Introduction

Psoriasis is an autoimmune disorder with high recurrence rate. It is a complex, chronic, multifactorial, inflammatory disease that involves hyper proliferation of the keratinocytes in the epidermis with an increase in the epidermal cell turnover rate. Environmental, genetic, and immunological factors appear to play a role. It is diagnosed clinically. There are various types of psoriasis like vulgaris, plaque, guttate, inversus, pustular. In modern science there is no specific medicine available for the complete cure of the disease. Ayurveda has explained a disease having similar symptomology under the heading of Kushta. In this Kushta it has been advised to administer Shodhana{1}.

            So it was an attempt done to show the effect in the management of Psoriasis through Shodhana Karma (Vamana, Virechana and Raktamokshana) because as per Acharya Charaka the Dosha involved in the pathogenesis of any disease may aggravate even after Shamana therapy but their elevation is not possible once they are removed from the body through Shodhana Procedure{2}  if done in appropriate manner after Ashtavidh Pariksha.In Charak Samhita it has been clearly mentioned that a physician should not get embarrassed if he is not able to diagnose any disorder by its name. Instead of that he must find the Dosha predominant and their imbalance in such patient and should treat these Dosha instead of disease {3}. Treating Dosha should be the prior goal of any physician because their imbalance is solely responsible for the production of any disorder {4}.

Patients Information

A male patient (XXX) of age 57 years came to the Panchakarma OPD of Jupiter Ayurved College, Nagpur on 12/6/2021. He belongs to Muslim community with the middle class economic status. He was complaining about the patches spread all over the body having severed itching in them and oozing of a watery discharge from the patches since 6 years making his life worsen. The pitchers from different angles were taken with his due permission. In the OPD patient was asked to write down in his own handwriting and understandable language that how the disease he has been suffering since years commenced and progressed furthermore.

Case History

On next day patient came with the note of his own handwriting that he was well before 6 years. Then he developed one indurated patch on abdomen with itching over it in 2015. He ignored it for some days and applied local ointments. But it was not resolving. Then multiple patches started appearing over the body (2016). Then he got to know that that was a serious problem. He took medicines from general practitioner near his residence, still he did not get satisfactory relief. He tried each and everything he could but the result was a big zero. Some of his friend advised him to take Ayurvedic treatment since he had got a good relief on skin disease he was suffering from. With this background patient came to us.

Ashtavidha Parikshan {5}

Nadi (Pulse)        : 76/min

Mala (Stool)        : Samyaka.

Mutra (Urine       : Ati mutra pravartana

Jivha (Tongue)    : Alpa Sama

Sparsha (Touch)  : Samashitoshna.

Shabda (Speech) : Spashta

Drika (Eyes)        : Prakrita

Akriti (Built)        : Madhyama

Systemic Examination:

• RS                        : Air entry bilaterally equal,  No Adventitious sounds
• CVS                      : S1S2 normal, Apex beat in position. No murmurs.
• CNS                     : Conscious, well oriented.

Per abdomen examination

• Soft, NT
• Liver/Spleen/Kidney          : NP
• Percussion                : Resonant

Investigations

All the basic blood investigations were done at the Jupiter Ayurved college, Nagpur like Complete blood count, fasting and post meal blood sugar levels, electrocardiogram, bleeding and clotting time, and all the investigations were within normal limits which are as follows -          

CBC : Hb – 11 gm%, RBC – 4.25 millions/cumm, TLC – 6500 /cumm, Neutrophills – 58 %, Lymphocytes – 26, Eosinophil – 4%,  Monocytes – 6%,  Basophils – 01 %, Platelet – 174000/cumm, ESR – 11 mm/hr, Fasting BSL – 89 mg/dl, Post prandial – 126 mg/dl, Bleeding Time : 2 min, Clotting Time : 6 min

Other History

? Known case of Hypertension (since 8years) and on tab Amlodep AT (5-50) once a day

? Known case of Type 2 Diabetes Mellitus and on tab Metformin 500 mg twice a day before meal

? No history of Ischemic heart disease, Asthma, tuberculosis or any other major illness

? No any surgical history.

? No documented drug allergy.

? Family History is also not significant

Hetu

? Aharjanya   : Excessive salt consumption,      non-veg (fish, chicken etc) very frequently.

? Vyasana    : Madyapana (Wine-180ml) Once or twice in a week since many years. Smocking 8-10  cigarettes daily, 10-15 cups tea daily, Kharra (tobacco) daily

? Vikrit Srotasa : Raktavaha,

                                Rasawaha,

                                Swedovaha.

? Vikrit Dosha   : Tridosh (Kapha  dominance)

Vikrit Dushya          : Tvacha, Rakta, Mansa, Lasika {6}.

Management

It has been said in Ayurved that avoiding the causes of disease is one of the treatments of that disease, that’s why Nidana Parivarjana is advised to the patient and a life style modification chart was given to him having indications from waking up in the morning to going to the bed. A chart of Do’s and Don’ts (Pathyapathya) is also provided to the patient.

Rukshana

As per the reference from Astanga Hridaya, it was decided to give Rukshana {7} in this patient with the help of following drugs.

Triphala (500mg), Vidanga (500mg), Nagarmotha (500mg), Khadira (500mg) in combination thrice a day for 7 days (15/6/2021 – 21/6/2021)

Vamana

After Rukshana it was planned to give Vamana to the patient and for that Snehapana is started from (23/6/2021 – 29/6/2021) with the help of Panchatikta Ghrita in Vardhamana Matra for 5 days Madhyam Snhena {8}. During this period all the instructions has been given to the patient as per text and his life style. And finally, Vamana was conducted on (01/07/2021) with the help of  Nimbatwak Kwatha and Yashthimadhu Phant.

Results:

            After Vamana also the assessment was done as above and found an improvement than the former assessment. Pitchers were taken in the angles taken previously for comparison.

Virechana:

After Sansarjana Krama for Vamana, Virechana was planned in a row. For that Snehapana was given for 3 days with Panchatikta Ghrita

Virechana was done with the help of Ichchhyabedi Rasa 2 tab along with Shita Jala as Anupana having Jaipala as its main content

Results:

            The same assessment was done after Virechana also showing better improvement than the previous assessment. Pitchers collected from the same angles as that of previous.

Raktamokshana

            Raktamokshana was done from a great sephanous vein with 18 number needle in a quantity of 250 ml.

Patient’s Estimate

According to the patient there was a gradual fainting and resolution in the patches all over the body with no itching and no discharge at all during all Shodhana procedures.

Follow up and Result :

At a glance assessment of the patient’s disease is shown from the photographs at different intervals of different treatment by various Shodhana Karma and final assessment after three follow ups was also recorded in the form of pitchers before and after the Shodhana.

Consent :

Written consent of the patient was taken before conduction the Panchakarma procedures in the Hindi language.

Discussion

Kushta is Saptadushta Sangraha Vikara as per Ayurveda, including Twak (skin), Rakt  (blood), Mans (Tissue) and Lasika (Serous fluid) along with the Tridosha [9]. Vaman and Virechana procedure help to remove the vitiated Dosha from the body resulting in non-relapsing condition of the Kushta. Through Vamana the vitiated Kapha Dosh is expelled out of the body resulting in reduction in the size of the patches and relief in the itching as the elevation in the patches are caused by Kapha and itching to results from vitiated Kapha. Virechan removes vitiated Pitta from the body resulting in improvement in the metabolic procedures in the body reducing the production of the Ama thus resulting in good health. Raktmokshan removes the vitiated Shakhagat Dosha circulation in the blood through bloodletting.

Conclusion

From the study done above it is clear that, Shodhana Karma have the power to treat the dreadful diseases in the society if used properly. It does not cause any sensitivity reactions to the body, neither form a resistance in someone, In Ayurved also frequent Shodhan procedures are advised in the patient suffering from Kusht.

            Through repeated application of various Panchakarma procedures along with the oral medication’s complete removal of the vitiated and deranged Dosha in the body occurs. Along with these Panchakarma procedures patient also been advised various oral medications like Arogyavardhini Vati, Gandhak Rasayan, Sukshma Triphala, Krumikuthar Ras, Vidagarisht and Khadirarisht and it is also been advised to the patient to be ready for regular Panchakarma procedures