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Deshpande S. V. et.al., Effect of Shodhana Treatment in Severe Psoriasis (Eka Kushtha)- A Case Study, Int. J. Ayu. Alt. Med., 2015; 3(1):43-48

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CASE REPORT eISSN 2348- 0173

Impact Factor (2014) – 0.815 by International Scientific Indexing (ISI) UAE

EFFECT OF SHODHANA TREATMENT IN SEVERE PSORIASIS (EKA

KUSHTHA) - A CASE STUDY

Deshpande Shailesh V.1*, Jadhav Krutika Subhash2, Deshpande Vaishali S.3

1. Associate Professor in Kayachikitsa, PDEA’s College of Ayurved and Research Centre, Sector 27, Akurdi, Pradhikaran, Pune 411044 Maharashtra, Contact No. +91 9763104451, Email- [email protected]

2. MD (Scholar), Department of Kayachikitsa, PDEA’s College of Ayurved and Research Centre, Sector 27, Akurdi, Pradhikaran, Pune 411044 Maharashtra

3. Assistant Professor in Kayachilkitsa, Sumatibhai Shah Ayurved College, Malwadi, Hadapsar, Pune Maharashtra

Article Received on - 12th

Feb 2015

Article Accepted on - 18th

Feb 2015

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CASE REPORT eISSN 2348- 0173

*Corresponding Author

Deshpande Shailesh V. Lecturer in Kayachikitsa, PDEA’s College of Ayurved & Research Centre, Sector 27, Akurdi, Pradhikaran, Pune 411044 Maharashtra, Contact No. +91 9763104451, Email- [email protected]

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ABSTRACT: A case of psoriasis showing outrageous symptoms is a challenge to treat.

Conventional modern management in such condition not only shows side effects but

can also be carcinogenic in long period. Psoriasis can be correlated with eka kushtha

according to ayurveda. Such condition can be treated successfully, if ayurvedic

principles mentioned in treatment of kushtha are followed. This case of psoriasis

was diagnosed as a case of eka kushtha. Considering severity of disease (PASI score

45.5) basti and virechana were carried out after short initial phase of oral

medications. Also prolonged external application of aragwadha mahatiktak ghruta

done in different way showed good results (PASI score 2.4). No conventional modern

medicines were used. Ayurvedic treatment can show good results in severe form of

psoriasis. Use of repeated shodhana treatments can be the key in getting such effects.

Key Words: Basti, Virechana, Panchakarma, PASI Score.

INTRODUCTION

Psoriasis is characterised by chronic inflammation

of skin, clinically characterized by erythematous

sharply demarcated papules and rounded plaque [1]. It is correlated mainly with three conditions

described in ayurveda namely mandal kushtha,

kitibha kushtha and eka kushtha. Ayurveda has

advocated use of repeated shodhana treatments

along with shaman treatment and external

applications. Further discussed patient was

diagnosed as a case of psoriasis. As regards to

Ayurveda principles, the nature of skin lesions, and

other associated symptoms, patient was diagnosed

with eka kushtha, and was given treatment

accordingly. Patient was started on internal

ayurvedic treatment along with pancha karma

(kala basti and virechan). After basti, marked

decrease in the raised greyish black lesions and

shedding of deceased skin was seen. Significant

reduction in discharge was seen. Body ache and

burning sensation at the site of lesions were also

less. After virechan significant reduction in all

symptoms was seen. Dryness and scaling were

considerably reduced.

Although conventional treatment shows effective

results in the management of psoriasis, but can

show serious side effects especially in long run.

Thus, the chronic and recurring nature of the

disease hampers the quality of life to a great

extent. As a result of which shodhan at regular and

in appropriate quantity along with shaman

treatment is a necessity in treatment of psoriasis

as per ayurvedic principles.

CASE REPORT

A female patient of 49 years presented in

outpatient department of Ayurveda Rugnalaya and

Sterling Multispecialty Hospital on 3.12.2013 with

complaints of raised, inflamed, grayish black

lesions or plaques covering the entire body surface

with severe itching, burning sensation, dryness,

watery and blood stained discharge from lesions,

generalised weakness, heaviness, body ache since

two months. Patient was diagnosed as a case of

psoriasis seven years before, for which she

received some ayurvedic treatment for three

months, which was then discontinued by patient.

Patient used to suffer from psoriasis after

discontinuing treatment but was on no regular

treatment. Considering severity of symptoms the

patient was admitted in hospital. Physical

examination showed that patient was over weight

(78 kg). Haemogram showed mild anemia

(haemoglobin 10.2 gm%, red blood cells

microcytic, mild hypochromic) while other

parameters were within normal limits (white

blood cells 8800/ cmm, neutrophils 70%,

lymphocytes 27%, eosinophils 2%, basophils 1%).

Blood sugar was slightly raised (fasting blood

sugar 130 mg/ dl and post prandial 180 mg/ dl).

Urine examination showed moderate sugar loss.

Renal functions were within normal limits. PASI

score was 45.2 on admission.

DIAGNOSIS

In view of modern science, considering the nature

of lesions it was clearly a case of psoriasis

EFFECT OF SHODHANA TREATMENT IN SEVERE PSORIASIS (EKA

KUSHTHA) - A CASE STUDY

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[Photograph 1]. Researchers have compared

psoriasis with various skin diseases mentioned in

ayurvedic classics namely mandal kushtha, kitibha

kushtha and eka kushtha [2], [3], [4]. Mandal kushtha is

seen due to dominance of kapha while kitibha

kushtha and eka kushtha are seen due to vata and

kapha dominance [5].

Lesions seen in this patient were well defined

raised papules, plaques, covered with scales and

resembled like scales on body of fish (matsya

shakalopama) [Photograph 1]. Hence the patient

was diagnosed as a case of Eka Kushtha.

Considering symptoms seen due to each dosha

dryness (rukshata) and grayish black

discolouration (shyava arunatva) of the skin

showed the involvement of vata [6], burning

sensation (daha) and discharge (srava) from the

skin eruptions showed involvement of pitta [7]

while severe itching (kandu), raised skin eruptions

(utsedha) and chronicity of disease (sthairya)

showed involvement of Kapha [8]. No symptoms of

involvement of specific dhatu (dhatu gata kushtha)

were seen.

TREATMENT

Patient received svayambhuva guggulu and

panchatikta ghruta guggulu 500 mg each thrice

daily before food, chandrakala rasa 250 mg thrice

daily after food, freshly prepared decoction of

patola (Trichosanthes dioica Roxb.), sariva

(Hemidesmus indicus R.Br.),musta (Cyperus

rotundus Linn.), patha (Cissampelos pareira Linn.),

kutaki (Picrorhiza kurroa Royle ex Benth) 50ml

twice daily after food and a combination

containing prawal pishti125mg, punarnava mandur

125 mg, musta (Cyperus rotundus Linn.) 250 mg

and sariva (Hemidesmus indicus R.Br.) 250 mg

twice daily with aragwadha mahatiktak ghruta.

Local application of aragwadha mahatiktak ghruta

was done in specific way of using gauze pieces.

After 17 days of oral treatment and local

application basti treatment was started. In view of

large amount of dosha, kala basti karma was used [9]. For initial three sessions of anuvasan basti,

mixture of vidangadi tail and sesame oil, each 15

ml, was used which was later replaced by mixture

of panchagavya ghrita, honey and rock salt, 50 ml,

10 ml and 3 gm respectively for remaining seven

sessions. Niruha basti was a mixture of 550 ml

decoction of patola (Trichosanthes dioica Roxb.),

vidanga (Embelia ribes Burm.), musta (Cyperus

rotundus Linn.), aragwadha (Cassia fistula Linn.),

patha (Cissampelos pareira Linn) and kutki

(Picrorhiza kurroa Royle ex Benth), 50 ml of

pancha gavya ghruta, 30 ml of honey, 5 gm of

rocksalt and paste of Madana phala (Randia

spinosa Poir) and Mishreya (Foeniculum vulgare

Mill.), each 10 gm. All the ingredients of niruha and

anuvasana basti were mixed as per directions

mentioned in ayurvedic classics [10]. Kaal Basti is

specific pattern of basti administration that

contains ten anuvasana and six niruha basti. For

this patient on first, eighth, ninth and tenth days

only anuvasana was administered while from

second to seventh day niruha was administered.

Anuvasana was administered after lunch while

niruha was administered empty stomach in

morning. Before administering any basti local

application of sesame oil on abdomen and low

back and mild sudation were done as purva karma.

Good remission in symptoms was seen after basti

(PASI score reduced from 45.2 to 14.6) [Table 1].

To augment evacuation of doshas, virechana was

done after basti. As purva karma of virechana

internal oleation was administered using pancha

gavya ghrita. Dose of pancha gavya ghrita was

calculated by giving a test dose (hrasiyasi matra)

empty stomach early in the morning and by

measuring time required for its digestion[11].

According to time required for digestion of test

dose, maximum dose (uttama matra)[12] for pancha

gavya ghrita was calculated which was 250 ml.

Based on this a dose schedule for seven days of

internal oleation was prepared by daily increasing

dose of pancha gavya ghrita. Maximum dose

tolerated by patient was 170 ml. Even after seven

days of internal oleation symptoms of adequate

oleation (samyak snehapana) were not seen[13]. So

after giving break for two days internal oleation

was restarted. On 12th day as symptoms of

adequate oleation (samyak snehapana) were seen,

internal oleation was stopped. It was followed by

external oleation with aragvadha mahatiktaka

ghruta and bashpa sweda for two days. On fifteenth

day after internal oleation virechan was given

using decoction of aragwadha (Cassia fistula Linn)

100ml and icchabhedi rasa 500 mg. Patient passed

17 vega of virechana and showed symptoms of

moderate evacuation of dosha (madhyam

shuddhi)[14]. Samsarjana krama was advised for

five days as per classics. Patient was discharged

after three days after Virechana. Patient was

advised to take arogyavardhini and svayambhuva

guggulu 500 mg each thrice daily after food,

aragwadharishta 20 ml twice daily after food and a

combination containing vanga bhasma 60 mg,

punarnava mandur 125mg, leaves of nimba

(Azadirechta indica Linn), raktapachak vati,

vidanga (Embelia ribes Burm.), daruharidra

(Berberis aristata Linn) 250mg each twice daily

after food with aragvadha mahatiktak ghruta for

three months. For local application aragvadha

mahatiktak ghruta was used.

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TREATMENT OUTCOMES

In initial 14 days of oral treatment, itching and

discharge was reduced from eighth day. No other

significant improvement was seen. Patient started

to show improvement after third day of basti.

After basti, marked decrease in the raised greyish

black lesions and shedding of deceased skin was

seen [Photograph 2]. Significant reduction in

discharge was seen. Body ache and burning

sensation at the site of lesions were also less. Skin

now showed reddish less inflamed small patches.

During internal oleation prior to virechana, mild

increase in discharge and itching at skin lesions

was seen. After virechana significant reduction in

all symptoms was seen. Dryness and scaling were

considerably reduced. Skin showed reddish less

inflamed patches. Scaling was minimal

[Photograph 3].

After two months after virechana; only a few

lesions, remained on lower limbs, but there was no

itching, scaling or dryness. Skin was almost normal

[Photograph 4]. No new skin lesion was seen.

Significant reduction in PASI score was seen [Table

1]. Patient continued the treatment for another

couple of months but discontinued as she had to

shift to her native place in southern Karnataka.

DISCUSSION

Global prevalence of psoriasis varies considerably

from 0.91% to 8.5% with variation in geographical

regions, age[15]. Prevalence of psoriasis in India

ranges between 0.44 and 2.8%.[16]. It is understood

as most common autoimmune disease caused due

to in appropriate activation of cellular immune

system[17] and causes considerable psycho-social

disability and badly affects quality of life.

In present patient considering the characteristics

of lesions, it was a clear case of psoriasis according

to modern medicine. Various researchers in

ayurveda have diagnosed patients of psoriasis as

cases of kitibha kushtha, mandal kushtha or eka

kushtha. In this case the nature of the skin lesion

i.e. matsya shakolapamam (well defined raised

papules, plaques, covered with scales), and the

associated symptoms i.e. Itching, dryness,

discharge from the lesions etc lead to the diagnosis

which is eka kushtha.

Considering fulminant nature of skin lesions,

watery and blood stained discharge, generalised

weakness, body ache it was clearly a case of bahu

dosha avastha in which shodhana is first line of

treatment[18]. Also while describing treatment

kushtha, Charaka has clearly advocated use of

shodhana in fulminant vitiation of dosha such as

present case[19]. Vagbhata has suggested use of

repeated shodhana in cases of kushtha[20]. But

considering severe vitiation of dosha in sama stage,

subjecting the patient to directly to shodhana could

have been detrimental, hence initially for first

fifteen days internal medicines such as

svayambhuva guggulu, panchatikta ghruta guggulu

and fresh decoction of raktapachaka which are

potent pachaka, were used along with external

application. After sama stage of dosha was reduced

patient was fit for shodhana. Classical texts have

advocated use of vamana and virechana over basti.

Also in this case, considering dominance of kapha

in pathology of eka kushtha, vaman could have

been better choice, but considering obesity (ati

sthaulya) patient was not fit for the treatment[21].

Though patients of kushtha are suggested as unfit

for niruha[22], considering involvement of vata in

pathology of eka kushtha and ability of basti to

vacate dosha from every part of body, basti was

administered[23].In this case, basti proved to be

very effective in reducing the severity of the skin

lesions, shedding of the deceased skin and

reduction in body ache, heaviness. During basti no

new lesions were seen. Basti included niruha and

anuvasan both. Anuvasan was given with vidangadi

tail and Panchagavya ghrita. Vidanga (Embelia

ribes) tail is a known krumighna and

kushthaghna[24].Sushruta has suggested

involvement of krimi in all kushtha, hence use of

vidangadi tail was found beneficial[25].

Panchagavya ghrita was used due to its capacity to

remove chronic accumulation of vitiated doshas

(leendosha), without vitiating vata. Niruha basti

was also a combination of krumighna as well as

kushthaghna medicines. Basti is also found as

effective anti inflammatory treatment in cases of

psoriasis in other study. [26] However exact

indications and contraindication for use of basti in

cases of kushtha needs to e studied further.

The next line of shodhan treatment done was

virechan that augmented effect of basti and helped

in further evacuation of remaining dosha. For

virechan decoction of aragwadha (Cassia fistula

Linn) and ichhabhedi rasa were used. Both,

Aragvadha and ichabhedi rasa, are purgatives and

also useful in kushtha[27].In this case it was evident

that shodhan treatment showed good and results

in a severe case as this. A lot of research done on

effect of virechana in psoriasis is available and it

justifies the effect of virechana seen in this case[28].

One of the primary treatments in kushtha is local

application. Considering extensive dryness and

scaling evident in eka kushtha extensive external

oleation is necessary to reduce itching and scaling.

Hence external application of aragwadha

mahatiktak ghrita was done by different method.

In this method the roller gauze was first soaked

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Deshpande S. V. et.al., Effect of Shodhana Treatment in Severe Psoriasis (Eka Kushtha)

into sneha and was then rolled over the affected

part. Once it was dry, again the ghrita

over the gauze by drip method. This was continued

for one hour daily. Benefit of this method was that

it showed better absorbance and faster remission

in the thickness of the skin lesions, itching and

dryness. Main ingredient of aragwadha mahatiktak

ghrita is aragwadha (Cassia fistula

a known kushthagna and kandughna

known to have anti-inflammatory and wound

healing properties which were beneficial in

reducing the swelling and burning of the lesions

It is also known to have anti-

bacterial activity thereby covering secondary

infection if any[31]. Local application of oil or

medicated ghee in such way is routinely done in

our institute especially in cases of psoriasis and it

has shown good results in all cases.

Table 1: Effect of Shodhana and Shaman t

Date Treatment Given

3/12/13 to 18/12/13

Shaman treatment

19/12/13 to 28/12/13

Kala Basti

17/01/2014 Virechan

March 14 Shaman treatment

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Deshpande S. V. et.al., Effect of Shodhana Treatment in Severe Psoriasis (Eka Kushtha)- A Case Study, Int. J. Ayu. Alt. 48

and was then rolled over the affected

ghrita was poured

over the gauze by drip method. This was continued

Benefit of this method was that

it showed better absorbance and faster remission

in the thickness of the skin lesions, itching and

aragwadha mahatiktak

Cassia fistula Linn), which is

kandughna[29]. It is

inflammatory and wound

healing properties which were beneficial in

reducing the swelling and burning of the lesions[30].

-fungal and anti-

bacterial activity thereby covering secondary

Local application of oil or

medicated ghee in such way is routinely done in

our institute especially in cases of psoriasis and it

has shown good results in all cases.

Modern sciences advocate use of various

medicines such as corticos

anthalin, Psoralen and ultraviolet A phototherapy

(PUVA), methotrexate etc. But each of the

treatment potential side effects which could be

resistance to treatment, thinning of skin, immune

suppression and also as severe as formation of

melanoma[32]. So potentials of

treatments such as panchakarma,

eradicating the disease from its roots needs to be

evaluated further. Also use of external application

in specific method as done in this patient needs

further assessment in large clinical trials. It is an

observation in single case and further study in this

direction can help in establishing

treatment of psoriasis.

Table 1: Effect of Shodhana and Shaman treatment in a case of Psorias

Treatment Given Treatment Outcomes

Shaman treatment Slight reduction in itching and discharge.

Kala Basti 25% decrease in body ache and burning sensation. 50% decrease in the raised grayish black lesions,

and shedding of deceased skin

Virechan Dryness and scaling were considerably reduced.

Skin showed reddish less inflamed patches. Scaling was minimal.

Shaman treatment No itching, scaling, dryness or new lesions.

Photograph 1-3 : Before Treatment -

Photograph 4-6 : After Basti Treatment

Photograph 7-9 : After Virechana Treatment

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Modern sciences advocate use of various

medicines such as corticosteroids, retinoids,

anthalin, Psoralen and ultraviolet A phototherapy

(PUVA), methotrexate etc. But each of the

treatment potential side effects which could be

resistance to treatment, thinning of skin, immune

suppression and also as severe as formation of

. So potentials of ayurvedic

panchakarma, that helps in

eradicating the disease from its roots needs to be

evaluated further. Also use of external application

in specific method as done in this patient needs

ent in large clinical trials. It is an

observation in single case and further study in this

direction can help in establishing ayurveda for

reatment in a case of Psoriasis

PASI score

45.2

14.6

7.9

2.4

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Photograph

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Med., 2015; 3(1):43-48

Source of Support – Nil

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Effect of Shodhana Treatment in Severe Psoriasis (Eka Kushtha)- A Case Study

Conflict of Interest – None Declared

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nasi: Chaukhamba Sanskrit Sansthan; 1984. p. 687




aukhamba Sanskrit Sansthan; 1984. p. 712

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Chaukhamba Orientalia;2002.p.283.

Singh AK. Anti inflammatory effect of basti therapy

(medicated enema) in the patients of psoriasis (Eka

Kushtha). International Research Journal of Pharmacy,

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