HTML Full Text

Introduction

Vamana is one of the panchakarma procedure that expels out vitiated doshas from stomach through oral route. (1) It is mainly indicated in the diseases arising from kapha dosha and pitta dosha in body. (2) “Kushtha” is one of the diseases arising due to involvement of all three dosha (3), however there can be differences in dominance of dosha in like some types are kushtha are kapha vaat dominant and some are kapha pitta or vaat pitta dominant. With a prevalence of 0.44-2.8% in India, it commonly affects individuals in their third or fourth decade with males being affected two times more common than females (4). The lesions are characterized by brownish red papules which are sharply demarcated and are covered with fine, silvery white scales. This condition resembles “sidhma kushtha” described in ayurvedic text (5) . In present case study a 42 years old male patient presenting with symptoms of psoriasis was treated with Vamana karma followed by Samsarjana kram and some internal medicine related with the symptoms. Patient got significant relief in the symptoms on follow up of one month.

Case report: A 42 years old male patient having symptoms of psoriasis since last seven years visited Panchakarma OPD in our institute for the treatment. The patient was having symptoms of whitish scales (raj: munchana ), dry patches, erythema and itching sensation over the body with duration of last seven years. The patient was diagnosed with “ sidhma kushtha” based on symptoms. The patient underwent “vamana karma” as it is indicated in management of kushtha vyadhi.

Plan of treatment was initiated with panchana - deepana upakram . It was given with Triphala churna – 3 gm, Musta churna – 1 gm and shunthi churna – 1 gm with Lukewarm water twice a day for 5 days. Snehapaan with Panchatikta ghrita was initiated with 30 ml on first day and later was given in vardhaman maatra ( 60 ml, 90 ml, 120 ml, 150 ml ) for the next days. Patient being a mrudu koshtha and showed signs of samyaka snehapaan in 5 days. Sarvang snehana along with mrudu naadi sweda was performed on sixth day and patient was asked to take kapha vriddhikar ahar a night before vaman karma. Informed consent in written form was taken before karma and examination of patient was done in following aspects – Naadi – 80 / min, Jivha – alpa saam, Koshtha – mrudu , Mala – samyak, Mutra – samyak, BP 110 / 70 mmHg, CNS – conscious , oriented and afebrile, CVS – S1 S 2 Normal P/A – soft. All srotas were reexamined. Gradation of psoriasis symptoms were based on following.

Scaling-

• No scaling – Grade 0

• Mild scaling by rubbing/by itching(scaling from some lesions)– Grade 1

• Moderate scaling by rubbing/by itching ( from all lesions) – Grade 2

• Severe scaling by rubbing / by itching (from all lesions) - Grade 3

• Scaling without rubbing / by itching (from all lesions)- Grade 4

Extent of lesions -

• No lesions on Mahasthanam – Grade 0

• Lesion on partial part of hand, leg, neck, scalp, hand, back - Grade 1

• Lesions on most part of hand, leg, neck, scalp, trunk, back -Grade 2

• Lesions on whole part of Mahasthanam (Vast area) - Grade 3

• Lesions on whole body - Grade 4

 

Mandala (Circular skin lesion):

• No Mandala- Grade 0

• Few mandala and smaller than coin – Grade 1

• Few mandala and big (larger) than coin – Grade 2

• More mandala and smaller than coin – Grade 3

• More mandala and bigger than coin – Grade 4

Erythma:

• Normal skin - Grade 0

• Faint or near to normal – Grade 1

• Blanching + red color – Grade 2

• No blanching + red color – Grade 3

• Red color + subcutaneous – Grade 4

 

Candle grease sign:

1. Absent – Grade 0

2. Improvement – Grade 1

3. Present Grade - 2

Auspitz sign:

1. Absent - Grade 0

2. Improvement- Grade 1

3. Present - Grade 2

Vamana was performed in Vasant Ritu (March, 2022 ) patient was prepared for the karma by doing sarvang snehana and mrudu naadi sweda Godugdha ( 1 lit ) was given for akanthpaan and vaman aushadhi yoga – Madanphal pippali churna 4 gm, vacha churna 1 gm, pippali churna 2 gm and saindhava churna was given in 2 gm with Madhu and yashtimadhu phanta was used as vamanopaga dravya. There were seven Vegas of vaman in profuse amount. Total of about 8700 ml dravya was taken in by patient and about 9100 ml was emitted out. Samsarjana krama was also advised for the next 5 days as it was madhyam shuddhi.

The follow up was given by patient after one month, patient had relief and significant effect in psoriasis symptoms like body itching, erythema, and white patches.

 

Observations and Results:

Table no. 1 : Gradations of the symptoms of psoriasis ( Sidhma Kushtha )

Discussion

Psoriasis is a skin disease that causes a rash with itchy, scaly pathches erythema over the skin which resembles “Sidhma Kushtha “described in ayurvedic texts. Sidhma kushtha being type of “Mahakushtha” arises due to kapha and vaat Dosha prodominently. Vamana is panchakarma procedure for the treatment of diseases arising due to Kapha dosha and surely is indicated for the treatment of Sidhma kushtha , However all types of Kushtha needs Shodhana upakrama periodically.(6) Panchatikta ghrita (7) is helpful for snehapana purpose as it contains drugs having Sanguine effects on blood and skin as well. Panchatikta ghrita having tikta ras dravya in it that helps rakta shuddhi and in reestablishing skin health.(8) Vamana breaks amalgamation of dosha-dushya involveds in samprapti , removes the dosha out of body and establishes individuals health again. This results in reduction in symptoms like itching, scaling, erythema etc.    

Conclusion

Shodhna upakrama (Panchakarma) has been indicated in Kushtha Vyadhi by all the Acharyas, In present case patient was treated with Vamana karma, after completion of the study it was observed that there was much decrease in the symptoms like itching, erythema and scaling. This case report highlights that psoriasis (sidhma kushtha ) being kapha vaat prominent disorder can be managed well by eliminating involved doshas through vamana karma and basic, appropriate

diet regimen. In today’s era when the world is facing challenges of pandemic of infectious diseases, diseases resulting from erroneous life style, diseases due to compromised immunity or the pathologies arising from air, water and noise pollution, adulterated food; “Ayurveda” the ancient science of life can bring the solution of these all.

The ability of evacuation, superiority of efficacy and enormity of procedures, target of eradication of doshas and multimode actions are the characteristics of Panchakarma described well in Ayurveda.