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GUIDED BY
DR.UMESH SHUKLA MD(ayu), PhD
DR.KAMINI SONI MD(ayu) DR.BABITA DASH
MD(ayu), PhD
PRESENTED BYPRAKASH SINGH RAJPUT
MD-FIRST YEAR
DEPARTMENT OF PANCHAKARMA
INTRODUCTION
All skin disease in ayurveda have been discussed under the
broad heading of “Kustha” which are further divided in
Mahakustha and kshudrakustha. Ekakustha is considered one
of the kshudrakustha in Ayurveda.
Acc. to Ayurvedic classics each type of kustha is to be a
Tridoshaja menifestation.their Doshik identity can be
established on the basis of dominance of Dosha in the
Samprapti.
The Ekakustha is Vata-Kapha dominance
Causes and Specific etiology for Ekakustha has been not
described in any Ayurvedic text . So it can be understood by
general etiology of Kustha all causes ok Kustha can be
considered under two main causes.
Aharaj hetu Faulty diet and dietetic pattern, the most common
Hetu cause of Kustha mentioned in all the Samhitas.
Viharaj hetu Faulty life style proper follow up of Dincharya,
Ritucharya, Aachar Rashayana, Ahara Vidhi Vidhana.
Accumulation of low potency poisons (dooshi
visha),exposure to severe climatic conditions, controlling
natural urges like vomit, micturition, bowel emptying etc.
Taking bath in cold water immediately after physical exertion,
afternoon sleep.
PATHOGENESIS
Nidan Sevana,
Tridoshas will get vitiated.
These vitiated Doshas move in the Triyaka Sira.
Then they have Sammurchchana with the Dushya.
Then it will reach the Bahya Roga Marga
The doshas thus lodges into the skin continue to aggrevate
If these Doshas are not treated properly they enter the deeper Dhatus
Resulting in discoloration in the form of patches on the skin.
Dosha Vata, pitta, kapha
dushya Tvaka, rakta, mamsa, laseeka
srotash Rasavaha, raktavaha, mamsavaha, svedavaha
srotodusti Sanga, vimargagamana
marga Baahya rogamarga
Adhishthana svabhava tvaka
Aswdanam- Absence of sweating. Predominance of Vata and
Kapha dosha cause Sankoch and Sanga respectively to cause
obstruction in Swedavaha Srotasa leading to Aswdanam.
Mahavastu- Extensive lesions invading whole body. The area of
involvement of the lesion is vast due to Sighkari Guna of Vata,
Redness ( due to Pitta ), Itching (due to Kapha ) through Rakta
spread quickly in vast area.
Matsyashakalopamam- Scaling resemble of fish. Due to Vata
dosh increase mitosis and produce more dead cells (Scaling ) in
Twacha within 2 – 14 days by increasing frequent cell division.
Krisna- aruna varnata
It is difficult to say that ekakustha is in terms of
modern science. There is no disease in modern science
which can be exactly be correlated with ekakustha. But
symptomatology of psoriasis are mostly related to
ekakustha.
Many researchers have tried to attribute psoriasis with
one or other type of kustha.
ekakustha psoriasis
aswedanam The lesion of this desease are dry and rough
mahavastum Lesions are found all over the body
matsyasaklopam Well defined raised macules, papules & plaques
of erythema found which are covered with
silvery scales.
Krishna- aruna varna The lesion are raised & erythamatous, thick
lesion becomes black colour.
Psoriasis is defined as chronic non-infectious inflammatory
skin disease.
Size from few milimetre to several centimeter, individual
lesion are well demarcated,
It is characterized by well defined Erathematous slightly
raised plaques and papules with silvery scales,
They may be covered by dry, brittle, silvery or grayish white
loosely adherent micaceous scales. and typically on extensor
distribution.
In psoriasis skin cells replicate at an extremely rapid rate .
New skin cells are produced eight times faster i.e. within
three days in comparison to normal duration of i.e. 21 – 24
days.
But the rate at which old cells slough off is unchanged. This
causes cells to build up on the skin’s surface forming thick
patches.
The exact cause of Psoriasis is not known but it is believed
to have a genetic component i.e. family history.
Several factors act as a trigger i.e. stress, climate change,
excessive alcohol consumption, smoking.
Metabolic factors (e.g. ca deficiency), Drugs (lithium salts,
iodine, beta blockers, ace inhibitors, anti epileptic drugs,
NSAIDs, Sun burn, Hormonal Imbalance, Throat infection
(Streptococcal), Trauma etc.
The pathogenesis of psoriasis remains unclear. The initial reaction is passibly on intrinsic defect of keratinocytes
increased cytokines production
expansion of CD45RO-T cells
production of type 1 cytokines
results in changes in epidermal proliferation,
migration of neutrophils in to the epidermis
proliferation of vessels in the pappilary dermis.
Sites of Psoriasis; extensor surface of Elbow,
Anterior aspect of Tibia, Palm, Soles, Nails,
back of trunk, Scalp. Lips are not involved ,
oral lesions rare.
(1) Guttate psoriasis.
(2) Pustular psoriasis.
(3) Palmo-Plantar psoriasis.
(4) Psoriasis erythroderma.
(5) Flexural psoriasis.
To study the treatment of Kustha systematically it is
necessary to look at three principles of treatment which are
described in Krimi Chikitsai.e.
Samsodhana ,
Samsamana and
Nidana Parivarajana separately.
All Acharyas have emphasized on Shodhana therapy in the
management of Kustha.
Acc to Acharya Charaka
Shodhana may be administered based on predominance of
vitiated Dosha.
Acc to Acharya Charaka
In Vata - Ghritapana,
Kapha - Vamana, and
Pitta - virechana, raktamokshana
Acc to Acharya Chakrapani
In excessive morbidity of the Doshas repeated Shodhana
should be performed at regular intervals i.e.
Vamana karma -15 days,
Virechana karma - in a month,
Raktamokshana - in 6 month ,
Nasya - in every 3 days.
Acharya Sushruta - also advised to carry out
“Ubhyato Samsodhana” even at the Purvarupa
condition of kustha .
Acharya Shusruta also advised Samsodhana treatment
in the management of Rasogata, Raktogata,
Mamsogata, Medogata kustha.
In Kustha Rakta Dhatu is considered as one of the main
Dhatu which is responcible for Prasraya stage of Kustha
Samprapti,
Pitta Dosha and Rakta Dhatu have Ashraya- Ashrayi
relationship,
hence treatment modality of Pitta Dosha and Rakta Dhatu
complimenting to each other.
It is a specific modality for the elimination of Pitta Dosha
and it is also effective upon Kapha and Rakta.
Acharya Sushruta recommends Nitya Virechana for Kustha
as it is a Bahudoshajanya Vyadhi.
When compared to Virechana Karma, Nitya Virechana can
be easily employed without hospitalization even for Alpa
Bala patient.
Previous studies shown that Nitya Virechana is highly
significant over -Matsyasakala, Mandala, Aswedanam,
Rukshta, and in Kandu.
Virechana removes vitiated pitta dosha from body .
Pitta dosha is resides in rakta dhatu (mala of rakta)
therefore the purificative measures of pitta dosha, also
improves the rakta dhatu.
Because of this reason virechana is very effective for the
management of ekakustha.
Potent stimulus for causing the G.B. contraction is from cholecystokinin hormone.
This cause increased secretion of digestive enzymes from pancrease .
The stimulation for this hormone is the presence of fatty foods in deodenum & G.B. is also stimulated by acetylecholine secreting nerves fibres from both vagus &
intestinal enteric nervous systems.
This bile contains bile acids, bile pigments, cholesterol, lecithin, water, sodium, potasium, bicarbonates ions, which
are eliminated out
can be called as pitta.
Panchakarma is a treatment modality which offers biological
purification and thereby the rejuvenation of cells, organ and
system.
It is a therapy for cleansing body toxins .
Among the Shodhana karma in ekakustha, Virechana karma
was adapted more in comparision to Vamana karma.
It might be due to the fact that according to Ayurved, Kustha
is considered as one among the Rakta Pradoshaja Vyadhies.
As such Pitta Dosha is accepted as mala of Rakta, so
Virechana is specific for Pitta dosha. Pitta shodhana occurs
due to Virechana karma and ultimately it decreases Dushta
Rakta (impure blood).
due to the deep level purification of Rakta Dhatu and
Pitta Dosha, Kustha ( Ekakustha) gets controlled easily.
Shaman Chikitsa was also very commonly utilized after
Virechana (Shodhana Chikitsa) to control the Sneha
Dosha.
Virechana karma ( sodhana ) there are least possibilities
of recurrence as vitiated Doshas are expelled out
completely. Psoriasis being a typical example of
increased toxic material “DOSHA” has therefore been
advocated to be treated with Virechana karma.
The Lakshnas of Ekakustha is similar to that of Psoriasis.
Faulty diets and life style are the main causative factor in Kustha Rogas.
Ekakustha is Kshudra Kustha with Vata-Kaphadominancy and In Kustha, Rakta Dhatu is considered as one of the main Dhatu which is responcible for Prasraya stage of KusthaSamprapti,
Pitta Dosha and Rakta Dhatu have Ashraya-Ashrayi relationship,.
Hence treatment modality of Pitta Dosha and RaktaDhatu complimenting to each other ,
Virechana is most important measures of Shodhanafor Kustha . Though it is a specific modality for the elimination of Pitta Dosha but it is also effective upon Kapha and Rakta.
Virechana karma followed by shaman Aushadhawith Pathya aahara was found as a suitable treatment plan to manage Ekakustha (psoriasis).
Prevalence of psoriasis varies in different part of the world. Prevalence in different population varies from 0% to 11.8% in the USA. The prevalence of psoriasis was estimated to be around 4.6% Prevalence studies from India are mostly hospital-based. Highest incidence was noted in the age group of 20-39 years.
Acc to Acharya Charaka
Usna , Tikshna , Sukshma , Vyavayi , Vikashi are the Guna
of Virechana Dravyas.
Because of their potency reaching the heart and circulating
through vessels effect the mass of impurity in the entire
body,
liquefy it out through large and small ducts due to Agni
nature and
disjoin it due to Tikshna guna, consequently the disjoined
mass floating in the body like honey in vessels,
reaches the stomach due to Sukshma guna nature
and being propelled by Udana (Vayu) is thrown down
because of the natural composition of the drug with jala and
prathvi (Mahabhutas) and the specific potency.