disease, so both Antah-Parimarjana and Bahi- Parimarjana treatments should be used. Considering the above facts, composite treatment plan was adopted. Initially DipanPachan, Anuloman was done to increase the Agnibala and to bring Dosha in NiramaAvastha.Shamana treatment was given for Doshshamana, Raktashodhana and Raktaprasadana. Whilelocal application of 777 oil was given to reduce itching and scaling. For the basis of improvement of lesions, PASI scale was considered. Before starting the treatment his PASI score was 5.6 and after 30 days it was 0.6.

Conclusion

This case report showed that Ayurvedicregimen is effective in treatment of Psoriasis. No adverse effect and aggravation of the symptoms were found in the patient during and after the treatment.

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Conflict of interest : Nil