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Introduction

Skin health is often considered a reflection of the body’s overall health status. Being the largest organ, the skin performs multiple physiological functions while also influencing an individual’s appearance. Palmo-plantar psoriasis (PPP) is a chronic immune-mediated inflammatory condition of the skin characterized by hyperproliferation of epidermal cells. It is a non-communicable disorder that typically affects genetically predisposed individuals, with environmental factors significantly contributing to its pathogenesis. [1].

Epidemiological data suggest that psoriasis occurs in nearly 2–3% of the world’s population, while in India the reported prevalence ranges from 0.44% to 2.88%. [2].

In Ayurveda, most skin diseases are collectively described under the broad term Kushta. Classical Ayurvedic texts have explained eighteen varieties of Kushta, among which eleven are categorized under Kshudra Kushta. Vipadika is considered one of the important conditions included in this group of minor skin disorders.

The clinical features of Vipadika have been described by different Acharyas with slight variations. Ashtanga Hridaya explains that the disease is characterized by Panipadasphutana (fissuring of palms and soles), Teevra Vedana (severe pain), Manda Kandu (mild itching), and Saraga Pidika (reddish eruptions or macules).[3]In Charaka Samhita, the condition is mainly described with the symptoms of cracks in the skin accompanied by intense pain.[4] Likewise, Acharya Sushruta has mentioned itching, burning sensation, and pain, predominantly affecting the Pada (soles), as the important manifestations of Vipadika.[5]

The present case report describes a patient who presented with complaints of persistent dryness, scaling, itching, and fissuring over both palms associated with severe pain for the past eight years. The patient was managed with Ayurvedic interventions including Virechana as a Shodhana therapy, followed by internal Shamana Aushadhis. Additionally, Raktamokshana was performed using Jaloka (leech therapy), which contributed to marked clinical improvement in the symptoms. Shodhana therapy is considered beneficial in eliminating the underlying pathological factors (Doshas) and thereby helps in reducing the chances of recurrence. The total duration of the treatment was approximately one and a half months. During this period, the patient was evaluated through regular follow-up visits conducted at 15-day intervals, with a total of three follow-ups to assess the progress and outcome of the therapy.

Aim And Objectives

1.To describe and analyze the clinical features of Vipadika as mentioned in classical Ayurvedic texts.

2.To evaluate the role and effectiveness of Ayurvedic management in the treatment of Vipadika.

3.To study the correlation between Vipadika and palmo-plantar psoriasis based on clinical presentation.

Material And Method

Case report-

A 45-year-old female patient reported to the OPD of Government Ayurvedic College, Nanded.She presented with complaints of cracks over both palms and soles.The condition was associated with a burning sensation in the affected areas.The patient also experienced mild itching.Severe pain was another major symptom reported by the patient.

Chief complaint-

The patient presented with fissures over both palms and soles.These lesions were associated with a persistent burning sensation.Mild itching was also reported in the affected areas.The patient experienced severe pain, particularly during manual work and while walking.These symptoms caused considerable discomfort and interfered with the patient’s routine activities.

History of present illness-

The patient presented with complaints of cracks on both palms and soles.These cracks were associated with burning sensation, mild itching, and severe pain.The patient had been suffering from these symptoms for the past 8 years.She had previously taken treatment from modern medicine and experienced only temporary relief.However, the symptoms recurred repeatedly.Due to the recurrence of symptoms, the patient approached our hospital for further management.On clinical examination, multiple deep fissures were observed on both palms and soles.Local tenderness was also present at the affected sites.Based on the clinical features, the condition was diagnosed as Vipadika.

Personal history

Appetite: Moderate

Bowel: Regular

Micturition: Regular

Sleep: Disturbed

Food: Mixed (Veg And Nonveg)

Occupation: Housewife + Farmer

Vital data

Pulse: 74/Min

BP: 120/80 mmHg

Respiratory Rate: 20 /Min

Weight: 78kg

Temp- Normal

Skin examination

 ·The site of involvement was the dorsum of the palm and the sole.

·The distribution of the lesions was symmetrical, involving both soles.

·Dryness, itching, and cracking were observed over both the palms and soles.

·The fissures correspond to Panip?da Sphutana described in Ayurveda.

·The cracks were associated with significant pain.

·On examination, the surface of the affected skin appeared rough and dry.

·The margins of the lesions were irregular.

·There was no evidence of oozing or pustule formation.

Samprapti:

Nidana Sevana

(Aharaja, Viharaja and Manasika factors)

            ↓

Agni Vikruti (Impairment of Agni)

            ↓

Tridosha Vikruti

along with Rasa, Rakta, Mamsa and Lasika Dushti

            ↓

Sanga (Obstruction) and Vimargagamana of Doshas

            ↓

Sthanasamshraya in Hastha (Palms) and Pada (Soles)

            ↓

Manifestation of Vipadika Kushta

Treatment given

Snehapana with Dadimadya Ghrita

Sneha Siddhi Lakshanas were seen on 5th day of Snehapana like Sneha Dwesha, Gatra Mardhava, Snighdha Gatrata, Pureesha Snigdhata etc.

Shamana Aushadi -(given after Samsarjana): for 15 days.

1. Panchatikta ghrita             -      250mg TDS with luke warm water

2. Rasapachaka Kashaya       -      15ml TDS after food with luke warm water.

3. Rajani Yoga                          -        250mg (10am)-250mg(2pm) after food with luke warm water.

4. Chakramarda Taila           -       LA BD

FOLLOW-UP(1st) AFTER 15 DAYS

1. Gandhaka Rasayana           -          250mg BD after food with luke warm water

2. Aaragvdhadi Kashayam      -         15ml TDS after food with luke warm water.

3. Manibhadra Guda              -          5gm BD with luke warm water.

4. Ropani ointment                -           LA BD

FOLLOW-UP(2nd) AFTER 15 DAYS

1. Gandhaka Rasayana          -           250mg BD after food with luke warm water.

2. Aaragvdhadi Kashayam    -           15ml TDS after food with luke warm water.

3. Manibhadra Guda             -           5gm BD with luke warm water.

4. Ropani ointment               -           LA BD

Observation And Results

Table 1: Assessment Criteria for Sphutan

Table 2: Assessment Criteria for Vedana.

Table 3: Assessment Criteria for Kandu(Itching)

Table 4: Assessment Criteria for Scaling

Table 5: observation table

The result was observed after Each follow-up of 15  days, pre-  and  post-treatment  after analysed the assessment criteria of the Patient.  After the complete treatment for 45 days,  the  condition  of  the  patient  after  each follow up is a follow: Table 5.After a complete treatment assessment score is 0,  it  shows  that  the  patient  has  100  % relief  in Cracks,    itching,  and  pain. Pictures  of  the  sole  of  both  feet  also  show significant  relief  during  the  treatment  and  after the treatment

Discussion

Vipadika is a Vata-Kapha dominant disorder. The Ruksha (dry) and Khara (rough) qualities of Vata cause the skin to lose elasticity, leading to painful fissures (Sphutana). Meanwhile, Kapha involvement manifests as Kandu (itching) and thickening of the skin. The disease resides in the Tvak (skin) and Rakta (blood) layers, making it a deep-seated condition. Patient had fissures on her palms and soles and itching due to vitiation of Vata and Kapha respectively. The treatment was given in accordance with vitiation of these Doshas. Panchakarma therapy emphasizes on expulsion  of aggravated  bio  humors  from  the body. Virechana is the second most therapy in the sequence as well as widely used especially for pittaja disorders[6]. Expulsion of humors from lower route is called as virechana[7]. Since, Vipadika is a chronic skin condition, Virechna (Purgation) & Raktmokshana (Bloodletting) is vital to expel accumulated toxins (Amavisha) and cleanse the blood, which helps in preventing the frequent recurrences typical of Palmoplantar Psoriasis. So, expulsion of vitiated  pitta or  kapha  associated  with pitta  through  anal  route  is  called Virechana.

Snehana (Oleation): External application of medicated fats like Tila Taila provides the necessary moisture to counteract Vata’s dryness, promoting the healing of cracks.

Gandhaka Rasayana is extensively used in treatment of various skin disorders such as psoriasis, urticaria, eczema and wound healing, gastro-intestinal disorders and sinusitis. It is used effectively in healing of abscesses and chronic non healing wounds.[8]

As Kushta is the Raktavaha Srotodusti Vikara, Virechana is the main line of treatment adopted in it. Virechana is given with Trivrutta Avleha[9] contains Vidanga, Amalaki, Haritaki and Trivrut. Haritaki and Amalaki have Anulomana action and Trivrut has Virechaka Prabhava. The ingredients of Panchatikta Ghrita include Nimba[10] (Azadirachta indica A. Juss), Patola[11] (Trichosanthes dioca Roxb.), Vyaghri[12] (Solanum surattense Burm.f), Guduchi[13] [Tinospora cordifolia (Thunb) Miers], Vasa[14] (Adathoda vasica Linn.), Haritaki[15] (Terminalia chebula Retz), Vibhitaki[16] (Terminalia bellerica Gaertn. Roxb), Amalaki[17] (Emblica officinalis Gaertn), and Goghrita (ghee prepared from cow’s milk(; most of which have Kushtaghna and Raktaprasadaka properties. [18] Tikta Rasa itself is ideal for Pitta and Rakta Vikaras. As a Shamana Ousadha, Panchatikta Ghrita is a good option for Vipadika.

Ingredients in Aragwadhadi Kashayam reduce Kapha Dosha and most of them act on the skin. It has anti-bacterial, anti- microbial, anti-parasitic, and anti-inflammatory properties. So, it is also helpful for clearing the skin infections. Aragwadhadi Kashaya indicated in skin disease like Kushta, Visrpa, Kandu, etc.[19]

Chakramarda Taila is an anuboota yoga. The ingredients of Chakramarda taila are Chakramarda seeds (Cassia tora. Linn) and Tila taila (Sesamum indicum). Chakramarda seeds (Cassia tora) are well known for their Kushtaghna, Kandughna, and Dadrughna effects.[20]

Jaloukavachran: It is a specialized Ayurvedic para-surgical procedure (Anushastra Karma) used for Raktamokshana (bloodletting). It is considered the gentlest method of detoxification. Ayurveda describes leeches as "Saugandhi" (preferring cool environments) and effective at sucking "vitiated" blood. By removing stagnant, Pitta-Rakta dominant blood, it clears the localized Srotas (channels). Its saliva contains substances like bdellins and Eglin that reduce swelling (Shotha) and provide immediate relief from the intense pain (Teevra Vedana) characteristic of Vipadika. [22]. By improving micro-circulation, it helps the skin tissues regenerate faster, closing deep cracks. It purifies the Rakta Dhatu, which significantly reduces the Kandu (itching) caused by Kapha-Pitta imbalance. Jaloukavacharan (Leech therapy)is best  for  diseases  of pittaj manifestations. [23]

Dadimadi Ghrita is a classical Ayurvedic formulation mentioned in Bhaishajya Ratnavali under Kushta Chikitsa. It is prepared using Dadima and other herbal drugs processed in Ghrita, which acts as a potent carrier for delivering the therapeutic properties of the ingredients. In Ayurveda, Ghrita-based formulations are considered beneficial in the management of skin disorders due to their ability to pacify aggravated Vata and Pitta dosha, nourish the tissues and promote wound healing.[26]

Ropani ointment is a classical Ayurvedic external preparation containing ingredients such as Bakuchi (Psoralea corylifolia), Gandhaka, coconut oil and beeswax, which possess antimicrobial, anti-inflammatory and wound healing properties. Local application of Ropani ointment helps in reducing fissures, relieving pain and dryness, and accelerates the healing of cracked skin. Therefore, it can be effectively used as a supportive local therapy in the management of Vipadika.[27]

Conclusion

Vipadika significantly hampers day-to-day activities due to severe pain and mobility issues, often leading to emotional stress and social withdrawal. While conventional treatments like topical steroids often provide only temporary relief and lead to recurrence upon discontinuation, Ayurvedic management focusing on Shodhana (purification) and Shamana (pacification) therapies offers a holistic and sustainable approach. This case study aims to demonstrate the efficacy of traditional Ayurvedic protocols in managing chronic Vipadika and preventing its recurrence. While conventional treatments frequently rely on topical steroids that may lead to recurrence, Ayurvedic interventions focusing on Shodhana (detoxification) and Shamana (balancing) offer a sustainable alternative. Vipadika  is  a  disease characterized  by  the combination of Vata  and Kapha  imbalances. The increased Ruksha Guna of Vata causes dryness of skin and  results in  cracks. Kandu is produced by Kapha Dosha. Nidana Parivarjana is crucial in treatment as it halts the disease’s progression by restricting Dosha vitiation. This case study documents the clinical management of a Vipadika patient, highlighting the efficacy of holistic protocols in achieving long-term remission. In the present case, the patient was managed by  means of Shodhna followed by Shamana Aushadis containing the effect of Snehapana & Virechana are found to be effective in the management of Vipadika like chronic skin aliments.