JOA€¦ · Chikitsa for Kushtha Rogi[4], thus in this present study we planned Vamana with Jeemutaka Yoga[5] followed by Virechana with Trivritadi Yoga[6] for the management of this

Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan155

JO

A

XII

I-3

2

01

9

ORIGINAL REASEARCH ARTICLE - CASE STUDY

A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study

*Dr. Anil Kumar Soni, **Dr. Gopesh Mangal

*P.G.Scholar, **Associate Professor, Department of Panchkarma, National institute of Ayurveda, Jaipur.

ABSTRACT

All type of skin disease is described under broad heading Kushtha, no any disease can exactly have correlated with psoriasis, but Mandala Kushtha type of Maha Kushtha can be correlated with psoriasis. Psoriasis is chronic papulo-squamous disorder characterized by well-defined erythematous plaque with silvery, large loose scales, accentuated by grating the lesions. It affects patient physically, socially as well as economically. Treatment available on contemporary system is only suppressive but not curative. It affects 2.5% of world’s population. Acharya Carak mentioned Shodhan therapy for expulsion of morbid Dosha of Kushtha Rogi. For present study, a 40 years old Hindu male patient having history, ofwell-defined erythematous scalylesion over the scalp, Trunk, back, bilateral upper limband lower limb with itching since last 3 year was registered. Considering the signs and symptoms of patient was treated in the lines of Kushtha Vyadhi Chikitsa. Classical Vamana & Virechana Karma was done for the management of disease along with Pathya-Apathya. Patient had significantly relieved in lesion with this line of treatment.

Keywords : Mandala Kushtha, Psoriasis, Shodhana therapy.

Address of Correspondence: Dr. Anil Kumar SoniP.G.Scholar, Department of Panchkarma, National institute of Ayurveda, Jaipur

Email ID : [email protected]

Contact No :9589835035

Introduction:

In present scenario majority of patients comes to the hospitals are suffering from Skin disease. Psoriasis is one of the main skin disease from patient suffers a lot, due to its relapse and incurable condition. All type of skin disease is described under broad heading Kushtha, no any disease can exactly have correlated with psoriasis, but Mandala Kushtha type of Maha Kushtha[1] can be correlated with psoriasis due to similarity of its sign & symptoms. Psoriasis is chronic papulo-squamous disorder characterized by well-defined erythematous plaque with silvery, large loose scales, accentuated by grating the lesions. It affects patient physically, socially as well as economically. It affects 1-3% of thepopulation.[2] It shows up anywhere- on the eyelids, ears, mouth and lips, skin folds, hands and feet, and nails[3]. Overall incidence of Psoriasis among total skin patients is 1.02% in India

How to Site the Article : Soni AK, Mangal G, A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study, JOA XIII-3, 2019; 155 - 160

JOAjournalofayurveda.in ISSN No:2321-0435


Soni AK, Mangal G,A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study, JOA XIII-3, 2019; 155 - 160

and Treatment available on contemporary system is only suppressive but not curative, thus whole world concern towards Ayurveda to establish safe & effective treatment for psoriasis. Acharya Caraka mentioned Shodhan Chikitsa for Kushtha Rogi[4], thus in this present study we planned Vamana with Jeemutaka Yoga[5] followed by Virechana with Trivritadi Yoga[6] for the management of this disease.

Further discussed patient is known Case of psoriasis showing classical symptoms with positive Auspitz sign. Patient had history of small papules appear on scalp & trunk and itching starts first before 3 year than it gradually spread onwhole over body surmounted with silvery scales and severity of itching increase day by day. Patient taking a lot of medication but he had no significant relief. Patient

was diagnosed as a case of Mandal Kushtha and was treated according to principal of treatment of Kushtha (Mandal Kushtha). He received Vaman with Jeemutaka Yoga followed by Virechana with Trivritadi Yoga[7] for Shodhan treatment. Remarkable improvement was noticed in scaling, induration and itching just after Vaman and Virechan treatment and residue only demarcation & blackish lesion.

Case Report:

A 40 yrs. old male registered by the O.P.D. No. 38827122018 on the date of 27/12/2018 came to O.P.D. No. 02 of National Institute of Ayurveda.

Basic information of patient:

Age 40 yrs. Pulse 80/minuteSex Male B.P. 110/70 mmHg

Region Hindu Appetite Decreased Socio-economic

status Lower-middle class Bowel habit Irregular

Diet Vegetarian Urination Normal, 4-5 times in a day

Marital Status Married Sleeping pattern Sound

There is no any abnormality found in haematological investigation.

Pradhanvedana (chief complain)

• Lesion on scalp, lower back, abdomen, bilateral upper arm, and lower leg with well demarcation.

• Lesion surmounted with silvery scales and falling after rubbing

• Severe itching present

• Patient suffer from last 3 years

Proper systematic examination and finding with positive Auspitz sign decided that patient suffer from psoriasis and treatment protocol were decided Shodhana Chikitsa, for complete purification. For this we planned Vamana with Jeemutaka Yoga followed by Virechana with Trivritadi yoga along with Pathya- Apathya.

Treatment Protocol:

All explain about Vamana and Virechana Procedure and its necessity for the treatment given to the Patient fristly. We first administered Vamana with Jeemutaka Yoga than Virechana with Trivritadi Yoga for complete purification with the aim ofsignificant relief.

Intervention:

Patient was admitted in I.P.D. ward of National Institute of Ayurveda Hospital and consent was obtained from patient on standard protocol followed in our hospital.

Purvakarma: (27/12/18-07/01/19)

Deepan & Pachana:

Panchkol Churna[8] 5 gm two times in a day for five days (27/12/18-31/12/18) with the aim of Ama Pachana and enhancing the Digestive Power.


Abhyanter Snehpana (01/01/2019-05/01/2019): Abhyantar Vardhamana Snehpana with Go-Ghrit was administered till Samyak Snigdha Lakshana achieved. During Snehpana, Sneha-Jiryamana and Jirna Lakshana were observed for assessment of next day’s dose of Sneha.

1st day – Test dose of 30ml Go-Ghrit given at 7:00 AM to patient

2nd day – 60ml

3rd day – 90ml

4th day – 120ml

5th day – 150ml

Snehpana was completed after obtaining Samyak Snigdha Lakshan. Hot liquid and light diet (easy to digestible) were advised in this period and regularly vitals were checked.Vishrama-Divasa (06/01/2019): In 6th day which is known as rest day, patient was advised Sarwanga Abhyanga & Vashpa Swedana in the morning. In same night Kaphotkleshaka Ahara like rice with curd, and Dalaof black gram was advised.

Pradhankarma (07/01/2019):In next morning of rest day, he was advised to came after taking bath & relief from natural urges. Sarvanga Abhyanga and Vashpa Swedan was done in the morning. Than Vamana Yoga- Jeemutaka Phant was ingested just after full of stomach (Akanthpana) with Yavagu (rice soup) with rock salt and Go-Ghrita. After ingestion of this Vamana Yoga wait till Vamana Vega not started. Once were started Vamanopaga-Yashtimadhu Phanta was given repeatedly till Samyak Shudhi Lakshan was not achieved.

VamanaYoga:

Preparation: Dry Fruit of Jeemutaka-12 soaked with 150 ml hot water at night. At morning-soaked fruit were properly squeeze than it filtered with sieve & before administration it warmed up to lukewarm than mixed honey & Saindhava Lavana in it.

Dose: Jeemutaka Phanta- 120 ml, Madhu- 50 ml,

Saindhava Lavana - 2 gm.

Vamana Karma observation: after assessment of Vamana Karma, patient achieved Uttam Shuddhi. In accordance of Vaigiki- 7 Vega, Antaki- Pittant, & Laingiki-Pravara Shuddhi were achieved.

Paschatakarma: After taking some rest patient were advised to clean his face hand & feet. After 20-minute Dashmoola Dhoompana was given to the patient. Samsarjan krama (07/01/2019-13/01/2019) was advised for the 7 days considering to Pravara Suddhi for candling the Agni.

Virechanakarma:

Purvakarma(15/01/2019-20/01/2019):

Abhyantara Snehpana: Abhyantara Snehapana

was given with Go-Ghrita after one day of completion of Samsarjana Karma in gradually increasing dose from 50 ml on 1st day to 150 ml on 3rd day respectively. After assessing Samyaka Snigdha Lakshana, Snehpana was completed and he was advised Sarwang Abhyanga with Dashmoola Taila and Vashpa Swedana for 3days. He was advised hot, liquid & lightdiet in this period. Patient was advised Snigdha Yusha with Daliya (coarse wheat granules) in previous night of Virechana Karma.

Pradhanakarma(21/01/2019):

After three rest day, in the next morning patient was advised to came after taking bath and pass natural urges and Sarvanga Abhyanga and Vashpa Swedana was given in the Morning. Virechana Yoga was administered after Kapha Kala - 10:30 AM in empty stomach.

Virechana Yoga:

Dose: Tripha Kwatha- 150 ml, Trivrita Churna-15gm, Danti Churna- 10gm.

Anupana- Draksha Panaka.

Patient was advised to had sips of Draksha Panaka and sudation of abdomen with hot water bag to continue the motion. Proper monitoring of vitals is done frequently to prevent any possible adverse effect.




Table no. I - Observations:

Time Vega Consistency Blood Pressure Pulse11:50 p.m. 1 Semisolid 120/80 mm of Hg 84/minute12:30 p.m. 2 Semiliquid 112/80 mm of Hg 88/minute01:00 p.m. 2 liquid 116/80 mm of Hg 94/minute01:20 p.m. 1 liquid 112/74 mm of Hg 90/minute02:30 p.m. 2 liquid 114/76 mm of Hg 88/minute03:15 p.m. 1 liquid 110/74 mm of Hg 88/minute04:40 p.m. 1 liquid 110/76 mm of Hg 82/minute06:10 p.m. 1 liquid 112/74 mmof Hg 78/minute09:00 p.m. 1 liquid 110/70mm of Hg 80/minute

Emergency medicines provided to the patient for any type of emergency conditions.

Paschatkarma:

Samsarjan krama was advised for 5 days according to Madhyama Shuddhi. He was advised for Parihar Vishaya (strict diet and rest) for some time to get homeostasis.

Follow up: Patient was advised about Pathya-Apathya & visited after 15 days of completion of Samsarjana Krama.

Assessment: assessment was done on the basis of PASI score.

Table no. II –The Psoriasis Area and Severity Index (PASI) is a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance.

Plaque Characteristic Lesion score Head Upper

Limbs Trunk Lower Limbs

Erythema 0 = None1 = Slight

2 = Moderate3 = 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, x 0.2 for upper body, x 0.3 for trunk, and x 0.4 for lower limbs.

Body Surface Area x 0.1 x 0.2 x 0.3 x 0.4Totals (D)Add together each of the scores for each body region to give the final PASI Score.


Table no. III -Results:

Sr. No. BeforeTreatment After SamsarjanaKrama of VamanaKarma

After follow up (15 days after VirechanaKarma

Date 27/12/2018 14/01/2019 09/02/2019PASI Score 23.7 20.1 8.4

After assessment of patient’s condition, considerable improvement observed in his symptoms gradually specially in induration, scaling and itching after Vamankarma. But moderate improvement was observed after Virechana Karma but after 15th day of Virechana Karma itching subside and good improvement observed in Skin lesion with residue of only peripheral demarcated line & blackish discolouration.

Discussion: � According to Acharya Caraka Kushtha is a

Bahudoshaja and Kleda Pradhana Vikara. He also emphasized the importance of Sapta Dravya (Tridosha and Twak, Rakta, Mamsa, & Ambu), these Sapta Dravya are Sannikrishta Hetu for Kushtha Rogi.[9] It means Kushtha is Tridoshaja Vyadhi[10].Whenever the Dosha-Dushya-Sammurchchana occurs at Twak Dhatu, Kushtha will be appeared. Thus, Acharya Caraka mentioned Vamana & Virechana in Bahudosha Avastha of Kushtha Rogi. After expulsion morbid Dosha, Samprapti Vighatana occurred because Tridosha were also be a part of Samprapti. Samshodhana cause for Kleda Harana & also correcting Agni, which are also cause for Kushtha.

Probable mode of action:

Purvakarma: Purva Karma[11], Dipana-Pachana, Snehana and Swedana are essential for Shodhana Karma. Dipana candling the Agni,[12] & Pachana digest

Ama,[13] Snehana[14] does Vridhi (increasing fluidity) & Vishyandana (liquification) of Dosha and Mardavata (softening) of body tissue (Dhatu) & Channels (Shrotasa) and Swedana[15] causes disintegrate the complex (Sangha) with its Ushna Guna. It means Purvakarma helps in mobilization of Dosha from Shakha to Koshtha for expulsion from nearest possible rout through Shodhana Chikitsa.

Pradhanakarma: Pradhanakarma means Vamana and Virechana was given with the aim of complete evacuation of morbid Dosha because all type of Kushtha are Tridosaja in nature. Mandala Kushtha is Kapha dominant Tridoshaja Vyadhi. Acharya Caraka mentioned Vamana and Virechana in the management Kushtha in Bahu-Doshavastha.[16] After Vamana and Virechana patient got good relief in his symptom.

Samsarjankrama:

Samsarjana Krama means strict diet regimen which was planned after Shodhana Chikitsa as per type of Shuddhi for candling Agni, which was diminished due to Sanshodhana Chikitsa. In Samsarjana Krama light and easy to digest food was are prescribed to restore appetite.

Conclusion:

Psoriasis which is a type of Skin disease correlated with Mandala Kushtha, was managed according to Kushtha Vyadhi and planned Vamana with Jeemutaka & Virechana Karma with Trivritadi Yoga in this study.



After completion of treatment significant result observed, thus we can say further study in huge scale will be conducted for establishment of management of psoriasis.

References

1. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, ,Chikitsasthana chapter no. 07 verse no. 16 Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 451.

2. Consuelo Huerta, MD, MPH; Elena Rivero, MD, MPH, FISPE: Luis A. Garcia Rodriguez, MD, MScIncidence and Risk Factors for Psoriasis in the General population,

3. www. Psoriasis.org/about-psoriasis.

4. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Chikitsasthana chapter no. 7 verse no. 41, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 452.

5. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Siddhisasthana chapter no. 11 verse no. 12, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 727.



8. Shrivastava Shailja, Sarangadhar Samhita of Acharya Sarangadhar, Jiwanpradahindi commentary, Madhyam Khanda, Chapter no. 6 verse no. 13-14, Chaukhambhaorientalia, Varanasi Fourth edition

2005, p. 175.


10. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Nidanasthana chapter no. 05 verse no. 04, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 216.

11. Tripathi Bramhan and, Srimad vagbhata, Astanga Hridayam, Nirmala Hindi Commentory, Sutra Sthana chapter no.13, verse no-29. Reprinted 2014; Chaukhamba Sanskrit Pratishthan Delhi, p. 188.

12. Shrivastava Shailaja, Sharangadhar Samhita of Acharya

Sarangadhar, Jiwanpradahindi commentary, Purva Khanda Chapter no. 04, verse no. 01, Chaukhambha Orientalia, Varanasi, 4th Edition, p. 30.

13. Shrivastava Shailaja, Sharangadhar Samhita of Acharya Sarangadhar, Jiwanpradahindi commentary, Purva Khanda Chapter no. 04, verse no. 02, Chaukhambha Orientalia, Varanasi, 4th Edition, p. 30.

14. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Sutrasthana chapter no. 22 verse no. 11, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 120.

15. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Siddhisthana chapter no. 01 verse no. 07-08, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 678.


lkjka'k%

lÒh Ádkj ds Rod~ j¨xä dk o.kZu o`gr 'kh"kZd dq"B ds vUrxZr fd;k x;k gS fdlh Òh ,d O;kf/k dh fuf'pr :i ls l¨fj;sfll ls

rqyuk ugh fd tk ldrh gSA ysfdu e.My dq"B t¨ egkdq"B dk ,d Ádkj gS fd rqyuk y{k.kä ds vk/kkj ij l¨fj;sfll ls dj ldrs

gSA l¨fj;sfll ,d th.kZ Ádkj dh iSiqy¨LDoSel fodkj gS] ftldk y{k.k ,fjFksesVlIySd gS] t¨ fdapkanhjax dh fBYyhiiM+h ls vkPNkfnr

g¨rh gS rFkk jxM+us ij vklkuh ls tM+us yxrh gSA ;g j¨xh d¨ 'kkjhfjd] lkekftd vkSj vkfFkZd :i ls ÁÒkfor djrh gSA ledkyhu

fpfdRlk Á.kkyh ij miyC/k mipkj dsoy neudkjh gSA ysfdu mipjkRed ugh gS ;g O;kf/k nqfu;k fd 2-5 Áfr'kr vkcknh d¨ ÁÒkfor

djrh gSA vkpk;Z pjd us dq"Bj¨xh ds nqf"kr n¨"kä ds fu"dklu ds fy, 'k¨/ku fpfdRlk dk mYys[k fd;k gSA orZeku fpfdRldh; v/;;u

ds fy, ,d 40 of"kZ; fgUnq iq:"k j¨xh] ftld¨ ,fjFksesVl iiM+hokys y{k.k flj] isV] ihB] gkFk ,o aiSj rFkk [kqtyh foxr rhu o"k¨± gS

dk iathdj.k fd;k x;kA y{k.kä ds vk/kkj ij j¨xh dk mipkj dq"BO;k/kh dh fpfdRlk dh Òkafr fd;k x;kA bl gsrq oeu ,oa fojspu

deZ dq"Bj¨x ds mipkj gsrq iF; ,oa viF; ikyu ds lkFk fd;k x;kA bl mipkj ls j¨xh d¨ cgqr vf/kd ykÒ ÁkIr gqvkA

Documents

JOA€¦ · Chikitsa for Kushtha Rogi[4], thus in this present study we planned Vamana with Jeemutaka Yoga[5] followed by Virechana with Trivritadi Yoga[6] for the management of this