Efficacy of Virechana Karma in Psoriasis (Ek Kushta) – A Case Study

Introduction

Psoriasis is a chronic dermatosis, characterized by an unpredictable course of remissions and relapses and presence at typical sites of well-defined, erythematous, indurated papules and plaques, which are surmounted by large, loose, silvery scale. Roughly 1% of population affected. It occurs with almost equal frequency in males and females [1]. Ayurveda diagnosis is Ek kushta, a Vata- Kapha predominant Kushta presenting with Aswedanam, Mahavastu, and Matsyashakalopamam [2]. Samshodhana, followed by Samshamana medications, is the basis of treatment for all varieties of Kushta [3].

Case Report

A male patient aged 41 years, visited OPD of Rishikul Campus (Reg. No: 32549/5756), Haridwar, Department of Panchakarma, with complaints of reddish white irregular dry, scaly lesions over both lower limbs and forearm since 10 years. Also, he complains having extreme itching, especially in the colder months. He had allopathic care and has been using topical steroids for the last past 10 years, but only brief alleviation.

History of Past Illness

No history of DM/HTN/Other systemic disorders.

Dashavidhapareeksha

• Prakruti- Vata Pitta

• Vikruti – Kapha Rakta

• Sara- Madhyama

• Pramana – Madhyama

• Satwa – Pravara

• Satmya – Madhyama

• Ahara Shakti – Madhyama

• Vyayama Shakti – Madhyama

• Vaya – Madhyama

General Examination

• Pallor – Absent

• Icterus – Absent

• Koilonychias – Absent

• Lymphadenopathy – Absent

• Edema – Absent

Investigation

• Hb – 14.27 g/dl

• TLC – 8.10/L

• DLC – Neutrophils: 72.85%

Lymphocytes: 19.12% Monocytes: 5.82% Eosinophils: 2.01% Basophils: 0.20%

• Glucose (Fasting) – 92.1mg/dl
• TSH – 1 microIU/Ml
• SGOT – 39.7 U/L
• SGPT – 26 U/L
• Serum Cholesterol – 194 mg/dl
• Serum Triglyceride – 640 mg/dl

Nidana

Excessive intake of Kshira, Dadhi, Kulatha, Masha, Katu Rasa Ahara, Virudha Ahara, Shoka, Chinta and Ratri Jagarana.

Samprapti

According to Acharya Charaka seven Dravyas are involved in the Samprapti. It includes all the three Doshas (Vata, Pitta, Kapha) along with four Dushyas i.e. Twaka, Rakta, Mamsa and Lasika. Acharya Charaka has stressed upon the dual part played by Nidana i.e., simultaneous vitiation of Tridosha and disturbance of normal configuration i.e., ‘Shaithiya’ in Dhatus. This leads to the final manifestation of Kushtha.

Samprapti Ghataka

Vyavachedakanidana

Vyadhi Vinischaya

Eka Kushta

Therapeutic Intervention

No. of Vegas – 24 Shuddhi – Uttama Antiki Shuddhi – Kaphanta Peyadisamsarjana Karma was followed after Virechana for next 7 days.

Life style modification

Advised to sleep early and wake up early, morning walk and to follow ideal daily routine, timely intake of food, to

Results

take green leafy vegetables, pomegranate fruit, and barley. Also advised to avoid rice, curd, tea, pickles, fried food and excessive salt.

Click to enlarge

Figure1: Before treatment.

Click to enlarge

Figure2: After treatment.

Click to enlarge

Click to enlarge

Discussion

According to the Ayurvedic perspective, psoriasis is viewed as a Raktaja condition with Dosha vitiation. Pre-operative, operative, and post-operative care during Virechana Karma is most crucial to produce better results in psoriasis. Virechana Karma is one of the treatment modalities for this condition. The Dosha situated in Twak. In order to normalize the deranged Agni, it is important to take Deepana and Pachana medicine before Snehapana. Typically, Arohana Snehapana is taken for up to seven days or Samyak Snigdha Lakshana. Sneha’s ability to disrupt the pathogenesis of psoriasis by gradually increasing dosage helps to loosen the connection between the Dosha, Dushya.

Panchatikta Ghrita was used for the Snehapana. The ingredients of Panchatikta Ghrita include Triphala, Guduchi, Patola, Nimba and Patola. The medication contains Ushna, Tikshna, Vyavayi, Vikasi, Katu, Tiktarasatmaka, and Katu Vipaka. It was found that the Deepana, Pachana, Amapachaka, Shrotoshodhaka, Raktaprasadhana, Raktashodhaka, Kandughna, Kushthaghna, and Varnya mode of action were mostly responsible for the effects of these medications. It also soothed the signs of exacerbated Vata and Kapha Doshas, such as itchiness, discoloration, and dryness.

Trivrit Avleha was used for the Virechana Yoga. The primary ingredient in this preparation is Trivrit, which is included in the group of “ten purgative herbs” (Bhedaniya Mahakashaya), “ten antidote herbs” (Vishaghna Mahakashaya), “ten herbs supportive for therapeutic enema” (Ashthapanopaga Mahakashaya), “colon cleanser, antitumor & antidote herbs” (Shyamadi Gana), Adhobhagahara Gana is of the class of “herbs removing toxins (i.e., vitiated Dosha) from lower half of the body” (Anantaram Sharma, 2008).

Virechana medications bring out the therapeutic purgation due to its Prabhava (potency). These medications can aid in the induction of purgation because they have a natural inclination to go downhill due to the dominance of Jala and Prithvi Mahabhuta. The waste products can be brought into the intestine to maintain homogeneity from where they can be eliminated out of the body by the action of the intestine, which is induced by the Virechana drug, as has already been mentioned. This process can occur wherever the waste products are present in the body, whether they are extracellular, intracellular, or in plasma. The supplied medication’s active ingredients will activate the mucosal membrane and momentarily alter the normal permeability of the mucosal lining, causing morbid pollutants that were transported from the cellular to the gut levels via Snehana and Swedana Karma to exude through the anal pathway.

Conclusion

The majority of the psoriasis condition seems to be a keratinization issue. In a psoriatic lesion, fast epidermis displacement is the primary problem (3-4 days in-stead of 28 days in normal skin). There is proof that biological mechanisms involving hormones and the immune system work together. The increased levels of arachidonic acid metabolites in psoriasis patient’s afflicted skin are associated with the clinical alterations. According to Ayurveda, psoriasis can be treated with Shodhana and Shamana therapy. Virechana Karma is frequently recommended in the treatment of psoriasis because it assists in addressing the fundamental pathogenic elements of Pitta, Rakta, Agni, and Twak. In this specific example, symptoms improved by 60% during Shodhana therapy and by 80% following the administration of an oral medication for two months. As a result, purgation therapy followed by internal drugs is seen to be the best course of treatment for skin conditions.