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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 57-62

Role of Nitya Virechana and Shaman Chikitsa in the management of Ekakushta with special respect to plaque psoriasis: A case study


Department of Panchakarma, Mahatma Gandhi Ayurved Medical College Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India

Date of Submission25-Mar-2020
Date of Decision02-Feb-2020
Date of Acceptance20-Apr-2020
Date of Web Publication2-Jul-2020

Correspondence Address:
Dr. Snehal Bhende
Department of Panchakarma, Mahatma Gandhi Ayurved Medical College Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_16_20

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  Abstract 

Background: Psoriasis is an inflammatory skin disease, which is characterized by well-circumscribed erythematous dry plaques of various sizes, covered with mica-like scales; according to its clinical features, it can be correlated with Ekakushta. The lifetime prevalence of psoriasis is 2%–3%. In India, the prevalence of psoriasis varies from 0.44% to 2.88% worldwide. Many treatment modalities have been adopted in medical sciences, but it has quite expensive and various side effects. Hence, it is necessary to find out an economical, effective, and an easily available medicine to treat psoriasis. Objectives: The objective of this study was to study the efficacy of Nitya Virechana and Shaman Chikitsa in the management of Ekakushta with respect to plaque psoriasis. Materials and Methods: A single case study: a 74-year-old man was already diagnosed with plaque psoriasis before 15 years. Symptoms such as redness of skin, silvery scaly skin, itching along with burning sensation was gradually emerging so for that he was advised for Nitya Virechana and Shamana Chikitsa.Result: Symptomatic assessment of patient was carried out after three months and satisfactory outcome was there and overall quality of life of patient was significantly improved. Conclusion: Nitya Virechana and Shaman Chikitsa, brought about satisfactory relief in symptoms in patients with Ekakushta.

Keywords: Ekakushta, Nitya Virechana, psoriasis, Shamana Chikitsa


How to cite this article:
Bhende S, Parwe S. Role of Nitya Virechana and Shaman Chikitsa in the management of Ekakushta with special respect to plaque psoriasis: A case study. J Indian Sys Medicine 2020;8:57-62

How to cite this URL:
Bhende S, Parwe S. Role of Nitya Virechana and Shaman Chikitsa in the management of Ekakushta with special respect to plaque psoriasis: A case study. J Indian Sys Medicine [serial online] 2020 [cited 2020 Aug 4];8:57-62. Available from: http://www.joinsysmed.com/text.asp?2020/8/1/57/288805




  Introduction Top


Skin is the largest part of the body, when it is diseased, it causes social stigma. Psoriasis is one of the most common dermatological diseases, which is immune-mediated genetically determined.[1] Psoriasis is defined as a persistent skin disease, which causes cell to build rapidly on the surface of the skin, forming thick silvery scales, itchy, dry, and red patches.[2] Psoriasis is a common, chronic, recurrent inflammatory disease of the skin of unknown origin, characterized by well-circumscribed erythematous, dry plaques of various sizes, and covered with mica-like scale.[3]

According to World Health Organization (WHO), the worldwide prevalence of psoriasis is 2%–3%. In India, the prevalence of psoriasis varies from 0.44% to 2.88%. Psoriasis first appears during two peak age ranges, the first peak occurs in persons aged 16–22 years, and the second occurs in persons aged 57–60 years.[4] Psoriasis correlated with Ekakushta is chronic and relapsing in nature, and there is an involvement of Tridosha along with Twak (skin), Rakta (blood), Mamsa (muscles), and Lasika (lymphatic channels ).[5]

Panchakarma therapy is a unique type of treatment for various chronic autoimmune hormonal and degenerative disorders,where as other sorts of treatments have no satisfactory answer as well equally beneficial for the promotion and preservation of health. Any disease in Ayurveda is managed with Shodhana, Shamana, and Rasayana Chikitsa.[6] The same is true for Kushta, which is difficult to treat; for the complete cure, it is important to understand the concept, characteristic features, indication, and appropriate use of these to get optimum results. Doshas get vitiated by external or internal factors, causing imbalance in them in the form of aggravation, depletion, or both. Abnormal variation and functioning of Dosha is the root cause of development of disease.[7]

Acharya Charaka had mentioned the general line of treatment for Kushta as when there is Vata predominant condition: Ghritapana, Kapha predominant condition: Vamana, and in Pitta predominant condition: Virechan Karma, followed by Raktamokshana.[8]Acharya Sushruta had given special importance to the Shodhana, so he mentioned that Vamana is done for every 15 days, Virechana for every 30 days, Raktamokshana for every 6 months, Nasya for every 7 days, and Lepa for every 3 days.[9] But as the patient is already weak due to his age factor and severity of the disease, in this condition, Bahudosha Nirharana is contraindicated in Kushta because it may lead to further debilitation of the body due to Vata Prakopa. On this context, Acharya Sushruta recommends Nitya Virechana for Kushta as it is a Bahudoshajanya Vyadhi.[10] So considering the strength of the patient, Nitya Virechana was selected as Shodhana (purificatory procedure) for the line of treatment. In addition to the Shaman Yoga, Bahirparimarjan Chikitsa (external application) of drug is administered after taking the proper course of Shodhan, which then provides additional relief and thus helps in the eradication of disease (psoriasis) completely.[11] In this case study, we evaluated the efficacy of Nitya Virechana and Shaman Chikitsa in the management of psoriasis.

Aim: The aim of this study was to find the efficacy of Nitya Virechana and Shaman Chikitsa in the management of Ekakushta with special respect to plaque psoriasis.


  Materials and Methods Top


It is a single case study, and the informed consent of the patient was obtained in his own language.

History of Present Illness

A 74-year-old male patient was symptomless before 6 years, he had gradual emerging symptoms such as redness of skin, silvery scaly skin, itching along with and burning sensation, and absence of sweating over both forelimbs. So he took allopathic treatment for 1 year but he got only symptomatic temporary relief, then he took homeopathy medicine, and there was reduction in itching only. That is why before 6 months, he approached our hospital for management; after examination, he was advised for Mrudu Shodhana and Shamana Chikitsa, which are briefly mentioned in [Table 1] and [Table 2].
Table 1: Demographic details

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Table 2: Chief complaints

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Past History

History of hypertension (HTN) from 20 years.

Family history: Siblings and his son (K/C/O eczema)

Personal history:

  • Drug history: On medication tab amlodepine 5mg once a day


  • Diet: Non-vegetarian twice a week


  • Addiction: Alcohol consumption occasionally


  • Sleep: Disturbed


  • Examination Specific to Diagnosis

  • Inspection:
    • Color—Redness of skin, silvery scaly skin


    • Local temperature was normal


    • Texture was rough and raised


  • •Palpation
    • Candle grease sign—Positive


    • Auspitz sign—Positive


    • Oil drop sign—Negative


  • Other examinations are mentioned in [Table 3] and [Table 4].
    Table 3: Ashtavidha Pariksha

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    ,
    Table 4: Dashvidh pariksha

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    Samprapti (Pathophysiology of the Disease)

    Nidanas of Kushta aggravates the Doshas, causes Agnimandya (indigestion) and it produces Dhatu Shaithilyata (weakness of muscles). Among all Doshas, Kapha Vata Dosha is aggravated predominantly and causes Shaithilyata of Dushya such as Twak (skin), Rakta (blood), Mamsa (muscles), Lasika (channels), and obstructed Lomakupa (sweat glands), leading to Sanghatmak Vikruti (vitiation) in Swedavaha Srotas (channels of sweat glands). This Prakupita (vitiated) Doshas enter into Rasaraktadi Paribhamana (systemic circulation), especially Sanchara (movement) in Tiryak Sira (vein) and lodges in Bahya Roga Marga (skin) and resulting in Mandalotpatti (formation of skin lesions).[12]

    Treatment Advised

    By analyzing the aforementioned pathogenesis of disease in this patient, following treatment plan, which is mentioned in [Table 5] and [Table 6], was prescribed, which can be categorized under Shodhan (Nitya Virechana for 15 days), Shaman and Bahirparimarjan Chikitsa.
    Table 5: Nitya Virechana for 15 days

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    ,
    Table 6: Shamana Chikitsa along with local application for 3 months

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      Observation and Results Top


    After completion of 3 months of total therapy (Nitya Virechana with Shaman Aushadhi), the patient symptomatically improved. He was feeling fresh and was of relaxed mind. He has sound sleep now. The patient was enjoying his day-to-day life very well. Assessment criteria are mentioned in [Table 7] and [Table 8] [Figure 1][Figure 2][Figure 3].
    Table 7: Assessment criteria

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    ,
    Table 8: PASI (Psoriasis Area Severity Index) score

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    ,
    Figure 1: Before treatment

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    ,
    Figure 2: After Nitya Virechana (after 15 days)

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    ,
    Figure 3: After treatment (after 3 months)

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      Discussion Top


    The plaque psoriasis appears to be largely a disorder of hyperkeratinization. The basic defect is rapid displacement of epidermis in psoriatic lesion. Excessive intake of yogurt, nonvegetarian (fish, chicken), salty, and sour foods acts as an aggravating factor in this disease. Samshodhana (purificatory therapy) is one of the important treatments of Ayurveda, which deals mainly with elimination of the aggravated Doshas from the body.[13] Virechan is prescribed once in a week because the Kleda (Moist discharge) accumulating on the account of Pitta due to its Upasneha, Drava (Liquid) and Visraguna is relatively a slow process. Ekakushta (psoriasis) is having Bahudosha Avastha described under the Raktapradoshaja Vyadhi (blood predominant diseases).[14] As Pitta is the Mala of Rakta and have Asraya Asrayibhava,[15] so for the elimination of Pitta Dosha, Virechana Karma is the best line of treatment. It is less stressful procedure than Vamana and has less possibility of complications. But the patient is already weak due to his age factor and severity of the disease, and in this condition, Bahudosha Nirharana is contraindicated in Kushta because it may lead to further debilitation of the body due to Vata Prakopa. In this context, Acharya Sushruta recommends Nitya Virechana for Kushta as it is a Bahudoshajanya Vyadhi.[9] So considering the strength of the patient, Nitya Virechana was selected as Shodhana for the line of treatment for duration of consecutive 15 days.

    Probable Mode of Action of Nitya Virechana

    Virechana pacify the morbid Pitta and help to carry out its function normally, hence helping the skin lesions to heal.[16]Nitya Virechana removes the toxic materials from the body and provides purification of the body at two level: (1) gross level, where various organs and systems of the body are thoroughly cleansed, cardiovascular level and gastrointestinal tract, and (2) cellular level, where the purification and cleansing of the body is produced at cell membrane and molecules. Gut absorption improves considerably and metabolism is also corrected.[17]Aragvadh, Avipaithikar Churna, and Haridra, these drugs eliminate Kleda and Doshas from Rasa, Rakta, and Meda. It causes Raktaprasadana by eliminating Dushta Kapha and Pitta. Gara Vishas present in Rakta are eliminated by its Tikta Rasa. It improves complexion by purifying blood and by absorbing Kleda from Rakta.

    Mode of Action of Nitya Virechana in Ekakushta

    Aswedanam (absence of sweating) is due to the obstruction in Swedavaha Srotas (channels carrying sweat), Nitya Virechana by Srotoshodhak (channel purificatory) property opens the microchannels and improves circulation, resulting in perspiration. Mahavastu (big lesions) are mainly associated with Dushita Kapha Dosha and Rakta Dushya, Nitya Virechana with Pitta Kaphahara property corrects Rakta Dhatu, thus reducing big lesions. Matsyashakalopamam (scaling), also called hyperkeratinization, is due to vitiation of Tridosha, Nitya Virechana acts on all Doshas and controls scaling. Rukshata (dryness) occurs mainly due to Vata Dosha, Nitya Virechana corrects it by Vatanulomana and ultimately reducing Rukshta.[18]Kandu (itching) indicates the involvement of Kapha, Rasa, and Rakta Dushya, Nitya Virechana has Pitta Shodhaka and Rasa Rakta Prasadana property, which may be the reason behind reduced Kandu.[19]Daha (burning) is mainly due to Pitta Dosha and Rakta Dusti, Nitya Virechana removes vitiated Pitta Dosha and Rakta, thus reducing Daha. “Candle grease sign” indicates extremely increased Ruksha and Khara Guna in Twaka caused by Vata Dosha, Nitya Virechana pacifies Vata Dosha and thus reduces candle grease sign. Auspitz sign is mainly due to Pitta Dosha and Rakta Dushya, Nitya Virechana is an ultimate therapy for Pitta Dosha and Rakta Dushti.[20] In this way, Nitya Virechana helps in breaking pathogenesis, resulting in controlling the symptoms in Ekakushta.

    Mahamarichyadi Taila

    Most of the drugs are of Katu, Tikta, and Kashaya Rasatmaka, which acts as Kapha Shamaka, which reduces Kandu. Laghu, Snigdha Guna reduces scaling. Ushna Virya increases Swedana by Vata Kapha Nashak Dravya having Raktashodhaka, immunomodulator, Kushta Kandu Nashak property.[21]

    Panchanimba Churna

    Panchanimba Churna acts as a Deepana, Pachana by Tikta and Katu Rasa. It inhibits Ama (undigested food materials) formation by Laghu, Rukshna Guna, and Ushna Virya. It does Samprapti Vighatana by Srotoshodhaka Guna of Katu Rasa and Laghu, Ushna Guna. It balances the Dosha through Vata Kapha Shamaka properties, and it helps in the management of Ekakushta by having Kushthaghna Prabhava of the drugs.[22]

    Panchatikta Ghrita

    In psoriasis, the essential fatty acids, which are required for lipid barrier of skin is reduced, and this will cause epidermal fluid loss and making skin susceptible for reaction. So Ghrita as Shamana plays role by enhancing lipid barrier. It has Deepana, Pachana, Amapachaka, Strotoshodhaka, Raktaprasadana, Raktashodhaka, Kandughna, Kushthaghna, and Varnya properties. Ingredients of Panchatikta Ghrita[23] has Katu, Tikta, Kashaya, and Madhura Rasa, Laghu, Ruksha, Sheeta, and Snigdha Guna along with Ushna Virya, which helps to pacify Vata, Pitta, and Kapha Doshas. Owing to pacification of Vata Dosha, roughness, dry scaling as well as blackish brown color and pinkish red color in Ekakushta subside. Pacification of Kapha Dosha helps to subside itching, demarcated and thickness plaque, and adhesion of plaque. In addition, pacification of Pitta Dosha helps to decrease burning sensation and pinpoint bleeding. Panchatikta Ghrita is having analgesic and anti-inflammatory properties. Ghrita has lipophilic action so it helps in ion transportation to a target organ. This lipophilic nature of Ghrita facilitates entry of drug into cell, and its delivery to mitochondria and nuclear membrane. Also it helps in restoring the normal texture to skin. So all these properties that act mainly at cellular level of skin decreases keratinization of cell layer. Thus improving cell cycle as a result; symptoms such as itching, deranged complexion, unctuous, perspiration, and white or red patches are reduced giving normal texture to skin.

    Gandhak Rasayan Vati

    Gandhaka Rasayana Vati acts as Agnideepaka, Pachaka, Kaphaghna, Kledaghna, Raktaprasadaka, Krimighna, Kushthaghna, Rasayana, and Vishaghna. Site of action of Gandhaka Rasayana is mainly on Rakta and Twacha. It helps to purify the impure Rakta by removing its Malinata and help to convert the saturated Vikrut Dravya of body. In disease, where Raktadushti occurs due to Rasadhatu Dushti, Gandhaka Rasayana works as Amrutvalli.[24]

    Krumikuthara Rasa

    Krumikuthara Rasa has de-worming action, thereby detoxifying the body. It protects the biological membrane against oxidative stress, inhibits the growth of bacteria, clears the airways, and stimulates the cell-mediated immune mechanisms.[25]

    Mahamanjishtadi Kwath

    Mahamanjishthadi Kwath is given in Kushta Chikitsa.[26] It acts as a Raktashodhaka, Kaphaghna, and Kushta Nashaka. It acts on Mamsa and Meda Dhatugata Kushta, and it does Pachana of Sthirata and Ghanata Guna.[27]


      Conclusion Top


    The conclusion of this case is that Ayurveda management by Shodhan and Shaman therapy in psoriasis is a disease that is triggered by some local and systemic factors. It has both hormonal and immunological mechanisms, which are involved at a cellular level. The treatment given for Ekakushta was Nitya Virechana and Shamana Yoga, which helped in the removal of vitiated Dosha from the body and opened the Strotomukh and brought Samyavastha of Doshas. In this study, it can be concluded that in the patients, age-group older than 60 years, having Ekakushta, Nitya Virechana was the best treatment for eliminating the Dosha. Clinically, no adverse effect was observed due to the administration of medicine and Nitya Virechana. Hence it can be concluded that Ayurveda line of management gives satisfactory result. It is equally beneficial for the promotion and preservation of health by removing toxic wastes, by balancing Tridoshas, and by correcting Agni.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
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        Figures

      [Figure 1], [Figure 2], [Figure 3]
     
     
        Tables

      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



     

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