ROLE OF VIRECHANA KARMA WITH HRIDYA VIRECHANA ...

ROLE OF VIRECHANA KARMA WITH HRIDYA

VIRECHANA LEHA IN THE MANAGEMENT OF PSORIASIS

By

Dr. CYRUS NEUPANE B.A.M.S.

Dissertation submitted to the

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BENGALURU

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATI

(Doctor of Medicine)

In

PANCHAKARMA

Under the Guidance of

Dr. NIRANJAN RAO M.D. (Ayu)

Professor & H.O.D.

Department of P.G. Studies in Panchakarma

S.D.M. College of Ayurveda, Udupi

Co-Guide

Dr. POOJA B. A. M.D., PhD (Panchakarma)

Assistant Professor

Department of P.G. Studies in Panchakarma

S.D.M. College of Ayurveda, Udupi

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA

S.D.M. COLLEGE OF AYURVEDA, UDUPI – 574118

2017- 2018

VIII

LIST OF ABBREVIATIONS USED

Ag. Pu. - Agni Purana

As. Hr. - Ashtanga Hridaya

As. Sa. - Ashtanga Sangraha

Ath. - Atharvaveda

ATP - Adenosine Triphosphate

B. P. - Bhava Prakasha

Bh. Ra. - Bhaishajya Ratnavali

Bh.S. - Bela Samhita

C.D. - Chakra Datta

Ch. Sa. - Charaka Samhita

K.S. - Kashyapa Samhita

Ka. - Kalpasthana

M. N. - Madhava Nidana

Sh. Sa. - Sharngadhara Samhita

Su.Sa. - Susruta Samhita

Y.V. - Yajurveda

IX

LIST OF TABLES

SR.

NO. TITLE OF TABLE

PAGE

NO.

1. Indications of Virechana 6

2. Contraindications of Virechana 7

3. Dose of Virechana drugs 12

4. Dose of Virechana drugs according to Koshtha 13

5. Observation of Suddhi Lakshanas of Virechana 14

6. Samyak Yoga Lakshana of Virechana Karma 14

7. Ayoga Lakshana of Virechana Karma 15

8. Atiyoga Lakshana of Virechana Karma 16

9. List of Virechana Vyapat 17

10. Peyadi Samsarjana Karma based on Suddhi 19

11. Points to classify Kushtha under Maha and Kshudra 27

12. Classification of Kushtha according to different Acharyas 27

13. Classification of Kushtha based on dominance of the Dosha 29

14. Nidana of Kushtha related to Atisevana 30

15. Nidana of Kushtha related to Mithya Ahara 31

16. Viharaja Nidana of Kushtha 32

17. Various Acharajanya Nidana for Kushtha 32

18. Poorvaroopa of Kushtha 34

19. Sadyasadhyata of Kushtha 36

20. Rasapanchaka of ingredients of Moorchhita Tila Taila 54

21. Age wise Distribution of Patients 70

22. Showing Sex Distribution 71

23. Showing Patients’ Distribution according to Religion 72

24. Distribution of patients based on their Education 73

25. Distribution according to Marital Status 73

26. Distribution of patients according to Socio-economic Status 74

27. Distribution of patients according to Occupation 75

28. Distribution according to Desha 76

X

29. Distribution according to Age of Onset 76

30. Distribution according to Chronicity of Disease 77

31. Distribution according to Aggravating factors 78

32. Distribution according to Relieving Factors 79

33. Distribution according to Family history 80

34. Distribution according to Vegetarian/Mixed food habit 81

35. Distribution of patients based on addictions 82

36. Distribution of patients based on Involvement of Joints 82

37. Distribution of patients according to changes in nails 83

38. Distribution according to Type of Psoriasis 84

39. Distribution according to Prakriti 85

40. Distribution according to Sara 86

41. Distribution according to Samhanana 87

42. Distribution according to Satmya 87

43. Distribution according to Satva 88

44. Distribution according to Abhyavaharana Shakti 89

45. Distribution according to Jarana Shakti 90

46. Distribution according to Vyayama Shakti 90

47. Distribution according to Koshtha 91

48. Observation of Snehajiryamana Lakshana 92

49. Observation of various Snehajirna Lakshana 93

50. Showing number of days to attain Samyak Snigdha Lakshana 94

51. Samyak Snigdha Lakshana observed on last day of Snehapana 95

52. Samyak Swinna Lakshana observed 96

53. Showing Vegiki Shuddhi 97

54. Laingiki Shuddhi 98

55. Antiki Shuddhi 99

56. Showing Maniki Shuddhi 100

57. Distribution of patients based on Atiyoga, Ayoga and Samyak

Yoga of Virechana 101

58. Distribution of patients based on Samsarjana Krama days 102

59. Virechana Aushadha Karya Samaya observed in patients 102

XI

60. Result for head after Virechana 104

61. Result for head after follow up 104

62. Result for upper limb after Virechana 105

63. Result for upper limb after follow up 105

64. Result for trunk after Virechana 106

65. Result for trunk after follow up 106

66. Result for lower limb after Virechana 107

67. Result for lower limb after follow up 107

68. Result on Total PASI Score after Virechana 107

69. Result on Total PASI Score after follow up 108

70. Effect on 5D Itch Score after Virechana 108

71. Effect on 5D Itch Score after follow up 108

XII

LIST OF FIGURES

SR.

NO.

NAME OF FIGURES

PAGE

NO.

1. Figure showing Samprapti of Kushtha 36

2. Age wise Distribution of Patients 71

3. Showing Sex Distribution 71

4. Showing Patients’ Distribution according to Religion 72

5. Distribution of patients based on their Education 73

6. Distribution according to Marital Status 74

7. Distribution of patients according to Socio-economic Status 74

8. Distribution of patients according to Occupation 75

9. Distribution according to Desha 76

10. Distribution according to Age of Onset 77

11. Distribution according to Chronicity of Disease 78

12. Distribution according to Aggravating factors 79

13. Distribution according to Relieving Factors 80

14. Distribution according to Family history 80

15. Distribution according to Vegetarian/Mixed food habit 81

16. Distribution of patients based on Addictions 82

17. Distribution of patients according to Joints Involvement 83

18. Distribution of patients according to changes in nails 83

19. Distribution according to Type of Psoriasis 84

20. Distribution according to Prakriti 85

XIII

21. Distribution according to Sara 86

22. Distribution according to Samhanana 87

23. Distribution according to Satmya 88

24. Distribution according to Satva 88

25. Distribution according to Abhyavaharana Shakti 89

26. Distribution according to Jarana Shakti 90

27. Distribution according to Vyayama Shakti 91

28. Distribution according to Koshtha 92

29. Observation of Snehajiryamana Lakshana 93

30. Observation of various Snehajirna Lakshana 94

31. Showing no. of days to attain Samyak Snigdha Lakshana 95

32. Samyak Snigdha Lakshana observed on last day of Snehapana 96

33. Samyak Swinna Lakshana observed 97

34. Showing Vegiki Shuddhi 98

35. Laingiki Shuddhi 99

36. Antiki Shuddhi 99

37. Showing Maniki Shuddhi 100

38. Patients’ distribution based on Atiyoga, Ayoga and Samyak

Yoga of Virechana

101

39. Distribution of patients based on Samsarjana Krama days 102

XV

STRUCTURED ABSTRACT with Key Words:

Title:

“ROLE OF VIRECHANA KARMA WITH HRIDYA VIRECHANA LEHA IN THE

MANAGEMENT OF PSORIASIS”

Background:

Virechana is the most suitable therapy for Pitta and disorders due to Pitta Prakopa.

Shodhana therapies are unique Ayurvedic therapies, where Doshas, which are

fundamental causes for the disease, are expelled out of the body. Psoriasis is one of

the most common dermatological conditions affecting 2% of world population. It is

a chronic inflammatory skin disorder clinically characterized by erythematous,

sharply demarcated papules and rounded plaques, covered by silvery micaceous scale.

Multi-dimensional assessment of Psoriasis was done with Psoriasis area severity

index (PASI), and 5 D itch score, Auspitz sign, and Candle grease sign.

Objectives:

To evaluate the Efficacy of Virechana Karma with Hridya Virechana Leha in

Psoriasis.

Methods:

It is an open clinical study with pre-test and post- test design in which, 25 diagnosed

patients of Psoriasis and fulfilling the selection criteria in the age group of 16 – 70

years, of either sex were selected. After Deepana and Pachana, Snehapana in Arohana

Krama was started and after obtaining Samyak Snigdha Lakshana, patients were

subjected for Parisheka for 4days. On 4th

day after Parisheka, Virechana Karma was

performed in empty stomach around 9:30 am and Samsarjana Krama was advised

according to the Shuddhi. Assessment of the patient was carried out before treatment,

after Treatment and 7 days after the Samsarjana Krama (follow up).

Results:

Study showed statistically significant result in decrement in PASI Score and 5D ITCH

Score.

Interpretation and Conclusion:

Hence, Virechana Karma with Hridya Virechana Leha was found to be effective in

reducing signs and symptoms of Psoriasis.

Keywords: Virechana, Kushtha, Psoriasis, PASI, 5D Itch Score.

Introduction

Role of Virechana Karma with Hridya Virechana Leha in the Management of

Psoriasis Page 1

INTRODUCTION

Virechana is a procedure in which the morbid Doshas are eliminated through

Adhobhaga, where Acharya Chkrapani while commenting on Adhobhaga clarifies it

as the Guda (anal route) 1

. Psoriasis is a chronic inflammatory skin disorder

clinically characterized by erythematous, sharply demarcated papules and rounded

plaques, covered by silvery micaceous scale.2 It is one of the most common

dermatological conditions, affecting around 2% of the world population, where in

about three-quarters of patients, the onset is before the age of 40 years and in about

one-third, it appears before the age of 20 years3.

In Ayurveda, almost all the skin diseases have been described under Kushtha.

Psoriasis is considered as one type of Kushtha and may resemble Ekakushta, Kitibh,

Mandala Kushta. Kushta is a Tridoshaja Vikara4

and Virechana is the best Shodhana

for Pitta predominant disorders5, meanwhile it also exerts its action on

Sleshmasamsrishta Avasta6 and also corrects the morbid Vata Dosha

7.

In Sahasrayoga, Hridya Virechana Leha is presented as one of the Vairechanik Yoga8.

It is one of the preparations of Trivrit and Trivrit is considered as the best drug

causing Rechana9. So, with this background, the study is taken to evaluate the efficacy

of Virechana Karma using Hridya Virechana Leha for the management of Psoriasis.

In the present study, patients diagnosed with Psoriasis were selected based on

selection criteria and subjected to Snehana and Swedana as Purvakarma, and

Virechana as Pradhana Karma and Samsarjana Krama as Pashchat Karma. Snehana

was achieved by internal administration of Moorchhita Tila Taila followed by Karanja

Kwatha Pariseka Swedana.

Introduction


Psoriasis Page 2

Virechana Karma in this clinical study was administered with Hridya Virechana Leha

with hot milk as Anupana.

Depending on Shuddhi, the Pashchat Karma was decided. Dosage and duration of all

the procedures were in accordance with Dosha Bala, Rogi Bala, Agni Bala, Koshtha

etc.

Objectives


Psoriasis Page 3

OBJECTIVES

1. To evaluate the efficacy of Virechana Karma with Hridya Virechana Leha in

Psoriasis.

Review of Literature


Psoriasis Page 4

REVIEW OF LITERATURE

VIRECHANA KARMA

HISTORICAL REVIEW:

Veda:

References of Virechana Yoga such as Haritaki, Trivrit etc. are found.

Agnipurana:

Agnipurana has stated Virechana as a best treatment for the disease caused due to

Pitta. It is mentioned to be indicated in Urdhwaga Raktapitta, Jwara, Hridroga. But

detailed description of Virechana is not found.

Vinaya Pitaka (Buddhist Literature):

In the text of Vinaya Pitaka, which was written during Buddha Kala, description of

administration of Virechana is found, where Virechana was given to Gautam Buddha

by Vaidya Jivaka. He used Greya Yoga, i.e. making Buddha smell some powder

spread over Utpalpatra.

Samhita Kala:

Virechana has been dealt elaborately in Charak Samhita, Sushruta Samhita, Astanga

Hridaya, Astanga Sangraha etc. The details will dealt below under different headings.

In Mesopotamia, Virecahan was in practice for pain in abdomen. Drugs used for

Virechana were Svarnapatri and Indrayana. (Jacqutta Hewks and Leonard Wooley).

In Western Medicine, the cathartics are amongst the most ancient methods of internal

medication used for treatments.



Psoriasis Page 5

Etymology:

The word Virechana is composed of three components (Vachaspatyam):

Vi: Upasarga (prefix)

Rich: Rich Dhatu (root)

Lyut: Pratyaya (suffix)

Accordind to Shabdakalpadruma:

Rechana is derieved from word root – Rich dhau and Lyut pratyaya.

Virechana word is formed from the root ‗Rich‘ dhatu, ‗Vi‘ Upasarga with ‗Nich‘ and

‗Lyut‘ Pratyaya, giving the meaning ‗Virechana Rechayateeti‘.

Rechana word is commonly used for the act of evacuation. As the evacuation of

Doshas is done by both Vamana and Virechana, sometimes the word Virechana

broadly may imply the both. But in general consideration, the word Virechana denotes

the evacuation of the doshas through the ‗Guda Marga‘. (Charkrapani on Ca. Ka. 1/4)

Definition:

Virechana may be defined as a process of eliminating the vitiated Doshas through the

Adhobhaga. Here, Chakrapani has clearified the meaning of Adhobhaga as ‗Guda‘14

.

It is the procedure in which orally administered drug acts on internally vitiated Dosha

(especially Pitta), and expels them through the Guda Marga.

Synonyms of Virechana:

Sramsan, Praskandanam.15

Panchabhoutika Sangathana:

Virechana drugs have the dominancy of Prithvi and Jala Mahabhuta. Virechana drugs

have Ushna, Teekshna, Sukshma, Vyavayi and Vikasi Guna. But many drugs though

may have Prithvi and Jala Mahabhuta priedominance, still may not exhibit



Psoriasis Page 6

Vairechanika property. This has been attributed to the Prabhava of the Virechana

drugs.16

Karyakshetra of Virechana:

Virechana has got actions on the following Dosha, Dhushya, Srotas, and Agni:

Dosha: Virechana is beneficial for Pitta Dosha predominant disorders, since

Virechana eliminates vitiated Pitta out of the body from its root. According to

Bagbhata, Virechana is helpful even in Pitta combined with Kapha, or Kapha in Pitta

Sthana.17

Also Acharya Bhela mentions Virechana in Sannipata condition also.

Dhushya: Virechana is mentioned as a Shodana procedure in Dushti of Rasa, Rakta,

Mamsa, Asthi, Majja and Shukra Dhatu. Hence, in majority of the Dhatu-Pradosaja

Vikaras, Virechana is a suitable treatment protocol.18

Srotas: Since on the above mentioned Dushya, Virechana is helpful, it can be inferred

that it is beneficial in Rasavaha, Raktavaha, Mamsavaha, Asthivaha, Majjavaha and

Shukravaha Srotodushti.

Agni: As in the Samyak Virikta Lakshana, Deeptagni is mentioned, so it can be

inferred that Virechana improves the Jatharagni and other Agni present in the body.

INDICATIONS AND CONTRAINDICATIONS OF VIRECHANA:

The Classical texts have similar opinions regarding the conditions and diseases where

Virechana is indicated and contraindicated, which is presented as follows:19, 20, 21, 22

Indications of Virechana:

TABLE NO. 1 INDICATIONS OF VIRECHANA

1. Kushtha 2. Vyanga

3. Jwara 4. Nilika

5. Prameha 6. Galaganda



Psoriasis Page 7

7. Pandu 8. Visphotaka

9. Halimaka 10. Bradhna

11. Naasasrava 12. Unmada

13. Netradaha 14. Apasmara

15. Shvasa 16. Yonidosha

17. Aasyadaha 18. Arbuda

19. Kasa 20. Bhagandara

21. Paiitika vyadhi 22. Arsha

23. Shotha 24. Vidradhi

25. Pakwashaya ruja 26. Granthi

27. Netrasrava 28. Dushtavrana

29. Shirashula 30. Vriddhi

31. Visarpa 32. Apache

33. Parshvaruja 34. Timira

35. Hridroga 36. Abhisyanda

37. Gulma 38. Kacha

39. Pliha 40. Akshipaka

41. Vatarakta 42. Krimikoshtha

Contraindications of Virechana:

TABLE NO.2 CONTRAINDICATIONS OF VIRECHANA

1. Langhita 2. Urustambha

3. Durbala 4. Garbhini

5. Durbalendriya 6. Bhakta



Psoriasis Page 8

7. Upavishta 8. Rikta Koshtha

9. Subhaga 10. Sukumara

11. Alpagni 12. Navaprasutaa

13. Abhighata 14. Ratri Jagrita

15. Kshatakshina 16. Atisnigdha

17. Shranta 18. Atiruksha

19. Pipasita 20. Bhayoptapta

21. Karma Bharadhvata 22. Chintaprasakta

23. Vriddha 24. Maithunprasakta

25. Bala 26. Adyayanaprasakta

27. Atikrisha 28. Vyayamaprasakta

29. Atishula 30. Shalyardita

31. Daruna Koshtha 32. Kamadi Vyagra

33. Kshama 34. Nava Pratishyaya

35. Adhmana 36. Nava Jwara

37. Talushosha 38. Adhoga Raktapitta

CLASSIFICATION OF VIRECHANA DRUGS:

A) Virechana drugs according to their origin and parts used:

1. Animal origin:

- Urine23

- Milk24

- Takra25



Psoriasis Page 9

2. Plant origin:

Mulini Virechana Dravya: Roots that have been recommended for Virechana are

Hastidanti, Shyamatrivrit, Adhoguda (Vidhara), Saptala, Pratyakshirni (Danti),

Gavakshi (Indrayana), Jyotismati, Bimbi, Vishanika, Ajagandha, Dravanti.26

Shankhini, Snuhi, Svarnakshiri, Chitraka, Kusha, Kasha, Kihini (Apamarga).27

Shalaparni, Prishniparni, Kantakari, Gokshura, Punarnava.28

Phalini Virechana Dravya: Fruits that are considered are Shankhini, Vidanga,

Anupa Klitaja(Madhuyasti), Sthalaja Klitaja, Prakirya (Latakaranaja), Abhaya,

Antahkotarpushpi, Kampillaka and Aragvadha.29

Puga, Amalaki, Haritaki, Vibhitaki,

Nilini, Chaturangula, Eranda, Kampillaka.30

Pilu, Priyala, Kuvala, Badara, Karkandu,

Kashmarya, Parusaka, Draksha.

Here, it is noteworthy that Acharya Charaka has mentioned the use fruit for

Virechana, while Acharya Susruta has told the root.

Kshirini Dravya: Latex of Snuhi and Arka.31

Saptacchada (Saptaparna), Jyotismati.32

Twak Dravya: Bark of Putika, Tilvaka,33

Kampillaka, Ramyaka, Patola.34

B) According to intensity of Action:

Mridu Virechana: Drugs that are Manda in Virya, administered in patient with

Ruksha Shareera, that too in low dose, drugs which have been given Bhavana with

drugs of oppsite Virya cause less degree of purgation. 35

Indiction: Alpa Dosha, Mridu Koshtha, Purva Shodhita

Drugs used: Draksha, Ksheera, Eranda Taila, Ambu36

Madhyama Virechana: Drugs which are Madyama in their Guna and Karma, drugs

which are exposed to water, heat, insects, not grown in proper Desha and Kala, and

not having all the desired properties will induce Madhyama Virechana. Also if a drug



Psoriasis Page 10

is given to a patient who is not properly Snigdha, or Swinna, then the drug givenfor

Virechana will have only Maadhyama Virechana action.37

Indication: Mdhyama Koshtha, Mdhyama Bala

Drugs used: Trivrit, Katuki, Aragvdha38

Tikshna Virechana: Drugs that have Tikshna Guna and Karma, and that cause

numerous loose stools by eliminating Doshas in large quantity without producing

Glani, pain in Guda and Hridaya Pradesha.39

Indication: Krura Koshtha, Balavana Rogi

Drugs used: Snuhi, Hemakshiri, Danti40

C) According to degree and Agrya Dravya41

:

Sukha Virechana: Trivrit (Operculina turpethum)

Mridu Virechana: Aragvadha (Cassia fistula)

Tikshna Virechana: Snuhi (Euphorbia nerifolia)

D) On the basis of mode of Action:

Sarangadhara has classified Virechana into four types depending on action, potency of

drug, onset and consistency of excretory product.

Anulomana: Drugs that do the digestion of Malas and breaks its Bandha and later

expels out through Adhobhaga are known as Anulomaka. Eg. Haritaki (Terminalia

chebula)42

. Acharya Sushruta has considered Sara as synonym of Anuloman, and

Dalhana addsthat Anulomana causes expulsion of Vata and Kapha.43

Bhavamishra

has considered undigested Doshas as Mala, and opines that drugs which expel them

are Anulomana.



Psoriasis Page 11

Sramsana: Drugs that expel the semi-digested and sticky Malas without digestion

come under this category. Eg. Aragvadha (Cassia fistula). The difference between the

Anulomana and Samsrana is about the digestion of Mala.44

Bhedana: Drugs that break Abaddha, Baddha, and Pindita Mala and expel them

through Guda come under Bhedana. Eg. Katuki (Picorriza kurroa)45.

Rechana: Drugs that expel both digested and undigested Mala after making them

watery through Guda Marga fall under this category. Eg. Trivrit (Operculina

turpethum)46

E) According to Kalpana:

Ghrita Yoga, Taila Yoga, Ksheera Yoga, Madya Yoga, Mutra Yoga, Mamsarasa

Yoga, Bhakshana Yoga, Avaleha Yoga47

are certain Kalpanas that are prepared based

on the purpose of easy intake (palatability), for enhancing or altering the potency, for

preserving for longer duration, and also for mixing with other drugs s as to increase or

reduce the potency.

Amongst the Virechana drugs, the following have been considered as the best in their

respective area:48

Mula Virechana: ShyamaTrivrit

Phala Virechana: Haritaki

Twak Virechana: Tilwaka

Swarasa Virechana: Karavellaka

Dugdha Virechana: Snuhi

PROCEDURE OF VIRECHANA:

The whole procedure of Virechana can be dealt under three headings viz. Poorva

Karma, Pradhana Karma and Paschata Karma.



Psoriasis Page 12

1) Poorva Karma:

a) Sambhara Sangraha: It is the collection of all the necessary equipment, drugs,

diet etc. used for the therapy.

b) Aatura Pariksha: The detail examination of the patient with regards to Dosha,

Dushya, Aatura Bala etc is to be carried out so as to ascertain the fitness of

him/her to undergo the procedure.

c) Aatura Siddhata: After observing Samyak Snigdha Lakshanas afeter

undergoing Snehapana, 3 days of Vishrama Kala is given prior to the

Virechana Karma. During these days, Bahya Snehana, and Swedana are to be

carried out.

d) Diet: Snigdha, Ushna, Drava, Mamsarasa, Yusha, Amla Rasa Ahara are

generally preferable during the Vishrama Kala. But it is to be noted that

Kaphavardhaka Aahara should be strictly avoided.49

e) Manasopachara: The whole procedure of Virechana is to be duly explained to

the patient and made him feel comfortable and relaxed.

f) Matra Vinischaya: Matra of the Vairechanika Yoga is to be selected in such a

way that it produces samyak Virechana, without giving rise to any

complications. The Matra (dose) is decided on the basis of Agni, Koshtha of

the patient, and Aushadha.

The dose fixation of Virechana drugs according to different aspects is presented

below:

Table No. 3 Dose of Virechana drugs (According to Sarangadhara):

Kalpana Hina Matra Madhyama Matra Uttama Matra

Kwatha ½ Pala (2 Tola) 1 Pala (4 Tola) 2 Pala (8 Tola)

Choorna, Kalka 1 Tola 2 Tola 4 Tola



Psoriasis Page 13

Table No. 4 Dose of Virechana drugs according to Koshtha:

Authors Mridu Koshtha Madhyama

Koshtha

Kroora Koshtha

Sushruta (Su.

Chi.33/21)

Mridu Matra Madyama Matra Tikshna Matra

Vangasena 1 Tola 2 Tola 3 Tola

2) Pradhana Karma:

Pradhana Karma includes:

a. Administration of Virechana Yoga

b. Observation and management during Virechana Vega

c. Observation of:

- Shuddhi Lakshanas

- Virechana Vyapat (if any)

a. Administration of Virechana Yoga:

The method of administration of Virechana Karma has been elaborately dealt by

Acharya Charaka. After the completion of Bahya Snehana and Swedana, after

checking if the patient has slept well the previous night, is cheerful, has digested his

previous night‘s meal, is advised to perform auspicious rites. Then after, considering

the Vaya, bala, dosha, Bhesaja etc., and after passing the time of Kapha Prakopa in

morning, the patient should be given with the Virechana Yoga in the empty

stomach.50

After administration of the Virechana drug, cold water is sprinkeled over the face so

as to avoid vomiting sensation, andthen the patient isasked to gargle with hot water,



Psoriasis Page 14

and to smell fragrance of flower etc. He is advised to avoid cold winds, and take rest.

He is advised not to hold the Vega, while also not to do Pravahana.51

b. Observation andmanagement during Virechana Vega:

During all the time, Vaidya should concentrate on the manifestation of Lakshanas of

Jirna/Ajirna of Aushadha, Suddhi and Vypat etc.

c. Observation of Suddhi Lakshanas:

Virechana Suddhi can be assessed as shown in the tables below, based on the

parameters like Vegiki, Manaki, Antaki, and Laingiki Lakshanas.52

TABLE NO. 5 Observation of Suddhi Lakshanas of Virechana:

Shuddhi Pravara Madhyama Hina

Vegiki 30 20 10

Manaki 4 Prastha 3 Prastha 2 Prastha

Antaki Kaphanta Kaphanta Kaphanta

Laingiki As described in the next table (Table No. 6)

Samyak Yoga Lakshanas, Atiyoga Lakshanas, Ayoga Lakshanas, and Vyapat should

be observed as per Classics which are presented below:

TABLE NO. 6 SAMYAKA YOGA LAKSHANA OF VIRECHANA KARMA53

:

S. NO. LAKSHANA

1. Sroto Visuddhi

2. Indriya Prasada

3. Laghuta

4. Agnivriddhi



Psoriasis Page 15

5. Anamayatva

6. Kramataha Vita, Pitta, Kaphagamana

7. Vatanolomana

8. Absence of Ayoga Lakshanas

TABLE NO. 7 AYOGA LAKSHANA OF VIRECHANA KARMA54

:

S. NO. AYOGA LAKSHANA

1. Kapha Prakopa

2. Pitta Prakopa

3. Vata Prakopa

4. Agnimandya

5. Gaurava

6. Pratishyaya

7. Tandra

8. Chhardi

9. Aruchi

10. Vata Pratilomana

11. Daha

12 Hridaya Ashuddhi

13. Kukshi Ashuddhi

14. Kandu

15. Vita Sanga

16. Mutra Sanga

17. Pidika



Psoriasis Page 16

TABLE NO. 8 ATIYOGA LAKSHANA OF VIRECHANA KARMA55

:

S. NO. ATIYOGA LAKSHANA

1. Kapha Kshaya Vikara

2. Pitta Kshaya Vikara

3. Supti

4. Angamarda

5. Klama

6. Vepathu

7. Nidrahani

8. Balaabhava

9. Tamah Pravesha

10. Unmada

11. Hikka

12. Raktakshaya Vikara

Virechana Vyapat:

The complications arising due to improper Virechana Karma are taken under

Virechana Vyapat. Ayoga and Atiyoga of Virechana may lead to manifestation of

Vyapat.56

Those Virechana Vyapat according to Acharyas have been listed in the

table as:



Psoriasis Page 17

TABLE NO. 9 LIST OF VIRECHANA VYAPAT:

Vyapat Charaka Sushruta Vaghbhata

Aadhmana + + +

Parikartika + + +

Parisrava + + +

Hridgraha + - +

Gatragraha + - Sarvanga Graha

Jivadana + + +

Vibhramsha + - Guda Vibhramsha

Stambha + - -

Klama + - -

Upadrava + - -

Vamana - + +

Saavashesha

Aushadhitva

- + +

Jirna Aushaditva - + +

Hina Aushadhitva - + -

Vata Shoola - + Vedana

Ayoga - + +

Atiyoga - + +

Hridaya-Upasarana - + -

Vibandha - + -

Pravahika - + +

Visamjnata - - +



Psoriasis Page 18

3) Pashchat Karma:

Following points are to be considered under Pashchat Karma:

1. Tatkalika Paschat Karma:

After the stoppage of Virechana Vega, the patient is advise to wash his/her hands,

feet, face, and also s/he is consoled if s/he is somewhat distressed, and then instructed

to follow the Pathya explained in the context of Snehana and Virechana.

2. Kalantarika Pashchat Karma:

The individual is instructed to follow appropriate Samsarjana Krama, as per the

Shuddhi Lakshanas:

- Peyadi Samsarjana

- Tarpanadi Samsarjana

Samsarjana Krama is a specific dietary regimen, which is to be followed after the

Shodhana Krama. The aim of Samsarjana Krama is to augment the Agni that gets

weakened during the whole process of Shodhana Karma.

Different Acharyas have given different modality of Samsarjana Krama, though the

goal is the same. Acharya Charaka has mentioned the use of Peya, Vilepi, Akrita

Yusha, Krita Yusha, Akrita Mamsarasa, and Krita Mamsarasa, which is depicted in

the table given below (Table 10). Achrya Susruta has mentioned Yusha of Kulattha,

Adhaki, Mudga, and Mamsa Rsa for this purpose. Dalhana advises that the Peya

should be given in the conditions of Kshina Kapha, but when Vata is dominant,

Mamsa Rasa is advisable.

Instead of Peyadi Samsarjana Krama, Tarpanadi Samsarjana Krama has been

mentioned in the case where proper Virechana hasn‘t taken place. It is also mentioned

that in persons who are addicted to alcohol, having Vata Pitta Prakriti, and in whom



Psoriasis Page 19

Kapha and Pitta are dominant even after Virechana, Chakrapani recommends use of

Svachha, and Ghana Tarpana in place of Peya, and Vilepi.

TABLE NO. 10 PEYADI SAMSARJANA KRAMA BASED ON SHUDDHI:

Days Annakala

Pravara

Shuddhi

Madhyama

Shuddhi

Avara Shuddhi

Day 1 Evening Peya Peya Peya

Day 2

Morning Peya Peya Vilepi

Evening Peya Vilepi Kritakrita Yusha

Day 3

Morning Vilepi Vilepi

Kritakrita

Mamsarasa

Evening Vilepi Akrita Yusha Normal food

Day 4

Morning Vilepi Krita Yusha -

Evening Akrita Yusha Akrita Mamsarasa -

Day 5

Morning Krita Yusha Krita Mamsarasa -

Evening Krita Yusha Normal food -

Day 6

Morning

Akrita

Mamsarasa

- -

Evening

Krita

Mamsarasa

- -

Day 7

Morning

Krita

Mamsarasa

- -

Evening Normal food - -



Psoriasis Page 20

MODE OF ACTION OF VIRECHANA:

Acharya Charaka explains mechanism of Virechana on the basis of qualities.

Virechana drugs have properties Ushna, Tikshna, Sukshma, Vyavayi, and Vikashee.

Prithvi and Jala Mahabhuta are predominant in Vairechanika Dravya whereas they

possess Adho Bhaga Prabhava, thus they act in downward direction.

Virechana Aushadhi by virtue of their Ushna, Tikshna, Sukshma, Vyavai and

Vikashee Guna, and their Swa Virya (Swo Prabhava), reach to Hridaya and spread

through Dhamani to all the macro and micro channels in the body. Here, Acharya

Chakrapani clearfies that it is not the Aushadhi in its physical form itself that traverses

throughout the Dhamani in body, rather it is the Virya of Aushadhi that spreads to all

the Dhamani. Then, Ushan Guna causes liquefaction of Dosha Samuha in the body;

Tikshna Guna causes disintegration (Vichhinnata) of Dosha. Those disintegrated

(Vichhinna) Dosha by virtue of the Anu Pravana Bhava (property to traverse through

microchannels) move smoothly to Amashaya of Sneha Bhavita patient, without

getting adhered in the route, similar to that of moving of honey smoothly in the

properly anointed mud pot. Then being the Virechana Aushadha Dravya predominant

of Prithvi and Apa Mahabhuta and its having Adho Bhagahara Prabhava, the Dosha

that were brought to Amashaya are expelled out through the Guda Marga by the

Aushadha.

CONTEMPORARY SCIENCE VIEW:

Laxatives/Aperients and Purgatives/Cathartics:

These are the drugs that promote evacuation of bowels. A distinction is made

according to intensity of action:

a. Laxative or Aperient: milder action, elimination of soft but formed stools.

b. Purgative or Cathartic: stronger action resulting in more fluid evacuation.



Psoriasis Page 21

Many drugs in low doses act as laxative and in larger doses as purgative.

Classification:

1. Bulk forming: Eg. Dietary fibre: Bran, Psyllium ispaghula (Plantago) etc.

2. Stool softener: Eg. Docusates, Liquid paraffin

3. Osmotic purgatives Eg. Magnesium salts, Lactulose etc.

4. Stimulant purgatives:

a. Diphenlmethanes Eg. Bisacodyl, sodium picosulphate

b. Anthraquinones Eg. Senna

c. 5-Ht4 agonist Eg. Tegaserod

d. Fixed oil Eg. Castor oil

Mechanism of action:

All purgatives increase the water content of faeces by:

a. A hydrophilic or osmotic action, retaining water and electrolytes in the

intestinal lumen- increase volume of colonic content and make it easily

propelled

b. Acting on intestinal mucosa, decrease net absorption of water and electrolyte;

intestinal transit is enhanced indirectly by the fluid bulk.

c. Increasing propulsive activity as primary action-allowing less time for

absorption of salt nand water as a secondary effect.

For some of the drugs, controversy continue as to whether they increase water

content of stools as the primary action or it is a consequence of increased motility.

However, certain purgatives do increase motility through an action on the

myenteric plexuses. Laxatives modify the fluid dynamics of the mucosal cell and

may cause fluid accumulation in gut lumen by one or more of following

mechanisms:



Psoriasis Page 22

a. Inhibiting Na+K

+ATPase of villous cells-impairing electrolyte and water

absorption.

b. Stimulating adenylyl cyclase in crypt cells-increasing water and electrolyte

secretion

c. Enhancing prostaglandin synthesis in mucosa which increases secretion.

d. Structural injury to the absorbing intestinal mucosal cells.

Stimulant purgatives: They are powerful purgatives: often produce gripping. They

were thought to irritate the intestinal mucosa and thus stimulate motor activity.

Though some of them do primarily increase motility by acting on myenteric plexuses,

the more important mechanism of action is accumulation of water and electrolytes in

the lumen by altering absorptive and secretory activity of the mucosal cell. They

inhibit Na+K

+ATPase at the basolateral membrane of villous cells-transport of Na

+

and accompanying water into the interstitium is reduced. Secretion is enhanced by

activation of cyclic adenosine monophosphate (cAMP) in crypt cells and by increased

prostaglandin synthesis.



Psoriasis Page 23

DISEASE REVIEW: KUSHTHA

In Ayurveda, almost all the skin diseases can be taken under generalized term

‗Kushtha‘. Acharya Charaka has quoted ‗Havi Prashanmeha Kushthayoh‘57

, which

indicates that Kushtha is a Santarpanajanya Vyadhi. Considering the vast number of

skin diseases with various morphology, colour, distribution, predominance of Dosha,

Acharya Charaka has classified Kushtha as 7 types, 18 types and also said that it can

be taken as innumerable58

. The Importance of Kushtha is highlighted by mentioning it

as ‗Agrya‘ for chronic diseases.

HISTORICAL REVIEW OF KUSHTHA

A.VEDIC PERIOD:

Rigveda :

In Rigveda there is no complete description about the ‗Kushtha Roga‘. But some

description indicates that Kushtha was prevalent during that period also.

- The Charmaroga of Apala was cured by Lord Indra (R.V. 8-91-7).

- Ghosa was suffering from ‗Kushtha Roga‘. By administration of proper medication

she got cured & ultimately was accepted by her husband. (R.V. 1-1/7-7).

Yajurveda :

Shukla Yajurveda mentions various medicines having Kushthanashaka properties.

(Y.V. 1-23, 1-4, 1-24, 10 – 13/30, 8-10).

Atharvaveda :

The names of various diseases have been illustrated, and Kushtha has been described

as Kshetriya Roga. There is description of some herbs like Rama, Nili, Asuri, Shyama

etc. for the treatment of Kushtha (Ath.1/23).



Psoriasis Page 24

B. PURANA KALA

Mahabharata:

It has been mentioned that the person suffering from ‗Tvakadosha‘ is not fit to be a

king. This reference highlights the fact that at that time people suffering from

‗Kushtha‘ were looked down by the society.

Agnipurana

Kushthaghna preparations are mentioned under the heading of ‗Nana Rogahara

Aushadhani‘ (Ag.Pu. 120/3).

C. SAMHITA KALA

Charaka Samhita :

Achrya Charaka is the one who has described Kushtha in detail for the first time. He

has described 18 types of Kushtha. Seven types of Kushtha have been described as

Mahakushtha in Nidana Sthana -5th

Chapter in detail. In the Chikitsa Sthana -7th

Chapter, eighteen types of Kushtha have been described where they are classified as

Mahakushtha 7 and Kshudrakushtha 11. Apart from the description of Kushtha in

Nidana Sthana - 5 and Chikitsa Sthana -7, there are some other references related to

Kushtha in Charaka Samhita; some of them are as follows :

(a) Kushtha is described as the Samanya Hetu of Nija Shotha59

.

(b) Use of Stambhana Dravyas in the initial stage of Raktapitta, Raktarsha &

Amatisara leads to Kushtha59

.

(c) Kushtha is mentioned in Lekhana Yogya & Prachhana Yogya Vyadhi59

.

(d) Agnikarma is contraindicated in Kushthaja Vrana59

.



Psoriasis Page 25

Sushruta Samhita :

Aacharya Sushruta for the first time clearly described the Anuvansika (hereditary) &

Krimija (infectious) Nidana as a causative factor of Kushtha60

. Kushtha has also been

included in the list of Aupasargika Roga, which may spread from one person to

another60

. Sushruta has described Chikitsa of Kushtha in two chapters i.e. Kushtha

Chikitsa and Mahakushtha Chikitsa. Guggulu, Shilajita, Shveta Bakuchi etc.

Rasayana drugs are mentioned in its Chikitsa.

Ashtanga Hridaya :

Acharya Vagbhata has followed Acharya Sushruta regarding classification of

Mahakushtha & Kshudrakushtha61

. But Ekakushtha has been mentioned under

Kshudrakushtha with same Lakshanas as described by Charaka61

.

D. SANGRAHA KALA

Madhava Nidana:

Madhava has described Nidana Panchaka of Kushtha as per Charaka & Vagbhata.

While Dhatugatatva, Sadhya-Asadhyata & Sankramakata (contagious) have been

described according to Sushruta.

Sharangadhara Samhita :

Classification of Kushtha has been described in Purvakhanda. According to

Sharngdhara, Tamra which is the fourth layer of the skin is the site of all types of

Kushtha62

.

Vangasena :

Vangasena has mentioned 7 types of special causes of Kushtha that is Tilataila,

Kulattha, Valmika, Linga Roga, Mahisha Dugdha, Mathita Dadhi & Vruntaka63

.



Psoriasis Page 26

Bhava Prakasha :

Bhava Prakasha has given detail description of Kushtha Roga. He has followed

Charaka for classification & nomenclature of Kushtha. The Dhatugatatva & Sadhya-

Asadhyata are compiled from Sushruta.

ETYMOLOGY:

The word ‗Kushtha‘ is derived from ‗Kush nishkarshane‘ + ‗Kthan‘ (कुष्नननकर्षणेहनन

+ क्थन ्)64

which implies ‗to destroy‘, ‗to scrap out‘ or to deform, by adding the suffix

‗kthan‘ which stands for firmness or certainty. Thus the word Kushtha means that

which destroys with certainty.

DEFINITION

Siddhanta Kaumudi:

कुनणानिननिःशरॆ्ेणकर्षनिविऱेखनंकरोनिअङ्गप्रत्यङ्गाननधािुउऩधािूननइनिकुनठम॥्

Kushtha is the condition in which different organs, Dhatus, Upadhatus are destroyed.

Ashtanga Hridaya:

त्िचिःकुिषष्तिििैर्ण्यदंनु्ािःकुनठमशुष्तििि।्

काऱेनोऩेक्षऺियंस्मात्सिषकुनणानिित्िऩिुः ।।65

The pathological condition of the body, in which the Dosha discolour the skin and

cause vitiation in all the Dhatu, and if untreated or neglected, destroys the entire body

is called Kushtha.

Acharya Charaka and Acharya Sushruta have mentioned that 7 Dravya Sangraha i.e.

Tridosha, Tvacha, Rakta, Mamsa and Lasika make the skin Kustsita (deformed). If it



Psoriasis Page 27

is neglected then normal condition of whole body may be affected therefore it is

called Kushtha.

CLASSIFICATION OF KUSHTHA:

Acahrya have described the Kushtha under Maha Kushtha and Kshudra Kushtha.

Some bases for the classification are as follows:

- Some aspects to be considered to classify Kushtha as Maha and Kshudra:

Table No. 11 Points to Classify Kushtha under Maha and Kshudra:

Maha Kustha Kshudra Kustha

Bahu Dosha Arambhata Alpa Dosha Arambhata

Bahu Lakshana Alpa Lakshana

Excessive discomfort Less discomfort

Penetrates into deeper Dhatus

Less tendency to penetrate into deeper

Dhatus

Mahat Chikitsa Alpa Chikitsa

Chronic Less Chronic

- Classification of various types of Kushtha by different Acharyas (under Maha

and Kshudra):

Table No. 12 Classification of Kushtha according to Different

Acharyas:66,67,68,69,70,71

No Types of Kustha (Maha Kushtha)

Ch.

S.

Su.

S.

A.H. K. S. M.N. B.P.

1 Kapala + + + + + +

2 Audumbara + + + + + +



Psoriasis Page 28

3 Mandala + - + + + +

4 Rushyajihva + + + + + +

5 Pundarika + + + + + +

6 Sidhma + - - + + +

7 Kakanaka + + + - + +

8 Dadru - + + - - -

9 Aruna - + + - - -

No

Types of Kustha (Kshudra

Kushtha)

Ch.

S.

Su.

S.

A.H. K.S. M.N. B.P.

1 Ekakustha + + + + + +

2 Kitibha + + + + + +

3 Charmadala + + + + + +

4 Pama + + + + + +

5 Vicharchika + + + + + +

6 Charmakhya + - + - + +

7 Vipadika + - + + + +

8 Alasaka + - + - + +

9 Dadru + - - + + +

10 Visphotaka + - + - + +

11 Shataru + - + + + +

12 Sidhma - + + - - -

13 Sthularushka - + - - - -

14 Mahakustha - + - - - -

15 Visarpa - + - - - -



Psoriasis Page 29

16 Parisarpa - + - - - -

17 Raksha - + - - - -

19 Vishaja - - - + - -

- Classification of Kushtha based on dominance of Dosha:

Table No. 13 Classification of Kushtha based on Dominance of Dosha72,73,74

:

Predominance of Dosha Name of Kushtha

Vata Kapala

Pitta Audumbara

Kapha Mandala, Vicharchika

Vata Kapha

Sidhma, Ekakushtha, Alasaka,

Charmakhya, Kitibha,Vipadika

Vata Pitta Rishyajihva

Kapha Pitta

Pundarika, Dadru, Charmadala,

Pama, Visphotaka, Shataru

Vata Pitta Kapha Kakanaka

NIDANA OF KUSHTHA:

Ayurvedic texts have described Samanya Nidana for all types of Kushtha instead of

specific Nidana for any particular type of Kushtha.

The Nidana can be categorized as follows:-

1. Aharaja- diet and dietetic pattern

2. Viharaja- pertaining to lifestyle

3. Acharaja- pertaining to conduct

4. Miscellaneous



Psoriasis Page 30

1. AHARAJA NIDANA

Aharajanidana can be described as following.

a. Atisevana

It can be categorized on the basis of following factors:

Table No. 14 Nidana of Kushtha Related to Atisevana75,76,77,78,79,80

:

Headings Nidana Ch.S. Su.S. A.H. A.S. M.N B.P. Present

counterparts

Rasa

Amla,

Lavana,

Katu

and Kshara

+ + - - + +

Pickle, Jam, and

Sauce, spicy foods,

fast foods,

processed, salted

and packaged

foods

Guna

Guru and

Snighdha

Ahara

+ - - - + + Sweets, Fried and

Oily foods

Dairy

product

Kshira,

Dadhi,

Payasam,

Takra

+ - - - + +

Milk, Buttermilk,

Butter, Cheese,

Payasa, Icecreams,

Lassi, Milk Shakes

Grains

Navdhanya

Nishpava,

Hayanaka,

Udalaka etc.

+ - - - + +

Mellowed gains

like Wheat,

Polished Rice,

Bajara, Barley

Pulses Kulatha,

Masha + - - - + +

Black gram,

Horse gram, Pea,

Lentils

Anupa

mamsa

Matsya,

Mahisha,

Srumara,

Varaha etc.

- + - - - -

Fish, Pig, Buffalo

etc



Psoriasis Page 31

Prasaha

Mamsa

Marjara,

Go, Khara,

Mushika

etc.

- + - - - -

Chicken, Mutton,

Peacock,

Cow,

Rat and Mice

Sweet

substances Madhu + - - - - - Honey

Guda + - - - + + Jaggery

Oil Tila, Atasi

Kusumbha + - - - + +

Gingily Oil,

Flax Seed Oil,

Saf-Flower Oil

Vegetables

Mulaka,

Lakucha,

Kakmachi

+ - - - + +

Raddish,

Monkey Jack,

Black Night Shade

Missellane

ous

Pishtaanna,

Tila, Kola + - - - - -

Noodles made out

of refined flour,

Tiila, Laddu etc

b. Mithya Ahara:

Table No. 15 Nidana of Kushtha Related to Mithya Ahara81,82,83,84,85,86

:

Headings Nidana Ch. S. Su. S. A.H. A. S. M. N. B. P. Present

counterparts

Foods

Vidahi,

Vidagdha,

Upaklinna,

Putianna

+ - - - - -

Too Spicy and

chilly foods,

Grilled foods,

Frozen foods,

Old Foods

Food

pattern

Viruddhashana + + + + + + Prakati, Karana,

Samyoga, Rashi etc.

Ajirnabhojana

+ - - - - -

Taking food

without digestion

of previous food

Asatmyabhoja - + - - - - Taking food which



Psoriasis Page 32

na

is not accustomed

to Desha, Kala.

Atibhojana + + - - - - Excessive Food

Adhyashana + + - - + + Eating too

frequently

Vishamashana + + - - - - Untimely food

Krama Varjita

Sheeta, Ushna + - - - - -

Eg. Taking Ice

cream after meals

AtibhuktvaVya

yama Sevana + - - - + +

Exercise

immediately after

meal

Krama

Varjitalanghan

a and Ahara

+ - - -

- - Improper fasting

Psycholo

gical

Disturba

nce

During

the meal

Santapa + + + - + + Taking Food in

Distress

2. VIHARAJA NIDANA:

There are various Vihara that are thought to be as Nidana for Kushtha:

Table No. 16 Viharaja Nidana of Kushtha87,88,89,90,91,92

:

Nidana Ch.S Su.S A.H A.S M.N B.P

Shitoshna Vyatyasa Sevana and

Anupurvya Sevana

+ - - - - +

Sudden diving in to cold water or

drinking cold water after fear,

exhaustion & coming from sunlight

+ + - - + +

Practice of sunbath after heavy

meals.

+ - - - + +



Psoriasis Page 33

Sex indulgence in Ajirna + - - - + +

Suppression of Chhardi, Mutra,

Purisha like Vegas

+ + - - + +

Kupathya in Panchakarma + + - - + -

Divasvapna after lunch + - - - - -

3. ACHARAJANYA NIDANA:

Various behavioral misconduct, antisocial activities, sinful activities and other

punishable activities are considered under this heading.

Table No 17 Various Acharajanya Nidana for Kushtha87,88,89,90,91,92

:

Achara Hetu Ch. S. Su. S. A.S. A.H. H.S. M.N. B.P.

Papa Karma + + + + + + +

Vipra Guru

Tiraskara + - - - - + -

Sadhu Ninda - - + + - - -

AnyasvaHarana - - + + - - -

Killing the

virtuous

persons.

- - + + - - -

4. MISCELLANEOUS NIDANA:

Samsargaja Hetu

According to Sushruta and Vagbhata, Kushtha is Aupasargika Roga. Sushrtua

describes in Nidanasthana 5/32-33 that Kushtha spreads from one man to another

due to Prasanga, Gatrasamsparsha, Ni shwasa, Sahabhojana etc.

Kulaja Nidana



Psoriasis Page 34

Kulaja Nidana is also known as Anuvanshika Nidana i.e. due to Beejadushti.

Sushruta has mentioned Kushtha as Adibalapravritta Vyadhi i.e. the original cause

of the disease is attributed to defects of Shukra and/or Shonita. Sushruta has also

explained that the children of Kushtha patients may also suffer from Kushtha93

.

Krimija Hetu

Acharya Sushruta has mentioned that all types of Kushtha originate from Vata,

Pitta, Kapha and Krimi93

.Charaka has also indicated that causative factors

&treatement of Raktaja Krimi is as same as Kushtha94

.

Kushtha has been mentioned as Raktapradoshaja and Santarpanajanya Vyadhi. So

the Raktaprakopaka and Santarpaka Nidana can be attributed for the production of

Kushtha.

Charaka indicated that the water of the rivers which are originated from Vindhya,

Sahya and Pariyatra hills may cause Kushtha95

.

KUSHTHA POORVAROOPA:

Poorvaroopa appears in the fourth stage of Kriyakala, that is ‗Sthana Samshraya‘

stage. Poorvaroopa of Kushtha as described by different Acharyas are :

TABLE 18 POORVAROOPA OF KUSHTHA96,97,98,99,100,101

:

Purvarupa Ch. Su. A.H A.S. M.N B.P.

Aswedana + + + + + -

Atiswedana + + + + + +

Parushya + + - - - -

Atislakshnata + - + + + +

Vaivarnya + - + + + +

Kandu + + + + + +

Nishtoda + - + + + +

Suptata + + + + + +



Psoriasis Page 35

SAMPRAPTI OF KUSHTHA102

:

The process of vitiation of Doshas due to etiological factors upto to the full-fledged

manifestation of the disease with Dosha-Dushya Sammurchana is called ‗Samprapti‘.

Samprapti of Kushtha may be shown as:

Pariharsha + - + + + +

Lomaharsha + + + + + +

Kharatva + - + + + +

Usmayanam + - - - - -

Gaurava + - - + - -

Svayathu + - - - - -

Kothonnati + - + + + +

Shrama + - + + - -

Klama + - - - - -

Visarpagamanam + + - - - -

Kayachhidresu Upadeha + - - - - -

Pakva-Dagdha- Dasta-Bhanga-

Kshata- Ativedana + - + + - -

Svalpamapi Vrananam Dushti + - + + - -

Svalpamapi Vrananam

Asamrohanan

- - + + - -

Ashruja Krishnata - + + + - -

Vranana Shighra Utpatti Chirah

Sthiti

- - + + - -



Psoriasis Page 36

NIDANA SEVANA

TRIDOSHA PRAKOPA SHITHILATA IN TWOK, RAKTA, MAMSA,

LASIKA

STHANA SAMSRAYA AND DUSHANA OF TWOK, RAKTA, MAMASA,

LASIKA

FIG. 1. SHOWING SAMPRAPTI OF KUSHTHA

SADHYASADHYATA OF KUSHTHA:

TABLE NO 19 SADHYASADHYATA OF KUSHTHA103,104,105

:

Sadhyasadhyata Ch. Sa. Su. Sa. A. H.

Asadhya Tridoshaja, Balarahita

Rogi, Trisha & Daha

Yukta, Shantaagni

Kushtha invading

Asthi, Majja and

Sukragata.

Tridoshaja and

Astimajjagata

Kustha Asadhya

Yapya Medogata Medogata

Krichhra Sadhya Kaphapittaja,

Vatapittaja Kushtha

Sadhya Vatakaphaj, When the rogi is Kaphaj,

KUSHTHA PRADURBHAVA



Psoriasis Page 37

Ekadoshaja Kushtha Jitendriya and

Kushtha

is invading Tvak,

Rakta

and Mamsa Dhatu.

dominant of

Vata, and

Ekadoshaja

CHIKITSA:

Chikitsa of Kushtha may be described under three headings- Shodhana, Shamana,

Nidana Parivarjana:

A. Shodhana Chikitsa:

A person having Kushtha Roga is called ‗Bahu Doshavan‘ because of vitiation

of Dosha in greater extent106

.

Kushtha is considered as a TridoshajaVyadhi106

and in Kushtha, Doshas are

‗Dirghakalanubandhi107

.

By nature, Kushtha is difficult to cure disease, so it is called ‗Duschikitsya108

.

But by the application of Shodhana therapy, cure of the disease becomes

easier due to removal of the root cause, hence Shodhana has great importance.

According to Acharya Charaka & Vagbhata Shodhana should be carried out

according to predominance of vitiated Dosha. For instance, in Vata dominance,

Ghritapana, in Kapha dominance, Vamana and in Pitta dominance,Virechana and

Raktamokshana are to be carried out. In excessive morbidity of the Doshas repeated

Shodhana should be performed at regular intervals. Sushruta has advised to carry out

‗Ubhayato Samsodhana‘ even at the Poorvaroopa condition of Kushtha.

B. Shamana Chikitsa: Shamana Chikitsa is very useful in those patients who are

unable to undergo or are contraindicated for Samshodhana. Acharya Charaka has

advised Shamana therapy with Tikta and Kashaya Dravyas after administration of



Psoriasis Page 38

proper Shodhana. Charaka has also indicated several other drugs & formulation of

Shamana therapy in 7th

chapter of Chikitsa Sthana109

.

- External application :

Kushtha, being exhibited through the skin, external application are also advocated.

For the external application drug should be applied after elimination of the Doshas

from the body by Shodhana Karma andRaktamokshana. Various forms of local

application are prescribed likeUdvartana, Pralepa, Parisheka, Abhyanga, etc. Kshara

Karma and Agadaprayoga are also prescribed in special condition of Kushtha.

C. Nidana Parivarjana: NidanaParivarjana stops the further progression of the

disease, by restricting vitiation of Doshas. Main etiological factors of Kushtha are

MithyaAhara-Vihara & Viruddha Ahara so they should be avoided.

PATHYAPATHYA:

PATHYA110

:

Ahara

Laghu Anna, TiktaShaka, PuranaDhanya, JangalaMamsa, MudgaPatola, Food

and Ghee prepared by Bhallataka, Triphala& Nimba, PuranaShali, Shashtika,

Yava, Godhuma, Kordusha, Shyamaka, Udaalaka: Mandukaparni, Bakuchi,

Atarushaka, Siddha Ghrita.

Vihara

Abhyanga with Karanja Taila, Utsadanam with AaragvadhadiKashaya, Pana,

Parisheka, Avagaha etc. with KhadiraKashaya.



Psoriasis Page 39

APATHYA110

:

Ahara

Guru Anna, Amla Rasa, Dugdha, Dadhi, Anupa Matsya, Guda, Tila, Mamsa,

Taila, Kulattha, Masha, Nishpava, Ikshupishta, Pishta-Vikara,

VirudhaBhojana, Adhyasana, Ajirnasana, Vidahi-AbhishyandiAhara.

Vihara

Divasvapna, Maithuna, Vegadharana, Paapkarma, Tapa Sevana, Svedana etc.



Psoriasis Page 40

PSORIASIS

ETYMOLOGY:

The word psoriasis is derived from the Greek word ‗Psora‘ and ‗iasis‘. ‗Psora‘ means

itch or scale and ‗iasis‘ means condition.

DEFINITION:

Psoriasis is a chronic inflammatory skin disorder clinically characterized by

erythematous, sharply demarcated papules and rounded plaques, covered by silvery

micaceous scale.

They vary in size from pinpoint to large plaques. At times, it may manifest as

localized or generalized pustular eruption111

.

EPIDEMIOLOGY:

Incidence and prevalence

In most reviews, the prevalence of psoriasis is said to be 2% of the world‘s

population112

. However, its prevalence in different populations varies from 0.1

percent to 11.8 percent, according to published reports. The incidence of the

disease has been estimated to be 60 individuals per 1, 00,000 per year. This study

also provided support for seasonal variation, with 68% of cases first diagnosed in

winter and spring months. The prevalence rate is estimated to be around 0.44% to

2.8% in India113

.

Racial and ethnic variation112

There are considerable racial variations with populations having a lower

prevalence of disease. In China, psoriasis is estimated to affect 0.3% of the

population, while the disease is very rare or nonexistent in Inuits, Latin American



Psoriasis Page 41

Indians or Samoans. Climate also appears to affect psoriasis prevalence, with

higher rates recorded in single countries at greater latitudes from the Equator.

Age of onset114

Psoriasis may begin at any age, but it is uncommon under the age of 10 years. It is

most likely to appear between the ages of 15 and 30 years.

Sex ratio115

Psoriasis is equally common in males and females.

ETIOLOGY:

A) Genetic predisposition: Studies have shown evidence that psoriasis has an

important genetic component. According to studies, about one out of three

people with psoriasis report having a relative with psoriasis116

. If one parent

has psoriasis, a child has about a 10% chance of having psoriasis, while if

both parents have psoriasis, a child has approximately 50% chance of

developing the disease116

.

B) Environmental / External risk factors117

: Many environmental factors

otherwise called ‗External triggers‘ have been linked to psoriasis, and have

been implicated in, for example, initiation of the disease process and

exacerbation of pre-existing disease. However, conclusive evidence is so far

lacking. External triggers are as follows:

1) Trauma

Psoriasis at the site of an injury is well known (Koebner phenomenon).

Koebner phenomenon is observed in approximately 25% of patients

with psoriasis. A wide range of injurious local stimuli, including

physical, chemical, electrical, surgical, and infective and inflammatory

insults, have been recognized to elicit psoriatic lesions.



Psoriasis Page 42

2) Infection

Acute guttate psoriasis is strongly associated with preceding or

concurrent streptococcal infection, particularly of the throat. As

mentioned earlier, guttate and chronic plaque psoriasis share strong

HLA associations, particularly with HLA-Cw6. HIV infection has also

been associated with psoriasis.

3) Drugs

There are many drugs reported to be responsible for the onset or

exacerbation of psoriasis. Chief amongst these are lithium salts,

antimalarials, beta-adrenergic blocking agents, non-steroidal anti

inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE)

inhibitors and the withdrawal of corticosteroids.

4) Climate

Most of the psoriasis patients state either first incidence of the disease

in winter or aggravation of disease in winter.

5) Light

Although sunlight is generally beneficial, in a small minority of

patients, psoriasis may be provoked by strong sunlight and cause

summer exacerbations in exposed skin. Rarely ultraviolet radiation

from the sun or from artificial source can worsen the condition. This

occurs in approximately 10% of cases.

6) Alcohol and Smoking

It has long been suspected that both cigarettes and alcohol have a

detrimental effect on psoriasis. Studies suggest that alcohol may

exacerbate pre-existing disease but does not appear to induce psoriasis.



Psoriasis Page 43

Excess drinking is undoubtedly also a consequence of the disease and

leads to treatment resistance and reduced therapeutic compliance.

C) Systemic triggering factors:

1) Endocrine factors117

:

Hypocalcemia has been reported to be a triggering factor for generalized pustular

psoriasis. Although active vitamin D3 analogues improve psoriasis, abnormal vitamin

D3 levels have not been shown to induce psoriasis. The early onset of psoriasis in

women, with a peak around puberty, changes during pregnancy and provocation of

psoriasis by high dose oestrogen therapy potentially indicates a role for hormonal

factors in the disease.

2) Metabolic factors:

Incomplete protein digestion and bowel toxaemia disturb the formation of cAMP and

therefore increasing the rate of cell proliferation.In patients with hypoparathyroidism

low serum calcium levels have been shown to exacerbate psoriasis.

3) Psychogenic Factors118

:

Psychogenic stress is a well-established systemic triggering factor in Psoriasis. It has

been associated with initial presentations of the disease as well as flares of pre-

existing psoriasis.

PATHOGENESIS OF PSORIASIS119,120

:

Components of Psoriatic Pathogenesis

Epidermal proliferation

A variety of techniques have demonstrated that the increased keratinocyte

proliferation observed in psoriasis is a consequence of an increase in the proliferating

cell compartment in the basal and supra basal levels of the epidermis, and not due to



Psoriasis Page 44

shortened cell cycle time. The number of cycling cells is increased approximately

sevenfold. Multiple growth factors, cytokines, which experimentally have been shown

to modulate keratinocyte proliferation, are present in lesional skin.

Vascular changes

Vertical dermal capillary loops in lesional skin are dilated, elongated and twisted.

Using various in vivo models of angiogenesis, it has been demonstrated that

epidermal keratinocytes are the primary source of angiogenicactivity. These cells

produce an array of soluble mediators with angiogenic activity including vascular

endothelial growth factor (VEGF). It is over-expressed in psoriatic epidermis as are

its receptors on lesional psoriatic microvasculature.

Immunology and inflammation

There is considerable evidence that T lymphocytes play an important role in

development of plaques of psoriasis. This includes:

(i) Early influx of T cells into expanding lesions

(ii) Strong association with the MHC, particularly HLA-Cw6

(iii) Ablative effect of anti-T-cell therapy

(iv) Increased antigen presentation in psoriatic plaques

(v) Anecdotal evidence of development of psoriasis after syngeneic bone

marrow transplant

(vi) Change in phenotype to lesional psoriatic skin in non-lesional psoriatic

skin transplanted on to severe combined immunodeficient mice and

injected with autologous T cells

Those T cells involved in psoriasis pathogenesis express markers of memory,

activation and skin homing (CLA).However, it is increasingly clear that the innate

immune system, which provides an early response.



Psoriasis Page 45

CLINICAL FEATURES OF PSORIASIS121,122

:

The classic lesion of psoriasis is a well-demarcated, raised, red plaque with a

white scaly surface. Lesions can vary in size from pinpoint papules to plaques that

cover large areas of the body. Under the scale, the skin has a glossy homogeneous

erythema, and bleeding points appear when the scale is removed, traumatizing the

dilated capillaries below (the Auspitz sign).

Koebner phenomenon (also known as the isomorphic response) is the traumatic

induction of psoriasis on nonlesional skin; it occurs more frequently during flares

of disease and is an all-or-none phenomenon (i.e., if psoriasis occurs at one site of

injury it will occur at all sites of injury). The Koebner phenomenon is not specific

for psoriasis but can be helpful in making the diagnosis when present.

CLINICAL PATTERNS OF SKIN PRESENTATION

1. Psoriasis vulgaris, chronic stationary psoriasis, plaque-type psoriasis

Psoriasis vulgaris is the most common form of psoriasis, seen in approximately 90

percent of patients. Red, scaly, symmetrically distributed plaques are

characteristically localized to the extensor aspects of the extremities, particularly the

elbows and knees, along with scalp, lower lumbosacral, buttocks, and genital

involvement. Other sites of predilection include the umbilicus and the intergluteal

cleft. Single small lesions may become confluent, forming plaques in which the

borders resemble a land map (psoriasis geographica). Lesions may extend laterally

and become circinate because of the confluence of several plaques (psoriasis gyrata).

Occasionally, there is partial central clearing, resulting in ring-like lesions (annular

psoriasis).



Psoriasis Page 46

2. Guttate (eruptive) psoriasis

Guttate psoriasis (from the Latin gutta, meaning ‗a drop‘) is characterized by eruption

of small (0.5 to 1.5 cm in diameter) papules over the upper trunk and proximal

extremities. It typically manifests at an early age and as such is found frequently in

young adults. This form of psoriasis has the strongest association to HLA-Cw6, and

streptococcal throat infection frequently precedes or is concomitant with the onset or

flare of guttate psoriasis. Patients with a history of chronic plaque psoriasis may

develop guttate lesions, with or without worsening of their chronic plaques.

3. Erythrodermic psoriasis

Psoriatic erythroderma represents the generalized form of the disease that affects all

body sites, including the face, hands, feet, nails, trunk, and extremities. Although all

the symptoms of psoriasis are present, erythema is the most prominent feature, and

scaling is different compared with chronic stationary psoriasis. Instead of thick,

adherent, white scale there is superficial scaling. Patients with erythrodermic psoriasis

lose excessive heat because of generalized vasodilatation, and this may cause

hypothermia. Patients may shiver in an attempt to raise their body temperature.

Psoriatic erythroderma has a variable presentation, but two forms are thought to exist.

In the first form, chronic plaque psoriasis may worsen to involve most or the entire

skin surface, and patients remain relative responsive to therapy. In the second form,

generalized erythroderma may present suddenly and unexpectedly or result from non-

tolerated external treatment (e.g., UVB, anthralin), thus representing a generalized

Koebner reaction.



Psoriasis Page 47

4. Pustular psoriasis

Several clinical variants of pustular psoriasis exist: generalized pustular psoriasis (von

Zumbusch type), annular pustular psoriasis, impetigo herpetiformis, and two variants

of localized pustular psoriasis—pustulosispalmarisetplantaris and acrodermatitis

continua. In children, pustular psoriasis can be complicated by sterile, lytic lesions of

bones and can be a manifestation of the SAPHO syndrome (synovitis, acne,

pustulosis, hyperostosis, osteitis).

A. Generalized pustular psoriasis (Von Zumbusch)

Generalized pustular psoriasis (Von Zumbusch) is a distinctive acute variant of

psoriasis. It is usually preceded by other forms of the disease. Attacks are

characterized by fever that lasts several days and a sudden generalized eruption

of sterile pustules 2 to 3 mm in diameter. The pustules are disseminated over the

trunk and extremities, including the nail beds, palms, and soles. The pustules

usually arise on highly erythematous skin, first as patches and then becoming

confluent as the disease becomes more severe. Characteristically, the disease

occurs in waves of fevers and pustules. Cases of acute respiratory distress

syndrome associated with generalized pustular psoriasis have been reported.

B. Exanthematic Pustular Psoriasis

Exanthematic pustular psoriasis tends to occur after a viral infection and consists

of widespread pustules with generalized plaque psoriasis. However, unlike the

von Zumbusch pattern, there are no constitutional symptoms, and the disorder

tends not to recur.

C. Annular Pustular Psoriasis.

Annular pustular psoriasis is a rare variant of pustular psoriasis. It usually

presents in an annular or circinate form. Lesions may appear at the onset of



Psoriasis Page 48

pustular psoriasis, with a tendency to spread and form enlarged rings, or they

may develop during the course of generalized pustular psoriasis. There is

usually no personal or family history of psoriasis.

5. Inverse psoriasis

Psoriasis lesions may be localized in the major skin folds, such as the axillae, the

genito-crural region, and the neck. Scaling is usually minimal or absent, and the

lesions show a glossy sharply demarcated erythema, which is often localized to areas

of skin-to-skin contact. Sweating is impaired in affected areas.

6. Sebo psoriasis

A common clinical entity, sebopsoriasis presents with erythematous plaques with

greasy scales localized to seborrheic areas (scalp, glabella, nasolabial folds, perioral

and presternal areas, and intertriginous areas). In the absence of typical findings of

psoriasis elsewhere, distinction from seborrheic dermatitis is difficult. Sebopsoriasis

may represent a modification of seborrheic dermatitis by the genetic background of

psoriasis and is relatively resistant to treatment.

7. Psoriasis of the scalp

The scalp is a favored site for psoriasis and may be the only site affected. Plaques are

similar to those of the skin except that the scale is more readily retained; it is anchored

by hair. Extension of the plaques onto the forehead is relatively common. A dense,

tight-feeling scale can cover the entire scalp. Even in the most severe cases, the hair is

not permanently lost.

8. Psoriasis of the palms and soles

The palms and soles may be involved as part of a generalized eruption, or they may

be the only locations involved in the manifestation of the disease. There are several



Psoriasis Page 49

presentations. Superficial red plaques with thick brown scale may be indistinguishable

from chronic eczema. Smooth, deep red plaques are similar to those found in the

flexural area.

9. Psoriasis of the nails

Nail changes are characteristic of psoriasis offer supporting evidence for the diagnosis

of psoriasis when skin changes are equivocal or absent.

Onycholysis.

Psoriasis of the nail bed causes separation of the nail from the nail bed. Unlike the

uniform separation caused by pressure on the tips of long nails, the nail detaches in an

irregular manner. The nail plate turns yellow, simulating a fungal infection.

Pitting.

Nail pitting is the best known and possibly the most frequent psoriatic nail

abnormality. Nail plate cells are shed in much the same way as psoriatic scale is shed,

leaving a variable number of tiny, punched-out depressions on the nail plate surface.

Nail deformity

Extensive involvement of the nail matrix results in a nail losing its structural integrity,

resulting in fragmentation and crumbling.

PSORIATIC ARTHRITIS123

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy of the peripheral joints,

spine, and enthuses. It may precede, accompany, or, more often, follow the skin

manifestations. Onset may occur at any age, but peak occurrence is between ages 20

and 40; women and men are equally affected. Symmetric polyarthritis with joint pain

and joint swelling often indicates erosive progressive disease. Unlike in rheumatoid



Psoriasis Page 50

arthritis, the distal interphalangeal joints are regularly involved. The presence of

inflammatory arthritis in patients with psoriasis varies between 5% and 42%.

Approximately 15% of patients with PsA have an onset of arthritis before the onset of

psoriasis. The prevalence of psoriatic arthritis is higher among patients with more

severe cutaneous disease.

Despite active treatment and a reduction in joint inflammation and the rate of damage,

psoriatic arthritis may be a progressively deforming arthritis.

Clinical features.

The most common pattern is an asymmetric arthritis involving one or more joints of

the fingers and toes. Usually one or more proximal interphalangeal (PIP), distal

interphalangeal (DIP), metatarsophalangeal, or metacarpophalangeal joints are

involved. During the acute phase, the joint is red, warm, and painful. Continued

inflammation promotes soft tissue swelling on either side of the joint (―sausage

finger‖) and restricts mobility. HLA-DR7 is significantly increased in this group with

peripheral arthritis.

COMPLICATIONS OF PSORIASIS124

Patients with psoriasis have an increased morbidity and mortality from

cardiovascular events, particularly those with severe and long duration of

psoriasis. Risk of myocardial infarction is particularly elevated in younger

patients with severe psoriasis.

Psoriasis patients have also been shown to have increased relative risk of

lymphoma, particularly in patients with more severe disease.

Psoriasis is emotionally disabling, carrying with it significant psychosocial

difficulties. Emotional difficulties arise from concerns about appearance,



Psoriasis Page 51

resulting in lowered self-esteem, social rejection, guilt, embarrassment,

emptiness, sexual problems, and impairment of professional ability. The

presence of pruritus and pain can aggravate these symptoms. Psychological

aspects can modify the course of illness; in particular, feeling stigmatized can

lead to treatment noncompliance and worsening of psoriasis. Likewise,

psychological stress can also lead to depression and anxiety. According to a

recent survey, 79 percent of patients with severe psoriasis reported a negative

impact on their lives.



Psoriasis Page 52

DRUG REVIEW

Drug has an important role amongst Chikitsa Chatushpada, so, it is placed next to the

part of physician. The selection of a proper drug in the management of a disease is

very important. Because, without proper planning of the drugs, Chikitsa is not going

to yield proper results. In Ayurvedic classics specific formulations are advocated for

particular disease.

Drugs used for present study

1) Drugs for Pachana Deepana

2) Drugs used for Snehapana

3) Drugs used for Swedana Karma

4) Drug used for Virechana Karma- Hridya Virechana Leha

DRUG USED FOR PACHANA-DEEPANA:

Shunthi Qwatha

SHUNTHI125

:

Botanical Name: Zingiber officinale

Family: Zingiberaceae

Gana: Triptighna, Arshoghna, Deeepaneeya, Shoolaprashamana,Trishnanigrahana (A.

Charaka); Pippalyadi Gana, Trikatu (A. Susruta)

Chemical composition: water 10.9%, protein 15.4%, Starch 5.3%, Total Ash 6.6%,

Volatile oil1-2.7%; Zingiberine, Zingiberol, Oleoresin-Gingerin, Gingerol, Shogaol,

Zingerone

Guna: Laghu, Snigdha; (Guru, Ruksha, Tikshna-Ardaka)

Rasa: Katu

Vipaka: Madhura; (Katu-Ardraka)

Virya: Ushna



Psoriasis Page 53

Dhoshaghnata: Kapha Vata Samaka

Action on Digestive System: Triptighna, Rochana, Deepana, Pachana, Vatanulomana,

Shoolaprashamana, Arshoghna

Action on Cardiovascular System: Shothahara, Raktashodhaka

Satmikarana: Aamapachana, Srotoshodhaka

Parts used: Rizome (Kanda)

ABHYANTARA SNEHANA:

MoorchhitaTila Taila

Preparation of Moorchhita Tila Taila has been described in Jwara chapter in Bhaisajya

Ratnavali126

.

Ingredients:

Tila Taila : 1 part (400 ml)

Manjishta : 1/16 part (25 gm)

Haridra : 1/64 part (6.25gm)

Lodhra : 1/64 part (6.25gm)

Musta : 1/64 part (6.25gm)

Nalika : 1/64 part (6.25gm)

Amalaki : 1/64 part (6.25gm)

Haritaki : 1/64 part (6.25gm)

Vibhitaki : 1/64 part (6.25gm)

Suchipushpa : 1/64 part (6.25gm)

Vatankura : 1/64 part (6.25gm)

Hribera : 1/64 part (6.25gm)

Water : 4 parts(1600ml)



Psoriasis Page 54

Procedure:

Tila Taila is taken in a clean wide mouthed iron vessel. It is heated until frothing

subsides. Then it is taken out of fire and allowed to self-cool. Then fine powder of the

herbal ingredients is taken and prepared fine paste adding little water. This paste is

added to the oil. Water is added, and started heating, until the oil part only remains.

The final product obtained is the Moorchhita Tila Taila.

Table No. 20. Rasapanchaka of ingredients of Moorchhita Tila Taila:

Drug Latin

name Rasa Guna Virya Vipaka

Doshagh-

nata Karma

Tila Sesamum

indicum

Madhura,

Kashaya,

Tikta

Guru

Snigdha Ushna

Madhu

ra Vatahara

Twachya

Balya

Shukrala

Manjishta Rubia

cordifolia

Madhura,

Tikta

Guru

Ruksha Ushna Katu

Kaphapitt

ahara

Varnya

Vishaghna

Lodhra Symplocos

racemosa

Kashaya,

Tikta

Laghu,

Ruksha Sheeta Katu

Kaphapitt

ahara

Grahi

Chakshushya

Musta Cyperus

rotundus

Tikta,

Katu

Laghu,

Ruksha Sheeta Katu

Kapha

Pitta

Shamaka

Pachaka

Amalaki Emblica

officinalis

Lavana-

Rahita-

Pancha-

Rasa

Snigha,

Laghu Sheeta

Madhu

ra

Tridosha

ghna Rasayana

Haritaki Terminalia

chebula

Lavana-

Rahita-

Pancha-

Rasa

Ruksha,

Laghu,

Ushna

Ushna Madhu

ra

Tridosha

ghna Rasayana

Bibhitaki Terminalia

belerica Kashaya

Laghu,

Ruksha

Ushna Madhu

ra

Kapha

pittaghna Rasayana



Psoriasis Page 55

Suchee

pushpa

Pandanus

odorotissimus

Tikta,

Madhura,

Katu

Laghu,

Snigdha Ushna Katu

Tridosha

Samaka

Katu

Paushtika

Vatankura Ficus

bengalensis Kashaya

Guru,

Ruksha Sheeta Katu

Kapha

pittahara

Varnya

sthambhana

Hribera Coleus

zeylanicus Tikta

Laghu,

Ruksha Sheeta

Madhu

ara

Kapha

Pitta

Shamaka

Balya,

Shukrala,

Pachaka

After Moorchana, Aamadosha of Tila Taila will be alleviated, and the Taila becomes

orange-tinged yellow, clear, and devoid of unpleasant smell126

. Tila Taila is

Yogavahi, after Dravyantara by Samyoga and Samskara, it becomes

Tridoshasamaka127

; and since it has Snigdha Guna predominance, and is indicated in

Twachagata Vikara127

, it can be used as a suitable Snaihika Dravya for Snehapana in

Twakgata Vikara, ie. Kushtha. Acharya Charaka has told one of the Guna of Tila as

Twachya128

, while Acarya Susruta also has mentioned Twachya as one of the

properties of Tila129

.

DRUG USED FOR SWEDANA:

Karanja Qwatha Pariseka

Karanja has been mentioned almost by every Acharya in the use of Kushtha. It is also

indicated in Raktavikara, Shotha, Aamavata etc. Kushtha, being a disease where

Rakta is invariably involved and Pitta is also involved (as Kushtha is Tridoshaja

Vyadhi, though Pitta may be in different Doshic proportionas per type of Kushtha), in

such Vyadhis, where Rakta and Pitta are involved, Achrya Susruta has advised to go

for Drava variety of Sweda, which is again of two variety- Pariseka and Avagaha.

Here, Pariseka with Karanja Qwatha is selected.



Psoriasis Page 56

Karanja130

:

Botanical Name: Pongamia pinnata

Family: Leguminaceae

Gana: Kandughna, Virechana, Katuskandha, Tiktaskandha (A. Charaka);

Aaragvadhadi Gana, Varunadi, Shyamadi, Shirovirechana, Kaphasamshamana (A.

Susruta)

Guna: Laghu, Tikshana

Rasa: Tikta, Katu, Kashaya

Vipaka: Katu

Virya: Ushna

Doshaghnata: Kaphavata Samaka

Parts used: Twak, Patra, Beeja (For Pariseka, Patra generally used)

Chemical composition: Karanjin, Pongamin, Pongamia oil, Pongamol

Systemic action (External): Bark and Leaves- Jantughna, Kandughna, and Shothahara

Integumentary System: Kushthaghna

Cardiovascular System: Raktashodhaka, Shothahara

DRUG USED FOR VIRECHANA:

Hridya Virechana Leha

―Hridya‖ means palatable or that is favorable for a person to take. Hridya Virechana

Leha is a preparation in which Trivrit is predominant, and Trivrit is considered as one

among the Shrestha Dravyas to cause Rechana. Hridya Virechana Leha is described

as one of the favourable preparations for Virechana.

Ingredients of Hridya Virechana Leha131

:

a. Trivrit

b. Sita



Psoriasis Page 57

c. Trijata (Twok, Ela, Patra)

d. Madhu

a. Trivrit:

Botanical Name : Operculina turpethum

Family : Convolvulaceae

Pharmacodynamics

Rasa : Tikta, Katu

Guna : Laghu, Ruksha, Tikshna

Virya : Ushna

Vipaka : Katu

Parts used : Moolatwak

Doshaghnata : KaphaPitta Samshodhana

Karma: It does Bhedana and Rechana. It is one of the best drugs for Sukha

Virechana. It has uses in Aanaha, Vibandha, Arsha, Kamala, Shotharoga, Udara Roga,

Vatarakta etc. Acharya Charaka has considered Trivrit as a Shreshtha Virechana

dravya (Cha. Ka. 6/3).

Chemical Composition: Root bark has glycoside up to 10%, and it is odorless, bitter,

and pungent; it contains Turpethin- a glucoside, which is the main component to

cause Rechana. Similarly, it also contains 2 more glycosides, and volatile oil.

b. Sita132

:

- Sumadhura

- Roochyaa

- Vata Piita Daha Shmaka

- Raktavikara Shamaka



Psoriasis Page 58

- Alleviates Moorchha, Chhardi, Jwara, Sheeta

- Shukrakara

c. Trijata (Twak, Ela, Patra)

Trijata is a mixture of Twak, Ela and Patra in equal quantity. It is also called as

Trisugandhi. It is Hridya, Rochana, Rooksha, Tikshna, Ushna,

Mookhadoorgandhahrita, Laghu, Agnivardhaka, and mitigates Kapha Vata and

alleviates poison133

.

1. Twok:

Botanical Name : Cinnamomuma verum

Family : Lauraceae

Pharmacodynamics

Rasa : Katu, Tikta, Madhura


Virya : Ushna

Vipaka : Katu

Parts used : Twok, Taila, Patra

Doshaghnata : Vatakapha Shamaka

Karma:-

Gastrointestinal System: Deepana, Pachana, Vatanulomana, Yakrttottejaka, Grahi,

Jantughna

Cardiovascular System: Hridayottejaka, Ojovardhaka, Raktashodhaka

Respiratory System: Shlesmahara and Yakshmanashaka

Urinary System: Mutrajanana



Psoriasis Page 59

Chemical Composition: Bark has an oil1/2-1%, which contains Cinnamaldehyde 50-

65% and Eugenol 60-75%. Leaf contains oil thathasEugenol 70-95%. Rootbark has

3% colourless oil; Seed has 33% fixed oil.

2. Ela:

Botanical Name : Elettaria cardamomum

Family : Zingiberaceae

Pharmacodynamics

Rasa : Katu, Madhura

Guna : Laghu, Rooksha

Virya : Sheeta

Vipaka : Madhura

Parts used : Veeja

Doshaghnata : Tridoshahara (Guna and Rasa- Kaphahara, Vipaka-Vata Shamaka,

Virya-Pitta Samaka)

Karma:-

Gastrointestinal System: Mukhashodhana, DUrgandhanashana, Chhardinigrahana,

Trishnanigrahana, Rochana, Deepana, Pachana, Anulomana

Cardiovascular System: Hridya

Satmikarana: Balya

Chemical Composition: Seeds have : volatile oil 2-8%, Potassium salt 3%, Starch

3%, Slimy substance 2%, Ash 6-10%, which contains Manganese. Oil has Cineol,

Terpineol, Terpinene, Limonene and Sabinene.



Psoriasis Page 60

3. Patra:

Botanical Name : Cinnamomum tamala

Family : Lauraceae

Pharmacodynamics

Rasa : Katu, Tikta, Madhura


Virya : Ushna

Vipaka : Katu

Parts used : Twok, Taila, Patra

Doshaghnata : Vatakapha Shamaka

Karma:-

Gastrointestinal System: Deepana, Pachana, Vatanulomana, Yakrttottejaka, Grahi,

Jantughna

Cardiovascular System: Hridayottejaka, Ojovardhaka, Raktashodhaka

Respiratory System: Shlesmahara and Yakshmanashaka

Urinary System: Mutrajanana

Chemical Composition: Leaves contain dark brown coloured odourous 1% oil,

which contains Eugenol-70-95%. Rootbark has 3% odourous oil, while seeds contain

33% fixed oil.

d. Madhu :

As told by Acharya Charaka134

:

Rasa : Kashaya, Madhura

Guna : Rooksha, Guru

Virya : Sheeta



Psoriasis Page 61

Karma : Vatala, Raktapittahara, Kaphahara, Sandhaneeya, Chedana

According to Acharya Susruta, Madhu is Tridhosha Shamaka135

. Nava Madhu is

Brimhaneeya, Ishat Kaphaghna, and Sara, while Purana Madhu is Atilekhana, Grahi,

Medohara, and Sthoulyanashaka. Madhu is Uttama Yogavahi, so is useful in different

preparations, in different diseases.

Chemical Composition: It is a viscous fluid with specific gravity 1.359-1.361. Is

97% sweet when compared to Sucrose. Contains moisture 12-24%, Dextrose 26-36%,

Laevulose 30-44%, Sucrose 0.4-6%, Dextrin and gum 0.7%. Contains Vitamin B and

C.

Method of preparation:

One Tula (400 Tola) of Trivrit Churna is taken, and added to 1 Vaha Jala (4096 Tola

or 49.152 litre), and boiled and reduced to 12.288 liter. And then filtered. To it, added

40 Pala (160 Tola) of Sita or Sugar candy, and heated until semisolid consistency is

obtained. Then 2 Kudava (16 Tola or 192 gm) each of Twok, Ela, and Patra should be

added along with 80 Tola of Madhu.136

Methodology


Psoriasis Page 62

METHODOLOGY

Kushtha is a Tridoshaja Vyadhi137

, in which Virechana Karma is presented as a prime

modality of treatment. And, Hridya Virechana Leha is a preparation of Trivrit, which

itself is considered as the best Virechana Dravya. This clinical Study was under taken

to assess the efficacy of Virechana performed with Hridya Virechana Leha in the

management of Psoriasis.

Objective of study

To evaluate the efficacy of Virechana Karma with Hridya Virechana Leha in

Psoriasis.

Source of data

Minimum of 20 patients diagnosed as Psoriasis will be selected for study from

IPD/OPD of S.D.M. Ayurveda Hospital Kuthpady, Udupi.

Diagnostic Criteria

1. The clinical signs and symptoms of Psoriasis like Itching, Scaling and

Erythema.

2. Positive Auspitz Sign, and Candle Grease Sign

a. Auspitz Sign

This sign occurs in psoriasis. There is a classical silvery white scaling and when

hyperkeratosis scales are mechanically removed from a psoriatic plaque by

scratching, within a few minutes, small blood droplets appear on erythematous

surface. This phenomenon is called Auspitz Sign.

Methodology


Psoriasis Page 63

b. Candle Grease Sign

When a psoriatic lesion is scratched with the point of a dissecting forceps, a

candle- grease-like scale can be repeatedly produced even from the non-scaling

lesions. This is called the Candle Grease Sign.

Inclusion Criteria:

1. Patients with signs and symptoms of Psoriasis.

2. Patients of either sex of age group between 16-70 years.

3. Patients fit for Virechana Karma.

Exclusion Criteria:

1. Patients suffering from other Systemic disorders.

2. Severely ill patients with weight loss

Assessment Criteria

1. PASI (Psoriasis area and severity index)

2. 5 D ITCH SCORE

Investigations

To evaluate the other pathologies and to avoid possible complications during

Virechana, the following laboratory investigations are carried out.

Hematological examination :

- Hb%, TLC, DLC, ESR, Blood Sugar

Skin Biopsy if required

Study design:

It is an open clinical study with pre-test and post-test design; where in minimum

of 20 patients diagnosed with Psoriasis of either sex with the age group between 16-

Methodology


Psoriasis Page 64

70 years will be selected. All patients fulfilling the inclusion criteria will be subjected

to Virechana Karma.

INTERVENTION

1. POORVA KARMA

A. Deepana Pachana with Shunthi Qwatha.

20 ml thrice in a day is given to the patient until Agnivriddhi and Ama

Pachana take place.

B. Snehapana with Moorchhita Tila Taila

I. Method of Snehapana:

The patients were given with Arohanakrama Snehapana starting with 25 ml

around 6.30 am (immediately after sun rise) with Ushnajala as Anupana.

It was gradually increased according to the symptoms present in the patient

(time taken to digest Sneha).

Maximum emphasis was given for attainment of Samyaksnigdha Lakshanas

and was recorded accordingly.

Patients were advised to avoid excessive wind, sunlight, emotional

exacerbations, heavy work, day sleep, sitting in the same posture, excessive

talking, standing.

Patients were advised to take the rice gruel when they would feel strong

sensation of hunger in the afternoon and in the evening.

Patients were advised to take lukewarm water frequently (whenever they felt

thirsty).

On the achievement of Samyaksnigdha symptoms, administration of ghee was

stopped.

Methodology


Psoriasis Page 65

I. Duration of Snehapana:

Snehapana was advised till patient exhibited Samyaksnigdha Lakshanas.

(Minimum 3 days – Maximum 7 days).

II. Assessment of Snehana attainment (by Snehapana):

1. Dose and Duration (for Snehajeernata):

Snehamatra

Time of Sneha administration

Time of onset and duration of Snehajeeryamana lakshnas

Time of appearance of Snehajeerna lakshanas.

2. Samyaksnigdha Lakshana:

Vatanulomana- Assessed by the normal expulsion of the flatus, faeces and

urine.

Deeptagni- Based on the time of feeling of hunger, and Matra of Sneha

Asamhata Varchas- Based on the loose consistency of the faeces.

Snigdha Varchas- Confirmed by greasy/ sticky/ pasted-like stool, floating

of faeces over water.

Twaka snigdhata- Assessed by comparing the touch, texture and also

luster of the skin before, during and after Snehapana.

Glani- It was assessed by presence of exhaustion / fatigue / debility.

Anga Laghava- By enquiring with the patient.

Snehodhvega- Confirmed by the presence of aversion towards Sneha.

Overall assessment of Samyaksnigdha Lakshana was done based on the

percentage of manifestation of Samyaksnigdha Lakshanas.

Methodology


Psoriasis Page 66

C. Pariseka with Karanja Qwatha

a. Pariseka Method

The patient was subjected to Pariseka with Karanja Qwatha for 4 days, ie. in 3

gap days after stoppage of Snehapana, and on the day of Virechana, at

morning time.

b. Duration of Parisheka

Pariseka was administered to the patient until s/he got Samyak Swinna

Lakshanas, but care was taken so as not to give for more time.

c. Assessment of Swedana

Swedana was assessed based upon Samyak Swinna Lakshana viz

Sheetovyuparama, Shoolovyuparama, Stambhanigraha, Gauravanigraha,

Mardavata, Swedapradurbhava, Viratirmataha, and Laghuta.

Importance of 3 Days Gap: After completion of Snehapana, 3 days gap was given

before the administration of Virechana, in order to bring Kapha to Manda stage.

Because since Sneha and Kapha have similar Gunas, Sneha administered as Purva

Karma increases Kapha. And in state of increased Kapha, if Virechana is

administered, there is possibility that Kapha covers the Grahani, and conditions like

Pravahika, Gaurava and Grahani may develop and even Vamana may happen instead

of Virechana, since there is Kapha Utkleshavastha. Hence, for Kapha Shamana, three

days’ time gap is helpful. Thereafter, the process of Virechana can be carried out.

Virechana Aushadhi also should be administered after passing of Kapha Kala.138

2. PRADHANA KARMA

After the Karanja Qwatha Pariseka followed by Ushna Jala Snana in the morning,

the patient was administered with Hridya Virechana Leha at around 9.30 am, with

Methodology


Psoriasis Page 67

Anupana of milk. Dose was decided on the basis of Koshtha, Agni of the patient

as well as Rga Bala and Rogi Bala. Based upon the Shuddhi, Samsarjana Krama

was advised.

ASSESSMENT CRITERIA FOR VIRECHANA

Criteria for assessment:

1. Number of Vegas: Number of Vegas of each patient was recorded. (Calculation of

Vegas was done leaving first 2 Mala Vegas).

2. Time of administration of drug and time of onset of first Virechana Vega were

noted. Latency was calculated by subtracting time of onset of first Vega from the

time of administration of drug.

3. Time of last Vega was noted and duration of Virechana was calculated by

subtracting the time of last Vega from the time of onset of Vega.

4. Laingiki Shuddhi:

The main 8 Laingiki subjective and objective Lakshanas were observed, viz. Vit

Pitta Kapha Kramatha, Vatanulomana, Anamayatva, Sharira Laghuta, Indriya

Prasada, Sroto Shuddhi, absence of Ayoga Lakshanas, and Agni Dipti.

5. Antiki Lakshanas :

Antiki Lakshanas were assessed based on the features exhibited at the last Vega

i.e. Malanta, Pittanta and Kaphanta.

6. Maniki Lakshanas :

In the present study, during each time of defecation, urine and stool was collected

and then measured separately. This was performed excluding first and second Vega.

Then finally the value of total quantity of stool and urine added to obtain total

amount of output. Apart from this total amount of water consumed by patient after

passing each Vega was documented and it was consider as total amount of input.

Methodology


Psoriasis Page 68

Afterwards difference between total amount of output and input was calculated and

documented as Maniki feature in terms of mililitres.

Criteria for the assessment of Psoriasis

(a) Itching

Itching was assessed with 5 D itch score.

5 d itch score.

5 d itch score is a measure of pruritus. The 5-D itch scale was developed as a

brief but multidimensional questionnaire designed to be useful as an outcome

measure in clinical trials. The five dimensions are degree, duration, direction,

disability and distribution.

Scoring

There will be 1 question covering one domain with the scoring from 1 to 5. So 5-D

scores can potentially range between 5 (no pruritus) and 25(most severe pruritus).

Single-item domain scores (duration, degree and direction) are equal to the value

indicated below the response choice (range 1–5).The disability domain includes

four items that assess the impact of itching on daily activities: sleep, leisure/social

activities, housework and work/school. The score for the disability domain is

achieved by taking the highest score on any of the four items. For the distribution

domain, the number of affected body parts is tallied (potential sum 0–16) and the

sum is sorted into five scoring bins: sum of 0–2 = score of 1, sum of 3–5 = score of

2, sum of 6–10 = score of 3, sum of 11–13 = score of 4, and sum of 14–16 = score

of 5. In present study, 5 d itch score was taken before Snehapana begins, after

Virechana and after 7th

day of Samsarjana Krama.

Methodology


Psoriasis Page 69

(b) Psoriasis Area and Severity Index (PASI)

A patient’s P.A.S.I. is measure of overall Psoriasis severity and coverage, which is

commonly used measure in clinical trials for Psoriasis treatment. PASI was

calculated before and after the treatment period in order to determine how well

psoriasis responds to the treatment under trial.

FOLLOW-UP STUDY:

The patient is asked to come for follow up after 7 days after the Samsarjana Krama is

over.

Results


Psoriasis Page 70

OBSERVATIONS AND RESULTS

In this clinical study, 25 patients of psoriasis were registered and subjected to

Virechana Karma. Observations were made before and after the treatment.

Total Number of Patients Registered for the clinical study: 25

Total Number of Patients that completed the clinical study: 25

Number of dropouts: 0

A. EPIDEMIOLOGICAL OBSERVATIONS:

1. Age:

In this study, maximum number of patients belonged to the age group 51-60 years, i.e.

36% (9), followed by 28% (7) to age group 31-40 years. It was followed by 24% (6)

to age group 41-50, while there were 8% (2) in age group 21-30 and one patient (4%)

was of age group 61-70. The details are presented below in Table No. 21 and Figure

No. 2.

Table No. 21. Age wise Distribution of Patients

Age (in years) No. of Patients Percentage

21-30 2 8

31-40 7 28

41-50 6 24

51-60 9 36

61-70 1 4

Total 25 100

Results


Psoriasis Page 71

Fig. No. 2 Age wise Distribution of patients

2. Sex:

Among 25 patients in this study, 88% (22) were male while 12% (3) were female. The

same is presented below in Table No. 22 and Fig. No. 3:

Table No. 22 Showing Sex Distribution

Sex No. of Patients Percentage

Male 22 88

Female 3 12

Total 25 100

Fig. No. 3 Showing Sex Distribution

0

5

10

15

20

25

30

35

40

21-30 31-40 41-50 51-60 61-70

No. of Patients

Percentage

0

10

20

30

40

50

60

70

80

90

Male Female

No. of Patients

Percentage

Results


Psoriasis Page 72

3. Religion:

In this study, out of 25 patients, 92% (23) were Hindu, while 8% (2) were Christians.

The details are elaborated in Table No. 23 and Fig. No. 4.

Table No. 23 Showing patients’ distribution according to Religion

Religion No. of Patients Percentage

Hindu 23 92

Christian 2 8

Muslim 0 0

Total 25 100

Fig No. 4 Showing patients’ distribution according to Religion

4. Education:

In this study, out of 25 patients, 52% (13) had completed graduation, while 28% (7)

had completed their high school. Similarly, 12% (3) had done post-graduation, while

8% (2) were only literate. The details are shown below:

0

10

20

30

40

50

60

70

80

90

100

Hindu Christian Muslim

No. of Patients

Percentage

Results


Psoriasis Page 73

Table No. 24 Distribution of patients based on their Education

Education No. of Patients Percentage

Illiterate 0 0

Literate 2 8

High School 7 28

Graduate 13 52

Post graduate 3 12

Total 25 100

Fig. No. 5 Distribution of Patients based on their Education

5. Marital Status:

Out of 30 patients, 92% (23) were married, while 8% (2) were unmarried. The same is

shown below in Table No. 25 and Fig. No. 5:

Table No. 25. Distribution according to Marital Status

Marital Status No. of Patients Percentage

Married 23 92

Unmarried 2 8

Total 25 100

0

10

20

30

40

50

60

No. of Patients

Percentage

Results


Psoriasis Page 74

Fig. No. 6 Distribution according to Marital Status

6. Socioeconomic Status:

Out of 25 patients in the study, 52% (13) belonged to middle- class family, while 40%

(25) belonged to lower class family, and 8% (2) belonged to upper class family. This

is shown in Table No. 25 and Fig No. 6 as:

Table No. 26 Distribution of patients according to Socio-economic Status

Socio-economic Status No. of Patients Percentage

Upper class 2 8

Middle class 13 52

Lower class 10 40

Total 25 100

Fig. No. 7 Distribution of patients according to Socio-economic Status

0

20

40

60

80

100

Married Unmarried

No. of Patients

Percentage

0

10

20

30

40

50

60

Upper

class

Middle

class

Lower

class

No. of Patients

Percentage

Results


Psoriasis Page 75

7. Occupation:

In the study, 44% (11) were professionals of different field, 24% (6) were manual

labourers, 20% (5) were having business, 8% (2) were housewives, and 4% (1) was

student. It is depicted in the Table No. 27 and Fig. No. 8.

Table No. 27 Distribution of patients according to Occupation

Occupation No. of Patients Percentage

Housewife 2 8

Student 1 4

Business 5 20

Manual Labour 6 24

Professionals 11 44

Total 25 100

Fig. No. 8 Distribution of patients according to Occupation

8. Desha:

In the study, 56% (14) of the patients belonged to Shadharana Desha, while 36% (9)

patients belonged to Anoopa Desha, and 8% (2) patients belonged to Jangala Desha,

which is presented below in Table No. 28, and Fig. No. 9:

05

1015202530354045

No. of Patients

Percentage

Results


Psoriasis Page 76

Table No. 28 Distribution according to Desha

Desha No. of Patients Percentage

Sadharana 14 56

Jangala 2 8

Anoopa 9 36

Total 25 100

Fig. No. 9 Distribution according to Desha

OBSERVATIONS FROM THE HISTORY:

1. Age of onset:

In the present study, out of 25 patients, regarding age of onset, 24% (6) patients each

were there in the age group 21-30, 31-40 and 41-50 years. It is elaborated in the Table

No. 29 and Fig. No. 10.

Table No. 29 Distribution according to Age of Onset

Age of onset No. of Patients Percentage

11-20 5 20

21-30 6 24

31-40 6 24

41-50 6 24

51-60 2 8

Total 25 100

0

10

20

30

40

50

60

Sadharana Jangala Anupa

No. of Patients

Percentage

Results


Psoriasis Page 77

Fig. No. 10 Distribution according to Age of Onset

2. Chronicity of Disease:

In the present study, out of 25 patients, 60% (15) patients had had the disease started

within last 10 years, 24% (6) had had the disease from 11-20 years, 8% (2) from 21-

30 years. And 8% (2) had had the history of disease from 41-50 years. The details are

depicted below in Table No. 30 and Fig. No. 11.

Table No. 30 Distribution according to Chronicity of Disease

Chronicity of disease (in years) No. of Patients Percentage

0-10 15 60

11-20 6 24

21-30 2 8

31-40 0 0

41-50 2 8

Total 25 100

0

5

10

15

20

25

11-20 21-30 31-40 41-50 51-60

No. of Patients

Percentage

Results


Psoriasis Page 78

Fig. No. 11 Distribution according to Chronicity of Disease

3. Aggravating factors:

In the present study, out of 25 patients, 48% (12) reported cold as an important

aggravating factor, while 24% (6) said stress was aggravating factor. Similarly, 12%

(3) considered pollution/dust as the same, while Non-vegetarian diet and exposure to

sunlight was considered as the aggravating factor by 8% (2) each. It is shown below

in Table No. 31 and Fig No. 12.

Table No. 31 Distribution according to Aggravating factors

Aggravating Factors No. of Patients Percentage

Cold 12 48

Non Veg 2 8

Stress 6 24

Pollution/Dust 3 12

Exposure to Sunlight 2 8

Total 25 100

0

10

20

30

40

50

60

0-10 11-20 21-30 31-40 41-50

No. of Patients

Percentage

Results


Psoriasis Page 79

Fig. No. 12 Distribution according to Aggravating factors

4. Relieving Factors:

Out of 25 patients, 52% (13) considered summer/warm weather as relieving factor,

while 20% (5) said they were unaware of any such factors. Similarly, 12% (3) found

medicines as relieving factor. And Shodhana and stress-free condition were

considered as relieving factor by 8% (2) each. It is depicted below in Table No. 32

and Fig. No. 13:

Table No. 32 Distribution according to Relieving Factors

Relieving Factors No. of Patients Percentage

Summer 13 52

Shodhana 2 8

Medicines 3 12

Stressfree condition 2 8

Not known 5 20

Total 25 100

05

101520253035404550

No. of Patients

Percentage

Results


Psoriasis Page 80

Fig. No. 13 Distribution according to Relieving Factor

5. Family history:

Out of 25 patients, 92% (23) gave the negative family history of psoriasis, while only

8% (2) had had the positive family history. The same is shown in Table No. 33 and

Fig No. 14 below:

Table No. 33 Distribution according to Family history

Family History No. of Patients Percentage

Positive 2 8

Negative 23 92

Total 25 100

Fig. No. 14 Distribution according to Family history

0102030405060

No. of Patients

Percentage

0

20

40

60

80

100

Positive Negative

No. of Patients

Percentage

Results


Psoriasis Page 81

6. Diet:

Vegetarian/ Mixed food habit:

Out of 25 patients, 52% (13) patients were of mixed food category. They all

consumed fish, chicken and mutton, but chicken and fish more than mutton. And 48%

(12) were vegetarian. The same is shown in Table No. 34 and Fig. No. 15 below:

Table No. 34 Distribution according to Vegetarian/Mixed food habit

Food Habit No. of Patients Percentage

Vegetarian 12 48

Mixed 13 52

Total 25 100

Fig. No. 15 Distribution according to Vegetarian/Mixed food habit

7. Addictions:

In the present study, 8% (2) patients had had the addiction of smoking, 20% (5) had

had the addiction of consuming alcohol, while 72% (18) did not have any such

addictions. It is shown below in the Table No. 35 and Fig. No. 16 below:

Table No. 35 Distribution of patients based on addictions

0

10

20

30

40

50

60

Vegeterian Mixed

No. of Patients

Percentage

Results


Psoriasis Page 82

Addictions No. of Patients Percentage

Smoking 2 8

Alcohol 5 20

None 18 72

Total 25 100

Fig. No. 16 Distribution of patients based on addictions

8. Joint involvement:

In the study, out of 25 patients, 60% (15) patients had had joint involvement in the

form of joint pain, while 40% (10) did not have joint pain.

Table No. 36 Distribution of patients according to presence of Joint Pain

Joint Pain No. of Patients Percentage

Present 15 60

Absent 10 40

Total 25 100

0

10

20

30

40

50

60

70

80

Smoking Alcohol None

No. of Patients

Percentage

Results


Psoriasis Page 83

Fig. No. 17 Distribution of patients according to presence of Joint Pain

9. Nail changes:

In the study, out of 25 patients, 68% (17) had had the changes in nail in the form of

pitting/ onchylosis/ ridging, while 32% (8) did not have any nail changes as shown in

the Table No. 37 and Fig No. 18 below:

Table No. 37 Distribution of patients according to changes in nails

Nail changes No. of Patients Percentage

Yes 17 68

No 8 32

Total 25 100

Fig No. 18 Distribution of patients according to Changes in Nails

0

10

20

30

40

50

60

Present Absent

No. of Patients

Percentage

0

10

20

30

40

50

60

70

Yes No

No. of Patients

Percentage

Results


Psoriasis Page 84

10. Type of Psoriasis:

In the present study, out of 25 patients, 72% (18) patients had had chronic plaque type

of psoriasis, 20% (5) had had scalp psoriasis, whereas 8% (2) had had guttae

psoriasis. It is shown in Table No. 38 and Fig. No. 19:

Table No. 38 Distribution according to Type of Psoriasis

Type of Psoriasis No. of Patients Percentage

Chronic plaque psoriasis 18 72

Scalp psoriasis 5 20

Guttae psoriasis 2 8

Total 25 100

Fig. No. 19 Distribution according to Type of Psoriasis

11. Auspitz Sign:

In the present study, out of 25 patients, 96% (24) had had positive Auspitz Sign, while

4% (1) had had negative Auspitz Sign.

0

10

20

30

40

50

60

70

80

Chronic

plaque

psoriasis

Scalp

psoriasis

Guttae

psoriasis

No. of Patients

Percentage

Results


Psoriasis Page 85

12. Candle Grease Sign:

In the study, out of 25patients, in 88% (22) patients, Candle Grease Sign was found to

be positive, while in 12% (3) patients, the Sign was found to be negative.

13. Shareerika Prakriti:

Among 25 patients, 36% (9) patients’ Prakriti was found to be of Vata Pitta, 28% (7)

patients’ was assessed to be as Pitta Kapha, while that of 20% (5) patients’ of Vata

Kapha. Similarly the Prakriti was assessed to be of Kapha in 12% (3) patients, while it

was found to be of Pitta in 4% (1) patient. It is depicted in Table No. 39 and Fig. No.

20.

Table No. 39 Distribution according to Prakriti

Sharirika Prakriti No. of Patients Percentage

Pitta 1 4

Kapha 3 12

Vata Pitta 9 36

Pitta Kapha 7 28

Vata Kapha 5 20

Total 25 100

Fig. No. 20 Distribution aacording to Prakriti

0

5

10

15

20

25

30

35

40

Pitta Kapha Vata

Pitta

Pitta

Kapha

Vata

Kapha

No. of Patients

Percentage

Results


Psoriasis Page 86

14. Sara:

In the present study, out of 25 patients, 44% (11) had Mamsa Sara, while 28% (7) had

Rakta Sara. Similarly Sara of 16% (4) patients was Asthi, and that of 12% (3) was

Meda. It is shown in Table No. 40 and Fig. No. 21.

Table No. 40 Distribution according to Sara

Sara No. of Patients Percentage

Rakta 7 28

Mamsa 11 44

Meda 3 12

Asthi 4 16

Total 25 100

Fig. No. 21 Distribution according to Sara

15. Samhanana:

Out of 25 patients of the study, 92% (23) patients had Madhyama Samhanana;

Susamhana and Hina Samhanana belonged to 4% (1) patient each. The details are

presented in Table No. 41 and Fig. No. 22.

0

5

10

15

20

25

30

35

40

45

Rakta Mamsa Meda Asthi

No. of Patients

Percentage

Results


Psoriasis Page 87

Table No. 41 Distribution according to Samhanana

Samhanana No. of Patients Percentage

Susamhata 1 4

Madhyama 23 92

Hina 1 4

Total 25 100

Fig. No. 22 Distribution according to Samhanana

16. Satmya:

Out of 25 patients in the study, 72% (18) gave history of Madhyama Rasa Satmya,

16% (4) Sarva Rasa Satmya and 12% (3) Ekarasa Satmya. It is presented here in

Table No. 42 and Fig. No. 23:

Table No. 42 Distribution according to Satmya

Satmya No. of Patients Percentage

Sarvarasa 4 16

Madhyama Rasa 18 72

Ekarasa 3 12

Total 25 100

0

10

20

30

40

50

60

70

80

90

100

Susamhata Madhyama Hina

No. of Patients

Percentage

Results


Psoriasis Page 88

Fig. No. 23 Distribution according to Satmya

17. Satva:

Out of 25 patients, 68% (17) had had Madhyama Satva, 24% (6) had had Pravara

Satva, and 8% (2) had had Avara Satva. It is depicted in the Table No. 43 and Fig.

No. 24:

Table No. 43 Distribution according to Satva

Satva No. of Patients Percentage

Pravara 6 24

Madhyama 17 68

Avara 2 8

Total 25 100

Fig. No. 24 Distribution according to Satva

0

10

20

30

40

50

60

70

80

Sarvarasa Madhyama

Rasa

Ekarasa

No. of Patients

Percentage

0

10

20

30

40

50

60

70

Pravara Madhyama Avara

No. of Patients

Percentage

Results


Psoriasis Page 89

18. Ahara Shakti:

Ahara Shakti is assessed by Abhyavaharana Shakti (food-intake capacity) and Jarana

Shakti (capability to digest). In the present study, out of 25 patients, 68% (17) had had

Madhyama Abhyavaharana Shakti, while 20% (5) had had Pravara, and 12% (3) had

had Avara Abhyavaharana Shakti. Similarly, regarding Jarana Shakti, 60% (15)

patients had had Madhyama Jarana Shakti, while 24% (6) had had Pravara, and 16%

(4) had had Avara Jarana Shakti. The description about Abhyavaharana Shakti is

depicted below in Table No. 43 and Fig. No. 24 and that for Jarana Shakti in table No.

44 and Fig. No. 25.

Table No. 44 Distribution according to Abhyavaharana Shakti

Abhyavaharana Shakti No. of Patients Percentage

Pravara 5 20

Madhyama 17 68

Avara 3 12

Total 25 100

Fig. No. 25 Distribution according to Abhyvaharana Shakti

0

10

20

30

40

50

60

70


No. of Patients

Percentage

Results


Psoriasis Page 90

19. Jarana Shakti:

Table No. 45 Distribution according to Jarana Shakti

Jarana Shakti No. of Patients Percentage

Pravara 6 24

Madhyama 15 60

Avara 4 16

Total 25 100

Fig. No. 26 Distribution according to Jarana Shakti

20. Vyayama Shakti:

Madhyama Vyayama Shakti was noted in 60% (15) patients, Avara Vyayama Shakti

in 16% (4) patients, while Pravara Vyayama Shakti was noted in 8% (2) patients. The

same is shown in Table No. 46 and Fig No. 27 below:

Table No. 46 Distribution according to Vyayama Shakti

Vyayama Shakti No. of Patients Percentage

Pravara 2 8

Madhyama 15 60

Avara 4 16

Total 21 84

0

10

20

30

40

50

60


No. of Patients

Percentage

Results


Psoriasis Page 91

Fig. No. 27 Distribution according to Vyayama Shakti

21. Vaya:

All 25 patients of this study were of Madhyama Vaya (following Acharya Sushrut’s

explanation of categorization of age).

22. Koshtha:

In the present study, out of 25patients, 56% (14) patients had had Madhyama

Koshtha, 28% (7) had had Mridu Koshtha, while 16% (4) had had Kroora Koshtha. It

is depicted in Table No. 47 and Fig. No. 28.

Table No. 47 Distribution according to Koshtha

Koshtha No. of Patients Percentage

Mridu 7 28

Madhyama 14 56

Kroora 4 16

Total 25 100

0

10

20

30

40

50

60


No. of Patients

Percentage

Results


Psoriasis Page 92

Fig. No. 28 Distribution according to Koshtha

OBSERVATIONS DURING THE TREATMENT

1. Observations of Sneha Jiryamana Lakshana:

Out of 25 patients, after Snehapana, Shiroruja was felt by 92% (23) patients, while

Bhrama and Murchha did not happen in any of the patients. Lalasrava was

experienced by 88% (22) patients, Angasada by 52% (13), Klama by 36% (9), Trishna

by all 100% (25) patients, Daha by 64% (16) patients, while Arati was felt by 76%

(19) patients. The details are given below in Table No. 48 and Fig. No. 29.

Table No. 48 Observation of Snehajiryamana Lakshana

Sneha Jiryamana Lakshana No. of Patients Percentage

Shiroruja 23 92

Bhrama 0 0

Lalashrava 22 88

Angasada 13 52

Murchha 0 0

Klama 9 36

Trishna 25 100

Daha 16 64

Arati 19 76

0

10

20

30

40

50

60

Mridu Madhyama Kroora

No. of Patients

Percentage

Results


Psoriasis Page 93

Fig. No. 29 Observation of Snehajiryamana Lakshana

2. Observations of Sneha Jirna Lakshana:

Among various Sneha Jirna Lakshana that do occur after Snehapana, 4 of the

Lakshana were felt by all the patients, ie. 100% or 25. Those Lakshana were

Jiryamana Lakshana Prashamana, Trishna, Kshuda and Vatanulomana. Similarly,

Udgara Shuddhi was felt by 96% (24) patients, and Sharira Laghava by 76% (19)

patients. The details are depicted in Table No. 49 and Fig. No. 30.

Table No. 49 Observation of various Snehajirna Lakshana

Sneha Jiryamana Lakshana No. of Patients Percentage

Jiryamana Lakshana Prashamana 25 100

Trishna 25 100

Kshuda 25 100

Udgara Shuddhi 24 96

Sharira Laghava 19 76

Vatanulomana 25 100

0

10

20

30

40

50

60

70

80

90

100

No. of Patients

Percentage

Results


Psoriasis Page 94

Fig. No. 30 Observation of various Snehajirna Lakshana

3. Day of attainment of Samyak Snigdha Lakshana:

In the present study, Samyak Snigdha Lakshana were seen in the 3rd

day of Snehapana

in 32% (8) patients, in 4th

day of Snehapana in 40% (10) patients. 16% (4) patients

took 5 days to show Samyak Snigdha Lakshana, while 8% (2) patients took 6 days to

show the same. 4% (1) patient took 7 days to attain Samyak Snigdha Lakshana. It is

shown below in Table No. 50 and Fig. no. 31.

Table No. 50 Showing no. of days to attain Samyak Snigdha Lakshana

Days to Attain Samyak Snigdha Lakshana No. of Patients Percentage

3 days 8 32

4 days 10 40

5 days 4 16

6 days 2 8

7 days 1 4

Total 25 100

0102030405060708090

100

No. of Patients

Percentage

Results


Psoriasis Page 95

Fig. No. 31 Showing No. of Days to Attain Samyak Snigdha Lakshana

4. Total number of Samyak Snigdha Lakshana observed on the last day of

Snehapana:

Regarding the Samyak Snigdha Lakshana that were exixibited by/in the patients on

the last day of Snehapana, the observation was as described ahead. Vatanulomana was

present in 84% (21) patients; Agnideepti was felt by 88% (22) patients. Snigdha

Varcha was seen in all the 25 patients. Asamhat Varcha was seen in 96% (24)

patients, while Snehodvega was felt by 92% (23) patients. Gatramardavata was seen

in 92% (23) patients, while Twok Snigdhata was seen in 88% (22) patients. The same

is depicted in Table No. 50 and Fig. No. 31:

Table No. 51 Samyak Snigdha Lakshana observed on last day of Snehapana

Samyak Snigdha Lakshana No. of Patients Percentage

Vatanulomana 21 84

Agnideepti 22 88

Snigdha Varcha 25 100

Asamhat Varcha 24 96

Snehodvega 23 92

Gatramardavata 23 92

Twok Snigdhata 22 88

0

5

10

15

20

25

30

35

40

3 days 4 days 5 days 6 days 7 days

No. of Patients

Percentage

Results


Psoriasis Page 96

Fig. No. 32 Samyak Snigdha Lakshana observed on last day of Snehapana

5. Observation pertaining to Swedana:

All the patients showed Samyak Swinna Lakshana on administration of Karanja

Kwatha Pariseka as depicted in Table No. 52 and Fig. No. 33:

Table No. 52 Samyak Swinna Lakshana observed

Samyak Swinna Lakshana No. of Patients Percentage

Sweda Pradurbhava 25 100

Mardavata 25 100

Laghuta 25 100

Gourava Nigraha 25 100

Sheetoparama 25 100

Stambha Nigraha 25 100

0102030405060708090

100

No. of Patients

Percentage

Results


Psoriasis Page 97

Fig. No. 33 Samyak Swinna Lakshana observed

6. Shuddhi - Vegiki:

Out of 25 patients, in 64% (16) patients, Madhyama Vegiki Shudhhi (11-20 Vega)

was seen. In 24% (6) patients, Avara Vegiki Shuddhi (1-10 Vega) was seen, while in

12% (3) patients, Pravara Vegiki Shuddhi (21-30 Vega) was seen, which is depicted

below in Table No. 53 and Fig. No. 34:

Table No. 53 Showing Vegiki Shuddhi

Vegiki Shuddhi Vega No. of Patients Percentage

Avara 1-10 6 24

Madhyama 11-20 16 64

Pravara 21-30 3 12

Total

25 100

0102030405060708090

100

No. of Patients

Percentage

Results


Psoriasis Page 98

Fig. No. 34 Showing Vegiki Shuddhi

7. Laingiki Shuddhi:

Out of 25 patients, among Laingiki Shuddhi, Srotovishuddhi was seen in 84% (21)

patients, Indriyaprasada in 96% (24) patients. In 92% (23) patients, Laghuta and

Agnivriddhi each were seen. In 88% (22) patients, Anamaytva was seen, while in

84% (21) patients, Vatanulomana and Vitpittakapaha Kramataha Nissarana each were

seen. In 12% (3) patients, Ayogabhava of Virechana Karma was seen. The same is

depicted in Table No. 54 and Fig. No 35.

Table No 54 Laingiki Shuddhi

Laingiki Shuddhi No. of Patients Percentage

Srotovishuddhi 21 84

Indriyaprasada 24 96

Laghuta 23 92

Agnivriddhi 23 92

Anamayatva 22 88

Vatanulomana 21 84

Vitpittakapha Kramataha Nissarana 21 84

Ayogabhava 3 12

0

10

20

30

40

50

60

70

1-10 11-20 21-30

Avara Madhyama Pravara

No. of Patients

Percentage

Results


Psoriasis Page 99

Fig. No. 35 Laingiki Shuddhi

8. Antiki:

In the present study, out of 25 patients, 84% (21) had had Kaphanta at the end of

Virechana, while 12% (3) had had Pittanta, and 4% (1) patient had had Malanta. It is

shown in Table No. 55 and Fig. No. 36:

Table No. 55 Antiki Shuddhi

Antiki No. of Patients Percentage

Kaphanta 21 84

Pittanta 3 12

Malanta 1 4

Total 25 100

Fig. No. 36 Antiki Shuddhi

0

20

40

60

80

100

No. of Patients

Percentage

0

10

20

30

40

50

60

70

80

90

Kaphanta Pittanta Malanta

No. of Patients

Percentage

Results


Psoriasis Page 100

9. Maniki Shuddhi:

In the present study, out of 25 patients, in 72% (18) of patients, the output was

between 1000ml-2000ml, while in 20% (5) patients, the output was below 1000ml,

and in 8% (2) patients, it was between 2000ml-3000ml. it is depicted in Table No. 56

and Fig. No. 37.

Table No. 56 Showing Maniki Shuddhi

Maniki Shuddhi No. of Patients Percentage

0-1000 ml 5 20

1000-2000 ml 18 72

2000-3000 ml 2 8

Total 25 100

Fig. No. 37 Showing Maniki Shuddhi

10. Samyak-Asamyak Yoga:

In the present study, out of 25 patients, 88% (22) patients exhibited Samyak Yoga

features, while 12% (3) patients exhibited Ayoga features. The details are given in

Table No. 57 and Fig. No. 38:

0

10

20

30

40

50

60

70

80

0-1000 ml 1000-2000 ml 2000-3000 ml

No. of Patients

Percentage

Results


Psoriasis Page 101

Table No.57 Patients’ distribution based on Atiyoga, Ayoga and Samyak Yoga of

Virechana

Samyak - Asamyak Yoga No. of Patients Percentage

Samyak Yoga 22 88

Ayoga 3 12

Atiyoga 0 0

Total 25 100

Fig. No. 38 Patients’ distribution based on Atiyoga, Ayoga and

Samyak Yoga of Virechana

11. Samsarjana Krama:

Once the Virechana Vega was over, the patients were advised with the Samsarjana

Krama that they were supposed to follow, which was decided based on the Maniki,

Antiki, Langiki and Vegiki Shuddhi features along with the strength of the patients.

Maximum patients, ie.64% (16) were advised with 5 days of Samsarjana Krama,

followed by 24% (6) patients with 3 days’ and 12% (3) patients with 7 days of

Samsarjana Krama. The details are given below in Table No. 58 and Fig. No. 39:

0

10

20

30

40

50

60

70

80

90

Samyak Ayoga Atiyoga

No. of Patients

Percentage

Results


Psoriasis Page 102

Table No. 58 Distribution of patients based on Samsarjana Krama days

Samsarjana Krama No. of Patients Percentage

7 days 3 12

5 days 16 64

3 days 6 24

Total 25 100

Fig. No. 39 Distribution of patients based on Samsarjana Krama days

RESULTS

Assessment of Virechana Karma:

After getting Samyak Snigdha Lakshana, all the 25 patients of psoriasis were given

three days of Vishrama Kala, during which Karanja Kwatha Pariseka Swedana was

done. Thereafter, on the fourth day, Virechana was carried out as per the details

mentioned earlier using Hridya Virechana Leha. The observations on various aspects

of Virechana were as follows:

0

10

20

30

40

50

60

70

7 days 5 days 3 days

No. of Patients

Percentage

Results


Psoriasis Page 103

Virechana Aushadha Karya Samaya:

The Drug used as a Vairechanika Dravya, ie. Hridya Virechana Leha, induced first

Vega in 61.8 minutes after its administration, while taking mean for 25 patients. The

Dravya worked for inducing Vega on an average till 586.6 minutes. The individual

variations are presented in the Table No. 58 below:

TABLE NO. 59 VIRECHANA AUSHADHA KARYA SAMAYA OBSERVED IN

PATIENTS:

Sr. No.

Time of

administration

of drug

First Vega

Time taken to

induce first

Vega (in min)

Last Vega

Total duration of drug

action

(in min)

1 9.30 AM 10:15AM 45 6:45 PM 555

2 9:30 AM 10:50AM 80 7:15PM 585

3 9:30 AM 10:20AM 50 5:30 PM 480

4 9:30AM 10:20AM 50 7:50PM 620

5 9:30 AM 10:15AM 45 8:50 PM 680

6 9:30 AM 10:10 AM 40 6:15PM 525

7 9:30 AM 10:15AM 45 7:15 PM 585

8 9:30 AM 10:30AM 60 4:45PM 435

9 9:30 AM 10:25AM 55 6:30 PM 540

10 9:30AM 2:40 PM 310 10:30PM 780

11 9:30 AM 10:25AM 55 5:00 PM 450

12 9:30 AM 10:20 AM 50 4:30PM 420

13 9:30 AM 10:30 AM 60 5:30 PM 480

14 9:30AM 10:15 AM 45 7:10PM 580

15 9:30 AM 10:10 AM 40 7:10 PM 580

16 9:30 AM 10:25 AM 55 7:05 PM 575

17 9:30 AM 10:20 AM 50 7:30 PM 600

18 9:30 AM 10:15 AM 45 7:05 PM 575

19 9:30 AM 10:20 AM 50 9:00 PM 690

Results


Psoriasis Page 104

20 9:30 AM 10:15 AM 45 8:15 PM 645

21 9:30 AM 10:20 AM 50 7:55 PM 625

22 9:30 AM 10:15 AM 45 6:30PM 540

23 9:30 AM 10:10 AM 40 9:30 PM 720

24 9:30 AM 10:30 AM 60 8:25PM 655

25 9:30 AM 10:45 AM 75 8:55 PM 745

RESULT ON PSORIASIS (PASI SCORE) AFTER VIRECHANA AND

FOLLOW UP:

RESULT FOR HEAD: (ERYTHEMA, INDURATION AND DESQUAMATION

COMBINED):

TABLE NO. 60 RESULT AFTER VIRECHANA:

N BT

Mean

AT

Mean Difference

%

Change SD SE d.f. t p

25 1.372 1.056 0.316 23.03% 0.39336 0.07867 24 4.017 <0.001

TABLE NO. 61 RESULT AFTER FOLLOW UP:

N BT

Mean

AF

Mean Difference

%


25 1.372 0.796 0.576 41.98% 0.87715 0.17543 24 3.283 <0.01

The mean score for head (erythema, induration and desquamation combined) of 25

patients before Virechana was 1.372. It reduced to 1.056 after Virechana with 23.03%

of the change. After follow-up, the mean score was reduced to 0.796 which was

41.98% less than the first one. The change that occurred after Virechana is greater

than that would occur by chance; there is statistically highly significant change

Results


Psoriasis Page 105

(p<0.001). Also, the change that occurred after follow up is also greater than that

would be expected by chance; i.e. there is statistically significant change (p<0.01).

RESULT FOR UPPER LIMB: (ERYTHEMA, INDURATION AND

DESQUAMATION COMBINED):

TABLE NO.62 RESULT AFTER VIRECHANA:

N BT

Mean

AT

Mean Difference

%


25 4.188 3.076 1.112 26.55% 1.08908 .21782 24 5.105 <0.001

TABLE NO.63 RESULT AFTER FOLLOW UP:

N BT

Mean

AF

Mean Difference

%


25 4.188 2.136 2.052 48.99% 1.39974 .27995 24 7.330 <0.001

The mean score for upper limb (erythema, induration and desquamation combined) of

the 25 patients before Virechana was 4.188, which got reduced to 3.076 after

Virechana with 26.55% reduction. The change that occurred may not be considered as

occurred by chance, as p<0.001, which means the change is statistically highly

significant.

Similarly, the mean score reduced to 2.136 at the time of follow up with 48.99%

reduction. Again the p<0.001 was obtained signifying the change is statistically

highly significant.

Results


Psoriasis Page 106

RESULT FOR TRUNK: (ERYTHEMA, INDURATION AND DESQUAMATION

COMBINED):


N BT

Mean

AT

Mean Difference

%


25 4.964 3.792 1.172 23.61% 1.15525 .23105 24 5.073 <0.001


N BT

Mean

AF

Mean Difference

%


25 4.964 2.644 2.32 46.74% 1.28517 .25703 24 9.026 <0.001

The mean score for trunk (erythema, induration and desquamation combined) of 25

patients before Virechana was 4.964. It reduced to 3.076 after Virechana with 23.61%

of the change. After follow-up, the mean score was reduced to 2.644 which was

46.74% less than the before treatment value. The change that occurred after Virechana

is greater than that would occur by chance; there is statistically highly significant

change (p<0.001). Also, the change that occurred after follow up is also greater than

that would be expected by chance; ie. there is statistically highly significant change

(p<0.001).

Results


Psoriasis Page 107

RESULT FOR LOWER LIMB: (ERYTHEMA, INDURATION AND

DESQUAMATION COMBINED):


N BT

Mean

AT

Mean Difference

%


25 7.776 6.176 1.6 20.58% 2.02649 .40530 24 3.948 <0.001

TABLE NO. 67 RESULT AFTER FOLLOW UP:

N BT

Mean

AF

Mean Difference

%


25 7.776 3.904 3.872 49.79% 2.43508 .48702 24 7.950 <0.001

The mean score for lower limb (with erythema, induration and desquamation

combined) of the 25 patients was 7.776 before Virechana. It reduced to 6.176 after

Virechana which was 20.58% reduction. Again after follow up, the mean score was

reduced to 3.904, which was 49.79% reduction. Here, the change that occurred both

the times were not merely co-incidental as the value of p<0.001 both the times,

signifying that the changes that occurred were statistically highly significant.

EFFECT ON TOTAL PASI SCORE:

TABLE NO.68 RESULT AFTER VIRECHANA:

N BT

Mean

AT

Mean Difference

%


25 18.364 14.208 4.156 22.63% 2.45103 .49021 24 8.478 <0.001

Results


Psoriasis Page 108


N BT

Mean

AF

Mean Difference

%


25 18.364 9.504 8.86 48.31% 3.18591 .63718 24 13.905 <0.001

The mean Total PASI score before treatment/Virechana of 25 patients was 18.364. It

got reduced to 14.208 with 22.63% change. Similarly, the Total PASI score reduced

to 9.504 at the time of follow up, with 48.31% change. The change that were observed

both after Virechana and after follow up may not be expected to have occured by

chance as p<0.001. Hence, the changes that have occurred both after Virechana and at

the time of follow up are statistically highly significant.

EFFECT ON 5D ITCH SCORE AFTER TREATMENT AND AFTER

FOLLOW UP:

TABLE NO. 70 RESULT AFTER TREATMENT/VIRECHANA:

N BT

Mean

AT

Mean Difference

%


25 12.48 10.32 2.16 17.30% .68799 .13760 24 15.698 <0.001


N BT

Mean

AF

Mean Difference

%


25 12.480 7.88 4.6 36.86% .91287 .18257 24 25.195 <0.001

Results


Psoriasis Page 109

Regarding 5D Itch Score, the mean score of 25 patients was 12.48, which was

reduced to 10.32 after Virechana. It was 17.30% change. Similarly, the mean Score of

5D Itch was found to be 7.88 at the time of follow up with 36.86% change. The t

value was calculated as 15.698 and 25.195 respectively for after Virechana and after

follow up, so the p value was found to be p<0.001 which signifies the change that

occurred after Virechaa and after follow up are both statistically highly significant.

Discussion


Psoriasis Page 110

DISCUSSION

Virechana is the procedure in which orally administered drug acts on internally

vitiated Dosha (especially Pitta), and expels them through the Guda Marga. Virechana

is considered as Shrestha procedure for Pitta Harana. Also it is indicated in Kapha

Samsrishta condition. Similarly, it is also advocated in Vatasyopakrama. Hence, it

can be inferred that Virechana can help correct all three morbid Doshas.

Psoriasis is a non-infectious, chronic inflammatory disease of the skin, characterized

by well-defined erythematous plaques with silvery scale, with a predilection for the

extensor surfaces and scalp, and a chronic fluctuating course. It is one of the most

common dermatologic diseases, affecting up to 2.5% of the world‟s population.

Studies have shown that major fractions of people with psoriasis consider their

disease to be a large problem in their everyday life. It is found that the disease affects

the quality of life, which again varies depending upon different factors.

Kushtha is a term in Ayurveda with much broad spectrum, and under which much of

the skin diseases can be put. Kushtha is basically a Tridoshaja Vyadhi as has been

said “Kushthanam Saptadravyako Sangrahah”. Samsodhana has been highlighted in

the management of Kushtha. Virechana has been quoted to perform as a

Samshodhana in Kushtha Chapter. As Kushtha is a Tridoshaja Vyadhi, with

involvement of Rakta Dhatu as well, Virechana on the other hand, is a measure that

may have its effect on all the three Doshas, along with its action in Raktaja Dhatu,

Virechana may act as one of the suitable treatment protocol in Kushtha disease.

In the present study, Virechana was performed in the patients of Psoriasis; psoriasis

being a condition that may be correlated with Ekakushtha, Mandala or Kitibha

according to different presentations. Prior to Virechana Karma, Deepana Pachana and

Discussion


Psoriasis Page 111

Snehapana were carried out as expected. Shunthi Qwatha was selected as Deepana-

Pachana Drug, which was given to enhance the Agni and also to digest Ama if any.

Moorchhita Tila Taila was used as Snehana Dravya for Snehapana. It was

administered in Arohana Matra depending upon the changes seen in patient until

Samyak Snigdha Lakshana were acheieved. Virechana was administerd with Hridya

Virechana Leha, which contains Trivrit as a main ingredient and Trivrit is considered

as one of best Sukha Virechana Dravya as well as Virechana Dravya. The individual

dose was fixed depending upon the Agni, Koshtha, Roga Bala, Rogi Bala etc. of the

individual.

Significant findings of the research work are discussed below with the following

headings:

Age:

In this study, maximum number of patients, i.e. 36% belonged to age group 51-60,

followed by 28% to age group 31-40 years, 24% to age group 41-50 years, 8% to age

group 21-30 years and 4 % to age group 61-70 years. The age wise distribution shows

the disease was found more in middle aged people and adults; the possible reason that

may be seen here is this age group is involved in some sort of income generating

works and it causes them to undergo mental stress, bear environmental extremities

like outdoor cold and heat, lack of rest, improper food, untimely food, familial

responsibilities etc.

Sex:

In this present study, out of 25 patients, 88 % (22) were male and 12% (3) were

female. Though in some studies, incidence and prevalence rate is shown to be slightly

more in males than in females, but most of the literatures do not accept any gender

variation as such. In one study published in 2010, with title „Psoriasis in India:

Discussion


Psoriasis Page 112

Prevalence and Pattern ‟, the researchers concluded that in their study psoriasis was

found to be twice more common in males than in females.139

But the question may

arise how much credibility may be given to the study. In this study, it may be co-

incidental, or some causes such as financial, social, familial aspects may have played

a role.

Religion:

In this study, out of 25 patients, 92% (23) were Hindu, while 8% (2) were Christians.

As this could be a result of demographical factors, no specific relation can be

established from this observation.

Education:

In the present study, 52% were graduates, 28% had completed high school, 12% were

post graduates, and 8% were literate. From the educational status, it may be difficult

to draw any direct relationship or conclusion but if there does exist any indirect or

slight relationship, it is beyond the scope of this study because of the small sample

size of this study.

Marital Status:

Out of 25 patients, 92% were married whereas 8% were unmarried. From the scope of

present study, there may not be found any obvious relationship between marriage and

Psoriasis.

Socioeconomic Status:

Out of 25 patients, 52% belonged to middle- class family, while 40% belonged to

lower class family, and 8% belonged to upper class family. Majority of people in

India belong to middle class and the same is seen in the study. No obvious or direct

Discussion


Psoriasis Page 113

relation may be thought of between these two variables, but if there does exist any, it

is difficult to say anything due to the small sample size of the present study.

Occupation:

Maximum numbers of patients were professionals, i.e. 44% (11) while 20% (5) were

businessmen. Generally, people of these professional background do have a lot of

mental stress, with hectic work schedule, as well majority of them are exposed to air

conditioner for much more time, contributing to increased incidence of Psoriasis.

Similarly, 24% (6) were manual labourers, and they too have to get themselves

undergo heavy physical works under extreme weather conditions as well which may

again contribute to the disease. Similarly, 8% (2) were housewives, 4% (1) was

student.

Desha:

In the study, 56% (14) of the patients belonged to Shadharana Desha, while 36% (9)

patients belonged to Anoopa Desha, and 8% (2) patients belonged to Jangala Desha.

Desha may have some role to play as in Anoopa Desha excessive Kledata is found,

while in Sadharana Desha in cold season, excessive cold is found which may

correlated with the above observation.

Age of onset:

There were 24% (6) patients each for 21-30, 31-50, and 41-50 years age group as

onset age group. Similarly, there were 20% (5) patients for 11-20 years. And there

were 8% (2) for 51-60. So this observation roughly matches with the idea that

psoriasis may start at any age but is unusual before age of 5, and also goes along the

idea that two epidemiological pattern may be found for psorisis i.e. early onset

(teenage or early adult years) and late onset (fifties or sixties).

Discussion


Psoriasis Page 114

Chronicity of Disease:

Out of 25 patients, 60% (15) patients had had history of psoriasis since last 10 years

or below, 24% (6) had had history of 11-20 years, and 8% (2) had had for each 21-30

years and 41-50 years. It shows the chronicity of the disease along with fluctuating

nature.

Aggravating factors:

48% (12) found cold weather or climate as the most sensitive aggravating factor, 24%

(6) found mental stress, 12% (3) found pollution or dust, and 8% (2) found each non-

vegetarian food and exposure to sunlight as most sensitive aggravating factor. This

observation shows cold as the important aggravating factor, which actually dries up

the skin and causes flare up of the disease.

Relieving Factors:

52% (13) patients opined summer/warm weather as relieving factor, 12% (3)

Samanaga Aushadhi, 8% (2) each stress free environment and Shodhana as relieving

factor. 20% (5) said they did not realize any such factor.

Family history:

92% (23) patients had had negative family history, while 8% (2) had had positive

family history. In medical literature it is said that Psoriasis has got genetic

predisposition, which is seen in this study as well but the figure may not have

matched due to small sample size of this study.

Diet:

Vegetarian/ Mixed food habit:

In the study, 52% (13) patients had had mixed food habit while 48% (12) were

vegetarians. The patients with mixed food habit generally consumed fish, chicken and

Discussion


Psoriasis Page 115

mutton. This data may indicate psoriasis is more common in non-vegetarians than in

vegetarians.

Addictions:

20 % (5) patients had had habit of consuming alcohol, while 8% (2) patients used to

smoke. And 72% (18) patients had had no addictions as such. Various addictions may

act as a Hetu for Kushtha due to Dosha Kopana but from this datal, no conclusion

may be drawn as sample size is small.

Joints Involvement:

60% (15) patients had had joint involvement in the form of pain in various joints,

while 40% (10) did not have any joint involvement. As the disease psoriasis

progresses, in considerable fraction of patients, joints involvement is found especially

form of joint/s pain, joint/s deformity. The same has been seen here that more than

half of the patients had had joints pain; it may be noteworthy that most of the patients

enrolled in this study had had quite long time history of the disease.

Nail changes:

Out of 25 patients, 68% (17) had had the changes in nail in the form of pitting/

onchylosis/ ridging, while 32% (8) did not have any nail changes. As the disease

psoriasis progresses, the changes in nail is also a feature, which is seen in this study.

Type of Psoriasis:

Out of 25 patients, 72% (18) had had chronic plaque type of psoriasis, 20% (5) had

had scalp psoriasis, and 8% (2) had had guttae psoriasis. It can be found in agreement

that chronic plaque type of psoriasis is the most common variety of psoriasis in the

world followed by others.

Discussion


Psoriasis Page 116

Auspitz Sign:

Out of 25 patients, 96% (24) had had positive Auspitz Sign, while 4% (1) had had

negative Auspitz Sign. Auspitz Sign is a classical finding in psoriasis but Auspitz

Sign may not be absolutely sensitive and specific to psoriasis. Here, most of the

patients had had positive Auspitz Sign.

Candle Grease Sign:

Out of 25patients, in 88% (22) patients, Candle Grease Sign was found to be positive,

while in 12% (3) patients, it was negative. It is a diagnostic sign of psoriasis but it is

not mandatory that all psoriasis patients have positive Candle Grease Sign.

Prakriti:

Among the 25 patients, maximum number of patients, i.e.36% (9) possessed Vata

Pitta Prakriti, followed by Pitta Kapha Prakriti by 28% (7) patients, Vata Kapha by

20% (5) patients, Kapha by 12% (3) patients and Pitta by 4% (1) patient.

Sara:

Study showed the maximum number of patients, i.e. 44% (11) were of Mamsa Sara,

followed by 28% (7) patients of Rakta Sara, 16% (4) patients of Asthi Sara and 12%

(3) patients of Meda Sara.

Samhanana:

Out of 25 patients in the study, 92% (23) patients possessed Madhyama Samhanana,

while Susamhana and Hina Samhanana each were possessed by 4% (1) patient.

Discussion


Psoriasis Page 117

Satmya:

Out of 25 patients in the study, Madhyama Rasa Satmya was possessed by 72% (18)

patients, Sarva Rasa Satmya by 16% (4) patients and Ekarasa Satmya by 12% (3)

patients.

Satva:

68% (17) patients were of Madhyama Satva, while 24% (6) of Pravara Satva and 8%

(2) of Avara Satva. Satva may have role in planning treatment, at least in terms of

preparing patient for the treatment.

Ahara Shakti:

Ahara Shakti is assessed by Abhyavaharana Shakti and Jarana Shakti. In the present

study, out of 25 patients, 68% (17) had had Madhyama Abhyavaharana Shakti, while

20% (5) had had Pravara, and 12% (3) had had Avara Abhyavaharana Shakti.

Similarly, regarding Jarana Shakti, 60% (15) patients had had Madhyama Jarana

Shakti, while 24% (6) had had Pravara, and 16% (4) had had Avara Jarana Shakti.

Vyayama Shakti:

In the study, out of 25 patients, 60 % (15) had had madhyama Vyama Shakti, while

16% (4) had had Avara Vyayama Shakti and 8 % (2) had had Pravara Vyayama

Shakti.

Vaya:

All the patients in this study belonged to Madhyama Vaya.

Koshtha:

Maximum number of patients, i.e. 56% (14) patients possessed Madhyama Koshtha,

28% (7) patients Mridu Koshtha while 16% (4) patients possessed Kroora Koshtha.

Discussion


Psoriasis Page 118

Koshtha assessment has crucial role to play especially during Snehapana so as to

make patient attain Samyak Snigdha Avastha.

EFFECT OF THE THERAPY:

Effect of Deepana and Pachana:

Nirama Avastha was achieved by Deepana Pachana with Shunthi Kwatha 20 ml thrice

a day prior to Snehapana. It is Laghu and Ushna and helps in Deepana Pachana.

Observation of Sneha Jiryamana Lakshana:

Out of 25 patients, after Snehapana, Shiroruja was felt by 92% (23) patients,

Lalasrava was experienced by 88% (22) patients, Angasada by 52% (13) patients,

Klama by 36% (9) patients, Trishna by all 100% (25) patients, Daha by 64% (16)

patients, and Arati was felt by 76% (19) patients.

Observation of Sneha Jirna Lakshana:

After Snehapana, various Sneha Jirna Lakshana are felt by patients. Among them,

four Lakshanas, viz. Jiryamana Lakshana Prashamana, Trishna, Kshuda and

Vatanulomana were experienced by all 25 patients, i.e. 100% patients. Similarly,

Udgara Shuddhi was felt by 96% (24) patients, and Sharira Laghava by 76% (19)

patients.

Days required for attainment of Samyak Snigdha Lakshana by patient:

In the present study, 40% (10) patients attained Samyak Snigdha Lakshana in 4th

day

of Snehapana, while 32% (8) patients in 3rd

day, 16% (4) patients in 5th

day, 8% (2) in

6th

day and 4% (1) patient took 7 days to attain the same. This shows the various types

of Koshtha of patients.

Discussion


Psoriasis Page 119

Total number of Samyak Snigdha Lakshana observed on the last day of

Snehapana:

Regarding Samyak Snigdha Lakshana, Vatanulomana was present in 84% (21)

patients; Agnideepti was felt by 88% (22) patients. Snigdha Varcha was seen in all the

25 patients. Asamhat Varcha was seen in 96% (24) patients, Snehodvega in 92% (23)

patients, Gatramardavata in 92% (23) patients and Twok Snigdhata in 88% (22)

patients. Most of the Samyak Snigdha Lakshana were exhibited by most of the

patients.

Observation of Swedana:

The study showed that 100% of the patients attained Samyak Swinna Lakshana on

administration of Karanja Kwatha Pariseka.

Observation pertaining to Virechana Karma:-

Virechana Aushadha Karya Samaya:

The Drug used as a Vairechanika Dravya, ie. Hridya Virechana Leha, induced first

Vega in 61.8 minutes at an average for 25 patients after its administration. The

Dravya worked for inducing Vega till 586.6 minutes on an average. Total time

required for first to last Vega suggests action of Hridya Viechana Leha depending on

Koshtha of the patient and also the quantum of Dosha vitiation. Major ingredient in

Hridya Virechana Leha that induces Virechana is Trivrit.

Vegiki Shuddhi:

Out of 25 patients, 64% (16) patients had had the number of bowels between 11-20,

i.e. in them Madhyama Shuddhi occurred, in 24% (6) patients, the bowel number was

1-10, i.e. Avara Shuddhi occurred and in 12% (3) patients it was between 21-30

indicating Pravara Shuddhi.

Discussion


Psoriasis Page 120

Antiki Shuddhi:

In 84% (21) patients, Virechana ended with Kaphanta, in 12% (3) Virechana ended

with Pittanta, while in 4% (1) patient, it ended in Malanta.

Maniki Shuddhi:

Among 25 patients, 72% (18) patients had had the output between 1000-2000 ml,

while in 20% (5) patients, it was below 1000ml and in 8% (2) patients, it was between

2000-3000ml.

Laingiki Shuddhi:

In the study, 96% (24) patients experienced Indriyaprasada after the Virechana,

Laghuta and Agnivriddhi each were felt by 92 % (23) patients, 88% (22) patients

developed Anamayatva, while Srotovishuddhi, Vatanulomana and Vitpittakapha

Kramataha Nissarana each were experienced by 84% (21) patients, and 12% (3)

patients experienced Ayoga Bhava. Hridya Virechana Leha produced Samyak Virikta

Lakshana in maximum number of patients.

Samyak-Asamyak Yoga:

It was observed in the clinical study that 88% (22) patients had had Samyak Yoga

features of Virechana, while 12% (3) patients had had developed more of Ayoga

features of Virechana.

Samsarjana Krama:

After the completion of Virechana, Samsarjana Krama was advised to the patients and

explained the importance of it and instructed to strictly adhere to it. The Samsarjana

Krama was decided on factors such as Maniki, Antiki, Langiki and Vegiki Shuddhi

features along with the strength of the patients. Maximum patients, ie.64% (16) were

Discussion


Psoriasis Page 121

advised with 5 days of Samsarjana Krama, 24% (6) patients with 3 days‟ and 12% (3)

patients with 7 days of Samsarjana Krama.

RESULTS:

Paired t-test was used for comparing the results and IBM SPSS Statistics was used for

data analysis.

a. PASI:- Erythema, induration and desquamation were taken into account

combined first for head, upper limb, trunk and lower limb separately. Then overall

PASI was calculated for after Virechana and after follow up.

Result for head (Erythema, Induration and Desquamation):

Erythema, induration and desquamation were taken into account combined first for

head, upper limb, trunk and lower limb separately. Then overall PASI was calculated

for after Virechana and after follow up.

For head, the mean of 25 patients was 1.372 before treatment and it reduced to 1.056

after treatment, with 23.03% change. It was reduced to 0.796 after follow up from

1.372 before treatment, with 41.98% change. In first result, i.e. after treatment, the p

value was less than 0.001, indicating the change that occurred was statistically highly

significant, or the result that occurred was highly unlikely that it occurred merely

because of chance. Similarly for after follow up result, the p<0.01 indicating that it is

statistically significant and may not be considered as occurred by chance alone.

Result for upper limb (Erythema, Induration and Desquamation):

The mean before treatment was 4.188 and it got reduced to 3.076 after treatment

which is 25.66% change. Similarly, after follow up the mean was reduced to 2.136,

with 48.99% change.

Discussion


Psoriasis Page 122

In both the incidences, the p<0.001 indicating the changes that have occurred are

statistically highly significant and not because of merely chance.

Result for trunk (Erythema, Induration and Desquamation):

The mean score before treatment was 4.964 which reduced to 3.792 after treatment,

with 23.61% change and t-value being 5.073. Similarly, after follow up the mean was

2.644 with 46.74% change and t-value being 9.026. In both the cases, the p<0.001

signifying the changes that occurred were statistically highly significant.

Result for lower limb (Erythema, Induration and Desquamation):

The mean score before treatment for lower limb was 7.776 and after treatment, it was

6.176, with 20. 58 % change. The mean score after follow up was 3.904 with 49.79%

change from the before treatment value. In both the cases p<0.001 signifying the

changes were statistically highly significant.

Total PASI Score:

The mean PASI score before treatment was 18.364 which got reduced to 14.208 after

treatment, with 22.63% change. Similarly the mean PASI score after follow up was

reduced to 9.504, with 48.31% change. The p value was less than 0.001 in both the

cases, so signifying the changes occurred at both the times were statistically highly

significant.

b. 5 D Itch Score:-

It is a score used to calculate overall aspects of itching. The mean score prior to

treatment was 12.48 which got reduced to 10.32, with 17.30% decrement. The mean 5

D Itch score after follow up was found to be 7.88, which was 12.48 before treatment,

and the change observed here was 36.86%. In both the cases, the p value was less than

Discussion


Psoriasis Page 123

0.001, which indicates that the change that occurred was statistically highly

significant and may not be considered to have occurred merely due to chance.

Probable Mode of Action of Virechana Drug:

Virechana drugs have properties Ushna, Tikshna, Sukshma, Vyavayi, Vikashee. They

have predominance of Prithvi and Jala Mahabhuta. They have Prabhava Adhobhaga

Doshaharatwa. Virechana Aushadhi by virtue of their Ushna, Tikshna, Sukshma,

Vyavai and Vikashee Guna, and their Swa Virya (Swo Prabhava), reach to Hridaya

and spread through Dhamani to all the macro and micro channels in the body. Here,

Acharya Chakrapani clearfies that it is not the Aushadhi in its physical form itself that

traverses throughout the Dhamani in body, rather it is the Virya of Aushadhi that

spreads to all the Dhamani. Then, Ushan Guna causes liquefaction of Dosha Samuha

in the body; Tikshna Guna causes disintegration (Vichhinnata) of Dosha. Those

disintegrated (Vichhinna) Dosha by virtue of the Anu Pravana Bhava (property to

traverse through microchannels) move smoothly to Amashaya of Sneha Bhavita

patient, without getting adhered in the route, similar to that of moving of honey

smoothly in the properly anointed mud pot. Then being the Virechana Aushadha

Dravya predominant of Prithvi and Apa Mahabhuta and its having Adho Bhagahara

Prabhava, the Dosha that were brought to Amashaya are expelled out through the

Guda Marga by the Aushadha.

Laxatives probably induce limited low-grade inflammation in the small and larger

bowel to promote accumulation of water and electrolytes, and also stimulate intestinal

motility. From the above view, we may assume that Virechana Dravya (Shodhana

Variety) are mild irritant to the stomach and the intestinal mucosa, and cause

inflammation to them. Due to this, the permeability of the membrane changes and

those substances are facilitated to come out, which cannot come out in normal

Discussion


Psoriasis Page 124

condition. This medically produced mild inflammation initially facilitates quick

absorption of the active principles (Virya) of the drug. Later on, it facilitates the

excretion of morbid matters that are usually not excreted out under normal

circumstances.

Conclusion


Psoriasis Page 125

CONCLUSION

Virechana is a procedure in which orally administered drug acts on morbid Doshas,

especially Pitta, and expels them out through the Guda Marga (rectal route).

Psoriasis is a non-infectious, chronic inflammatory disease of the skin, characterized

by well-defined erythematous plaques with silvery scale, with a predilection for the

extensor surfaces and scalp, and having a chronic fluctuating course.

In Ayurveda, almost all the skin diseases have been described under the heading

‘Kushtha’. Psoriasis can be considered as one type of Kushtha and may resemble

Ekakushtha, Kitibha or Mandala Kushtha based upon its presentation.

Kushtha is a Tridoshaja Vyadhi and Virechana is best Shodhana therapy for Pitta

predominant disorders, meanwhile it also exerts its action on Shleshmasamsrishta

Avastha and also corrects the morbid Vata Dosha.

In this clinical study, Hridya Virechana Leha has been administered as Vairechanika

Yoga in the management of psoriasis. Trivrit is the chief component of Hridya

Virechana Leha, and Trivrit is considered as the best Virechana Dravya.

The results were found to be statistically significant. The results dealt with decrement

in the signs and symptoms of psoriasis viz. erythema, thickness, scaling and itching.

Summary


Psoriasis Page 126

SUMMARY

The dissertation entitled “ROLE OF VIRECHANA KARMA WITH HRIDYA

VIRECHANA LEHA IN THE MANAGEMENT OF PSORIASIS” consists of 8

Chapters namely Introduction, Objective, Review of Literature, Methodology,

Results, Discussion, Conclusion and Summary.

1. Chapter-1 Introduction: A brief introduction which gives concise idea about the

disease in Ayurvedic perspective as well as contemporary science perspective and

utility of Samshodhana and Virechana in treating psoriasis.

2. Chapter-2 Objectives: Gives idea about aims and objectives of the study.

3. Chapter-3 Review of Literature: Consists of 4 parts:

Part-1 Virechana Karma is described under the following headings:

Etymology of Virechana and its definition, Synonyms, Historical review of

Virechana, Indications and Contraindications of Virechana, Classification of

Virechana drugs, Procedure of Virechana - Poorvakarma, Pradhana Karma

and Paschat Karma, Samyak Yoga of Virechana, Virechana Vyapat, Mode of

action of Virechana.

Part-2 Kushtha is dealt in following headings: Etymology, Definition,

Historical review, Classification, Nidana, Poorvaroopa, Samprapti,

Sadhyasadhyata, Chikitsa, Pathyapathya

Part-3 Psoriasis is described under following headings: Etymology,

Definition, Epidemiology, Etiology, Pathogenesis, Clinical features, Types of

Psoriasis, Complications.

Part-4 Drug Review explains the properties of the drugs used in Deepana-

Pachana, Snehapana, Pariseka, Virechana Karma.

Summary


Psoriasis Page 127

4. Chapter-4 Methodology: Deals with the overall aspect of the Clinical Study, i.e.

materials and methods including selection of the patients for the study, study design,

interventions, criteria for assessment of results.

5. Chapter-5 Results: All the Observations regarding Epidemiology, history, clinical

examination, intervention were obtained and analyzed, and graphically presented.

Results of Assessment Criteria scorings obtained were analyzed statistically and

presented.

6. Chapter-6 Discussion: Deals with interpretation of the Review of Literature and

its subheadings, Methodology, results, i.e. change in PASI and 5 D Itch scores. Also

describes the logical interpretation of observation obtained in the clinical study.

7. Chapter-7 Conclusion: Conclusion of the various sections of the work are given

here.

8. Chapter-8 Summary: Summarizes the entire work.

References


Psoriasis Page 128

REFERENCES:

1. Chakrapanidatta, Caraka Samhitha of Agnivesha with Ayurveda Dipika

Commentary Edited by Acharya Jadavji Trikamji. Edition: reprint, 2013.

Varanasi, U.P.: Chaukhamba Prakashan; Pp-738 Page no-651

2. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL ,Jameson JL ,

Loscalzo, Editors. Harrison’s Principle of Internal Medicine, Volume-1 17th

Edition MC Graw - Hill Medical Publishing division, Pp-1364 Page no-315

3. Apps.who.int/gb/ebwha/B133_5-en.pdf







6. Vagbhatacharya, Ashtanga Sangraha with Vidhyotini Vyakhya. Kaviraj

Aatridev Gupta. Krishnadas academy, 1993 Varanasi, Pp-407, p-197

7. Kashyapa, Kashyapa Samhita, Revised by Vatsya, Hindi commentary and

translation by Satyapala Bhishagacharya, 5th

edition. Varanasi, Chaukamba

Sanskrit Samstana, 1998, Siddisthana, 2nd

chapter. Pp- 364, p- 150

8. Dr. D B Panditrao, Hindi Translation of Sahasrayoga, Chapter 4, Verse 348,

New Delhi, Central Council for Research in Ayurveda and Sidda, 1990, 245

9. Sharangdhara Samhita; Translated into English by Dr. P. Himsagara Chandra

Murthy; Chowkhamba Orientilia , Varanasi ; Edition: 2010 Pp- 454 Pg-34

References


Psoriasis Page 129

10. Devarushi V. Praveen ; “Role of Virechana karma in the management of

Psoriasis- A clinical study” [Department of P.G. Studies in Panchakarma,

S.D.M. College of Ayurveda , Kuthpady, Udupi, RGUHS, Karnataka, 2009 ]

11. M.N. Girija ; “ Role of virechana karma in the management of the psoriasis –

A clinical study” [Department of P.G. Studies in Panchakarma , S.D.M.

College of Ayurveda , Kuthpady, Udupi, RGUHS, Karnataka, 2011]

12. Rao Srinivas ; “To evaluate the efficacy of Virechana with Karvellaka patra

and Abhyadi modaka in Ekakushta w.s.r. Psoriasis – A comparative study”;

[Government Ayurvedic Medical College Bangalore, Karnataka , 2011]

13. Thakur Avantika; “Role of Virechana Karma with Kalyanaka Guda in the

management of Psoriasis”; SDM College of Ayurveda, Udupi, Karnataka,

2016]










17. Vagbhata; Ashanga Samgraha with Sasilekha Commentary Choukambha

Krishnadas academy, Varanasi 2006. Indu, Sutrasthana 27/4

References


Psoriasis Page 130







20. Sushruta, Sushruta Samhita with Nibandha Sangraha Commentary

Choukhamba Sanskrit series 2002.Chikitsa Sthana 33/25-32 page no 518-519

21. Vagbhata; Astanga Hridaya with Sarvaga Sundara Commentary, Krishnadas

academy, Varanasi 1995.Sutrasthana 27/8-9 page no 327

22. Sharangadhara, Sharangadhara Samhita with Commentaries Adhamallas

Dipika and Kasiramas Gudhartha Dipika, Published by, Varanasi. Uttara

Khanda, 4/7-11 page no 313









26. Agnivesa, Charaka Samhita with Ayurveda Dipika Commentary,

Choukhamba Sanskrit series. Varanasi.1994.Sutra Sthana 1/78-80 page no 20


Choukhamba Sanskrit series 2002.Sutra Sthana 39/4 page no 170.

References


Psoriasis Page 131




Choukhamba Sanskrit series .Varanasi.1994.Sutra Sthana 1/82-87 page no 21.




Choukhamba Sanskrit series .Varanasi.1994.Sutra Sthana 1/115-116 page no

22.

32. Sushruta, Sushruta Samhita with Nibandha Sangraha commentary



Choukhamba Sanskrit series .Varanasi.1994.Sutra Sthana 1/117-118

page no 22.


Choukhamba Sanskrit series 2002.Sutra Sthana 39/4 page no 170


Choukhamba Sanskrit series .Varanasi.1994.Kalpa Sthana 12/56 page no 673.



Khanda, 4/13 page no 313


Choukhamba Sanskrit series .Varanasi.1994.Kalpa Sthana 12/56 page no 673.

References


Psoriasis Page 132





Choukhamba Sanskrit series .Varanasi.1994.Kalpa Sthana 12/51-53 page no

672-673





Dipika and Kasiramas Gudhartha Dipika, Published by, Varanasi. Purva



Choukhamba Sanskrit series 2002.Sutra Sthana 46/329 page no 237










References


Psoriasis Page 133





Choukhamba Sanskrit series 2002.Sutra Sthana 44/90-91page


Choukhamba Sanskrit series 2002.Sutra Sthana 44/3 page no188


Choukhamba Sanskrit series 2002. Sutra chikitsa 33/20 page no 518


Choukhamba Sanskrit series .Varanasi.1994. Sutra Sthana 15/17 page no 95


Choukhamba Sanskrit series 2002.Chikitsa Sthana 33/2 page no 519


Choukhamba Sanskrit series 2002. Chikitsa Sthana 33/24 page no 520


Choukhamba Sanskrit series 2002. Chikitsa Sthana 33/23 page no 519







References


Psoriasis Page 134






Varanasi, U.P.: Chaukhamba Prakashan; Pp-738 Page no-227.

58. Agnivesha, “Charaka Samhita”, redacted by Charaka and Dridhabala,

Ayurvedadipika commentary of Chakrapanidatta, edited by Yadavji Trikamji,

Reprint edition 2011, Chaukhambha Orientalia, Varanasi, U.P. 2008. Pp : 738

:Page No 216.




:Page No.513,458,616,600.

60. Maharshi Sushruta, Sushruta Samhita, Nibandhasangraha Samsrutatika by

Dalhana, Nyayachandrika samskruta tika by Gayadasa, Edited by Yadavji

Trikamji Acharya, Choukhamba samskruta samsthana, Varanasi, edition:

Reprint 2010, Pp:824, Page no.82,167

61. Vagbhatacharya, Astanga Hrudaya, Sarvangasundara by Arunadatta and

Ayurveda Rasayana by Hemadri Samskrita Commentry, Edited by Dr Anna

Moreshvara Kunte and Dr Krishna Shastry Navare, Edition: reprint 2010,

Choukhamba Samskrita Samsthana, Varanasi, Pp: 956, Page no 244.

62. Sharngadhara, Sharngadhara Samhita, Deepika by Adhamalla, Gudhartha

Deepika by Kashirama,Edited by Pandit Parushurama Shastri, Edition: Printed

1931, Nirnaya Sagara Press, Mumbai, Pp:398, Page No144.

References


Psoriasis Page 135

63. Vangasena, Vanga Samhita, Hindi Commentary by Kaviraj Sri Saligramaji

Vaidya, Samshodhan Karta Sri Vaidya Shankarlala Jain Khemaraja; Sri

Krishnadas Prakashana, Varanasi

64. Agnivesha, Charakasamhita, redacted by Charaka and Dridhabala,



, Page No 227

65. Vagbhatacharya, Astanga Hrudaya Sarvangasundara by Arunadatta and

Ayurveda Rasayana by Hemadri Samskruta Commentry, Edited by Dr Anna


Choukhamba Samskrita Samsthana, Varanasi, Pp:956, Page no143




67. Maharshi Sushruta, Sushruta Samhita, Nibandhasangraha Samsrita Tika by

Dalhana, Nyayachandrika Samskrita Tika by Gayadasa, Edited by Yadavji

Trikamji Acharya, Choukhamba Samskrita Samsthana, Varanasi, Edition:

Reprint 2010, Pp:824, Page no :230




Choukhamba Samskrita Samsthana, Varanasi, Pp:956, Page no524.

69. Maharshi Kashyapa or Vridhajivaka, Kashyapa Samhita or Vridha Jivaka

Tantra revised by M Narayanan Vaydyar Edakkad, Danwantari Publishers

1995 Pp 656 Page No: 437

References


Psoriasis Page 136

70. Madhava, Madhava Nidana, Edited by Yadavji Trikamji, Edition – 1st 1920,

Nirnaya Sagara Press, Mumbai, Pp:495, Page No: 334.

71. Bhavamishra, Bhavaprakasha Part 2, Edited by and Vidyotini Hindi

commentary by Brahmashankara Mishra, Edition: 1st Edition, 1941,

Choukhamba samskruta series, Varanasi, Pp:755, Page No: 561







Reprint 2010, Pp:824, Page no 283




Choukhamba Samskrita Samsthana, Varanasi, Pp:956, Page no524







Reprint 2010, Pp: 824, Page no: 230



References


Psoriasis Page 137


Choukhamba Samskrita Samsthana, Varanasi, Pp:956, Page no524.

78. Vagbhatacharya, Astanga Samgraha, Shashilekha Samskrita Commentry by

Indu, Edited by Dr. Shivaprasada Sharma, Edition: reprint 2010, Choukhamba

Samskrita Samsthana, Varanasi, Pp:964, Page no :408.

79. Madhava, Madhava Nidana, Edited by Yadavji Trikamji, Edition1st

1920,



Commentary by Brahmashankara Mishra, Edition: 1st Edition, 1941,

Choukhamba Samskrita Series, Varanasi , Pp:755, Page No: 561







Reprint 2010, Pp: 824, Page no:230







Samskrita Samsthana, Varanasi, Pp: 964, Page no: 408.

References


Psoriasis Page 138


1920,




Choukhamba Samskrita Series, Varanasi, Pp: 755, Page No: 561







Reprint 2010, Pp: 824, Page no: 230

89. Vagbhatacharya, Astanga Hridaya Sarvangasundara by Arunadatta and






Samskrita Samsthana, Varanasi, Pp: 964, Page no:408.


1920,

Nirnaya Sagara Press, Mumbai, Pp: 495, Page No 330.



Choukhamba Samskrita Series, Varanasi, Pp: 755, Page No: 561

References


Psoriasis Page 139

93. Maharshi Sushruta, Sushruta Samhita, Nibandhasangraha Samsrutatika by



Reprint 2010, Pp:824, Page no. 230




:Page No.235




:Page No177.




:Page No 450.

97. Maharshi Sushruta, “Sushruta Samhita”, Nibandhasangraha Samsrutatika by




98. Vagbhatacharya, “Astanga Hrudaya” Sarvangasundara by Arunadatta and

Ayurveda rasayana by Hemadri SamskrutaCommentry ,edited by Dr Anna

Moreshvara Kunte and Dr Krishna shastry navare, Edition: reprint 2010,

Choukhamba samskruta samsthana, Varanasi, Pp:956, Page no :524.

References


Psoriasis Page 140

99. Vagbhatacharya, “Astanga Samgraha” ShashilekhaSamskruta Commentry by

Indu, edited by Dr. Shivaprasada Sharma, Edition: reprint 2010, Choukhamba

samskruta samsthana, Varanasi, Pp:964, Page no :408.

100. Madhava, “Madhava Nidana” edited by Yadavji Trikamji, Edition1st1920,


101. Bhavamishra, “Bhavaprakasha Part 2” Edited by and vidyotini Hindi

commentary by Brahmashankara Mishra, Edition: 1st Edition, 1941,

Choukhamba samskruta series, Varanasi , Pp:755, Page No: 556




:Page No 217.




:Page No 452.

104. Maharshi Sushruta, “Sushruta samhita”, Nibandhasangraha Samsrutatika by





Ayurveda rasayana by Hemadri SamskrutaCommentry ,edited by Dr Anna

Moreshvara Kunte and Dr Krishna shastry navare, Edition: reprint 2010,

Choukhamba samskruta samsthana, Varanasi, Pp:956, Page no :527.

References


Psoriasis Page 141




:Page No 259.




:Page No.176.




Reprint 2010, Pp:824, Page no :232,357




:Page No.262

110. Vagbhatacharya,”Astanga Samgraha” ShashilekhaSamskruta Commentry by

Indu, edited by Dr. Shivaprasada Sharma, Edition: reprint 2010, Choukhamba

samskruta samsthana, Varanasi, Pp:964, Page no :550.

111. Tony burns, Stephen breathnach, Neil cox, Christopher Griffiths, “Rook’s

Textbook of Dermatology, 8th

edition, 2010, Wilie-Blackwell Publication,

Volume 1, Chapter No 20, Page no 20.

112. Jean L Bolognia, Joseph L Jorizzo,Julie V Schaffer, Jeffrey P Callen,

George J Hruza, James W Patterson, Lorenzo Cerroni, Anthony J Mancini,

References


Psoriasis Page 142

Martin Röcken, Warren R Heymann, Thomas Schwarz, ”Dermatology”, 3rd

edition 2012, Elsevier Saunders, Pp:2572, Page no:135

113. Dogra S, Yadav S. Psoriasis in India: Prevalence and Pattern. Indian J

Dermatol Venerol Ceprol.2010;76:595-601

114. Klaus wolffs, Lowella A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest,

Amy S. Paller, David J. Leffel,” Fitzpatrick’s Dermatology in general

medicine”, 7th

edition, 2008, The Mcgraw-Hill Companies, Inc, Volume 1,

Chapter No 18, Pp: 1190, Page no 170.




Volume 1, Chapter No 20, Page no 20.1

116. www.mg217.com/your-psoriasis/statistics

117. Jean L Bolognia, Joseph L Jorizzo, Julie V Schaffer, Jeffrey P Callen,



edition 2012, Elsevier Saunders,Pp:2572, Page no:139




Volume 1, Chapter No 20, Page no 20.7.




Volume 1, Chapter No 20, Page no 20.7.

120. Jean L Bolognia, Joseph L Jorizzo, Julie V Schaffer, Jeffrey P Callen,


http://www.mg217.com/your-psoriasis/statistics

References


Psoriasis Page 143


edition 2012, Elsevier Saunders,Pp:2572, Page no:137.

121. Klaus Wolffs, Lowella A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest,


medicine”, 7th


Chapter No 18, Pp: 1190, Page no 178.

122. Thomas P Habif, “Clinical Dermatology; A color guide to diagnosis and

therapy” Fifth edition, 2010, Mosby Publications, Pp: 1028 Page no 267

123. Thomas P Habif, “Clinical Dermatology; A color guide to diagnosis and

therapy” Fifth edition, 2010, Mosby Publications, Pp: 1028 Page no 276.

124. Klaus wolffs, Lowella A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest,


medicine”, 7th


Chapter No 18, Pp: 1190, Page no 183

125. Sharma Priyavrat, Dravyaguna Vigyana, Vol 2, Reprinted 2013, Chokhamba

Bharati Akadami, Varanasi, Pp: 873, Page no 331-334

126. Bhaisajya Ratnavali, Edited by Acharya Siddhinandan Mishra, Chaukhamba

Surabharati Prakashana, Varanasi, Pp 1194, Page no 206


Bharati Akadami, Varanasi, Pp: 873, Page no 122


Ayurvedadipika commentary of Chakrapanidatta, Edited by Yadavji Trikamji,

Reprint edition 2011, Chaukhambha Orientalia, Varanasi, U.P. 2008. Pp: 738,

Page no155

References


Psoriasis Page 144


Dalhana, Nyayachandrika Samskruta Tika by Gayadasa, Edited by Yadavji

Trikamji Acharya, Choukhamba Samskruta Samsthana, Varanasi, Edition:

Reprint 2010, Pp: 824, Page no 217


Bharati Akadami, Varanasi, Pp: 873, Page no 145

131. Dr. D B Panditrao, Hindi Translation of Sahasrayoga, Chapter 4, Verse348,

New Delhi, Central Council for Research in Ayurveda and Sidda, 1990, Pp:

621, Page no-245

132. Bhavaprakasha, Commentry by Bulusu Sitaram, Vol. 1 , Chaukhamba

Orientalia, Varanasi, Pp: 738, page no 538

133. Bhavaprakasha, translated by K. R. Shrikantha Murthy, Vol. 1, Reprint

2008, Choukhamba Krishnadas Academy, Varanasi, Pp: 738, Page no 217


Ayurvedadipika commentary of Chakrapanidatta, Edited by Yadavji Trikamji,

Reprint edition 2011, Chaukhambha Orientalia, Varanasi, U.P. 2008. Pp: 738,

Page no167


Dalhana, Nyayachandrika Samskruta Tika by Gayadasa, Edited by Yadavji

Trikamji Acharya, Choukhamba Samskruta Samsthana, Varanasi, Edition:

Reprint 2010, Pp: 824, Page no 207-8


Ayurveda Rasayana by Hemadri SamskrutaCommentry, Edited by Dr Anna


Choukhamba Samskruta Samsthana, Varanasi, Pp: 956, Page no 742.

References


Psoriasis Page 145

137. Chakrapanidatta, Charaka Samhita of Agnivesha with Ayurveda Dipika

commentary edited by Acharya Jadavji Trikamji edition: reprint, 2013

Chaukhamba Prakashan, Varanasi U.P. Pp-738, page no-216.

138. Chakrapanidatta, Charaka Samhita of Agnivesha with Ayurveda Dipika

commentary edited by Acharya Jadavji Trikamji edition: reprint, 2013

Chaukhamba Prakashan, Varanasi U.P. Pp-738, page no-649

139. Dogra S, Yadav S. Psoriasis in India: Prevalence and Pattern. Indian J

Dermatol Venerol Ceprol. 2010; 76:595-601


Psoriasis 146

FORMAT OF CONSENT FORM

I, ……………………………………, declare that I have been briefed and here by

consent to be included as a subject in the following dissertation, “Role of Hridya

Virechana Leha in the management of Psoriasis”.

I have been informed to my satisfaction by the attending Dr. Cyrus Neupane, the

purpose of work done and laboratory investigations required and other investigations

that may be required in management of my case.

This has been explained to me in the language I understand and fully consent for

the same.

Signature of the doctor: Signature of patient:

Name of doctor: Date:

Date:


Psoriasis 159


Psoriasis 147

PROFORMA FORMAT

DEPARTMENT OF PG STUDIES IN PANCHKARMA

S.D.M. COLLEGE OF AYURVEDA,

KUTHPADY, UDUPI

RESEARCH PROFORMA FOR STUDY ON

ROLE OF VIRECHANA KARMA WITH HRIDYA VIRECHANA LEHA IN

THE MANAGEMENT OF PSORIASIS

Guide: Dr. Niranjan Rao Co-guide: Dr. Pooja B A

Scholar: Dr. Cyrus Neupane

Name: Serial No.:

Age: OPD No.:

Sex: IPD No.:

Education: DOA:

Occupation: DOD:

Social status: Address:

Marital status: Phone No.:

Religion: Desha:

Chief Complaints: Duration:

Associated Complaints:

Any joint complaints: Yes/ No

Any nail changes: Onchylosis/ Ridging/

Pitting

HISTORY OF PRESENT ILLNESS:

1. Onset of lesion: Sudden/ Gradual/

Insidious

2. Site of onset:

3. Character of lesion: Continuous/ Intermittent/ Progressive/ Waxing and

waning

4. Aggravating factor:

5. Relieving factor (if any):


Psoriasis 148

HISTORY OF PAST ILLNESS:

H/o similar complaints earlier as well: Yes/ No

H/o Systemic illness:

H/o Others :

FAMILY HISTORY:

TREATMENT HISTORY:

Ayurvedic: Duration

Allopathic: Duration

Others: Duration

PERSONAL HISTORY:

1. Ahara Veg/ Mixed

Veg- Yava/ Shali/ Snigdha/ Madhura/ Amla/ Lavana/Katu rasa

pradhana Ahara/ Ksheera/Dadhi/Udada/Avalaki/Moolaka/

Vruntaka/Any Kanda Saka Ahara

Non-veg: Matsya/ Aja Mamsa etc

2. Emotional

status

Normal/ Anxiety/ Depression/Anger/ Irritation/Fear/Jovial

3. Vyasana Beedi/Cigarettes Yes/No

If yes, _ (No.)/day/week Duration

Alcohol Yes/No

If yes, _ (Quantinty)/ day/ week/month Duration

Tobacco chewing Yes/No

If yes, _ (No. of times/ Quantity)/ day/ week/month Duration

Tea/ Coffee Yes/ No

If yes, number of cups _ /day Duration

4. Vyayama Work Nature of work: both physical


Psoriasis 149

Sedentary/ Moderate/ Heavy and mental

5. Nidra _ hours per day

Sound/Disturbed/Delayed

Diwaswapna:

_ hours/day

Daily/ Occasional

Ratrijagarana:

_ hours/day

Daily/ Occasional

6. Mala

Visarjana

Regular

Irregular

Constipation

Loose stools

Frequency

_ /day

Colour

Consistency

7. Mutra

Pravritti

Normal

Polyuria

Dysuria

Oliguria

Frequency: _ /day

_ /night

Colour

Pravritti:

Sadaha

Sashula

Sahaja

8. Sweda

Pravritti

9. Urges Normal

Supression

Occasional suppression

10. Koshtha Mridu

Madhyama

Kroora

OBSTETRIC HISTORY:

Gravidity: Parity: Abortion: Living: Term Birth: Premature

Birth:

GYNECOLOGICAL HISTORY:

Menarche: Menstrual Cycle: Dysmenorrhea:

Menopause (If attained):

GENERAL EXAMINATION:

Pulse

Respiration

Blood pressure

Temperature

Nourishment


Psoriasis 150

Built

Pallor

Icterus

Cyanosis

Clubbing

Lymphadenopathy

Oedema

Deformities

Contractures

Others

DASHAVIDHA PAREEKSHA:

Prakriti

Vikriti

Sara

Samhanana

Prammana

Satmya

Satva

Ahara Shakti

Vyayama Shakti

Vaya

SYSTEMIC EXAMINATION:

RS

CVS

PA

CNS

EXAMINATION OF THE SKIN:

1. Colour of the skin Normal, Black, White, Other

2. Shape of the lesion Round/ Oval/ Polygonal/ Irregular

3. Type of lesion Macule/ Papule/ Maculo palpular/ Plaque/


Psoriasis 151

Lichenification/

Nodule/ Patch/ Other

4. Distribution Exposed area/ Closed area/ Exposed+Closed

area/ Flexor/ Extensor/ Medial Lateral/

Anterior/ Posterior

5. Pattern Localised/ Generalised/ Symmetrical/

Asymmetrical

6. Border Well demarcated/ diffused

7. Itching Present/ Absent

8. Type of scale Dry/ Moist/ Greasy

9. Discharge Present/ Absent

10. Vedana Supti/ Shoola/ Daha/ Kandu

11. Sparsha Rooksha/ Khara/ Kathina/ Shootha

Kushtha Dosha Taratamatva:

Vataja Lakshana-

Roukshya Shosha Sankocha Ayama

Parushya Kharabhava Harsha Shyavaarunatva

Pittaja Lakshana-

Raga Prisrava Paka Visragandanda

Kleda Daha Angapatana

Kaphaja Lakshana-

Shveitya Shaitya Sneha Kleda

Sthairya Gaurava Kandu Utsedha

CONFIRMATORY SIGNS

Auspitz Sign

Candle grease Sign

INVESTIGATIONS

Hb%


Psoriasis 152

TC

DC

ESR

Blood Sugar

Skin biopsy if needed

TREATMENT SCHEDULE

Poorva Karma:

Deepana Pachana: Shunthi Kashaya

Dose-20 ml tds for ….. days (Until Niramvastha and Agnideepti)

SNEHAPANA VIDHI

Name of the Sneha given- Moorchhita Tila Taila with Ushna Jala

DAY DATE TIME QUANTITY TIME OF SNEHA

JIRNATA

DAY 1

DAY 2

DAY 3

DAY 4

DAY 5

DAY 6

DAY 7

SNEHA JEERYAMANA LAKSHANA

LAKSHANA Shiro

ruja

Bh

rama

Lalash

rava

Angasaad

a

Murch

ha

Klam

a

Trish

na

Dah

a

Arati

DAY 1

DAY 2

DAY 3

DAY 4

DAY 5

DAY 6


Psoriasis 153

DAY 7

SNEHA JEERNA LAKSHANA

LAKSH

ANA

JeeryamanaLaksha

na Prashamana

Trishna

Pravritti

Kshuda

Pravritti

Udgarash

uddi

Shiralag

havata

Vatanulo

mata

DAY 1

DAY 2

DAY 3

DAY 4

DAY 5

DAY 6

DAY 7

SAMYAK SNIGDHA LAKSHANA

LAKSHANA Vatan

olo

mata

Agnid

eepti

Snig

dha v

archa

Asam

hata

varch

a

Sneh

odveg

a

Gatran

ardav

ata

Tw

oksn

igd

hata

DAY 1

DAY 2

DAY 3

DAY 4

DAY 5

DAY 6

DAY 7

VISHRAMA KALA:

Karanja Kwatha Pariseka for 4 days

SAMYAKA SWINNA LAKSHANA

LAKSHANA

DAY 1 DAY 2 DAY 3 DAY 4

Sheetoparama


Psoriasis 154

Shooloparama

Stambhanigraha

Gouravanigraha

Mardavata

Sweda

pradurbhava

Rogaprashamana

PRADHAN KARMA:

ADMINISTRATION OF VIRECHANA YOGA- HRIDYA VIRECHANA LEHA

ANUPANA- HOT MILK

TIME OF ADMINISTRATION- 9:30 AM

DOSE-

SAMYAKA VIRIKTA LAKSHANA

Serial

no. of

Vegas

Time Colour Consistency Virikta

dravya

Water

consumed Urine

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16


Psoriasis 155

17

18

19

20

21

22

23

24

25

26

27

28

29

30

INPUT = ml Total Virikta(stool) Dravya: =

ml

URINE OUTPUT = ml Total output (urine and stool) =

ml

SAMYAKA YOGA ATI YOGA AYOGA

Srotovishuddi Supti Apravritti

Indriyaprasada Angamarda Vitsanga

Laghuta Klama Vidgraha

Agnivriddhi Vepana Alpapravritti

Anamayatva Balaabhava Agnimandya

Vatanulomana Nidraabhava Gaurava

Vitpittakapha vata kramasha nissarana Tama Pratishyaya

Moorchha Tandra

Unmada Chardi

Hikka Aruchi

Gudabhramsa Vatapratiloma

Shula Pidika


Psoriasis 156

Mala vaivarnya Daha

Trishna Hridya vishuddhi

Netra praveshanam Kukshee ashuddhi

Kandu

Mutrasanga

ANTIKI

VEGIKI

MANIKI

LAINGIKI

OBSERVATION OF VITAL DATA & WEIGHT

TIME

PULSE BLOOD PRESSURE RESP. RATE WEIGHT

CONFIRMATORY SIGNS:

SIGNS

BT AT

Ausptiz Sign

Candle grease Sign

5 D ITCH SCALE:

ASPECT SCORE (0-5):

1. Duration

2. Degree

3. Direction

4. Disability

5. Distribution

TOTAL 5D ITCH SCORE:

P.A.S.I. SCORING


Psoriasis 157

TIME

PART LESION

SCORE (0-4)

LESION

SCORE

SUM

(A)

AREA

SCORE

(0-6)

(B)

SUB

TOTAL

(A X B)

(C)

C X

BODY

SURFAC

E AREA

TOTAL

E S T

BEFORE

VIRECH

ANA

HEAD X 0.1

TRUNK X 0.2

U. LIMB X 0.3

L. LIMB X 0.4

TOTAL

(PASI

SCORE)

TIME

PART LESION

SCORE (0-4)

LESION

SCORE

SUM

(A)

AREA

SCORE

(0-6)

(B)

SUB

TOTAL

(A X B)

(C)

C X

BODY

SURFAC

E AREA

TOTA

L

E S T

AFTER

VIRECH

ANA

HEAD X 0.1

TRUNK X 0.2

U. LIMB X 0.3

L. LIMB X 0.4

TIME

PART LESION

SCORE (0-4)

LESION

SCORE

SUM

(A)

AREA

SCORE

(0-6)

(B)

SUB

TOTAL

(A X B)

(C)

C X

BODY

SURFAC

E AREA

TOTA

L

E S T

AFTER HEAD X 0.1


Psoriasis 158

FOLLO

W UP

TRUNK X 0.2

U. LIMB X 0.3

L. LIMB X 0.4

I= ITCHING E= ERYTHEMA S= SCALING T= THICKNESS

Signature of the candidate

Signature of the guide

Role of Virechana Karma with Hridya Virechana Leha in the Management of Psoriasis 160


Psoriasis 168

ANNEXURES

PSORIASIS AREA AND SEVERITY INDEX (PASI) WORKSHEET

Plaque characteristic Lesion score Head Upper

Limbs

Trunk Lower

Limbs

Erythema 0 = None

1 = Slight

2 = Moderate

3 = Severe

4 = Very severe

Induration/Thickness

Scaling

Add together each of the 3 scores for each body region to give 4 separate sums (A).

Lesion Score Sum (A)

Percentage area affected Area score Head Upper

Limbs

Trunk Lower

Limbs

Area Score (B)

Degree of involvement as a

percentage for each body

region affected (score each

region with score between

0-6)

0 = 0%

1 = 1% - 9%

2 = 10% - 29%

3 = 30% - 49%

4 = 50% - 69%

5 = 70% - 89%

6 = 90% - 100%

Multiply Lesion Score Sum (A) by Area Score (B), for each body region, to give 4

individual subtotals (C).

Subtotals (C)

Multiply each of the Subtotals (C) by amount of body surface area represented by that

region, i.e. x 0.1 for head, x0.2 for upper body, x 0.3 for trunk, and x 0.4 for lower limbs.

Body Surface Area

Totals (D)

Add together each of the scores for each body region to give the final PASI Score.

PASI Score =


Psoriasis 169

ROLE OF VIRECHANA KARMA WITH HRIDYA VIRECHANA ...

Documents

Transcript of ROLE OF VIRECHANA KARMA WITH HRIDYA VIRECHANA ...