Efficacy of Virechana Karma Along with Shaman Yoga in Ekakushtha W.S.R....

[Full title: Efficacy of Virechana Karma Along with Shaman Yoga in Ekakushtha W.S.R. Psoriasis: A Single Case Study]

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139 Journal of Ayurvedic and Herbal Medicine 2020; 6(3): 139-144 Case Report ISSN: 2454-5023 J. Ayu. Herb. Med. 2020; 6(3): 139-144 © 2020, All rights reserved www.ayurvedjournal.com Received: 27-08-2020 Accepted: 18-10-2020 *Corresponding author: Dr. Yogesh Kumar P.G. Scholar, Dept. of Panchkarma, Gurukul Campus, Uttarakhand Ayurved University, Haridwar, India Email: yogeshpanwar 783@gmail.com Efficacy of Virechana Karma Along with Shaman Yoga in Ekakushtha W.S.R. Psoriasis: A Single Case Study Yogesh Kumar* 1 , Mayank Bhatkoti 2 , Vipin Kumar 3 , Sheetal Varma 4 1 P.G. Scholar, Dept. of Panchkarma, Gurukul Campus, Uttarakhand Ayurved University, Haridwar 2 Associate Professor, Dept. of Panchkarma, Gurukul Campus, Uttarakhand Ayurved University, Haridwar 3 Assistant Professor, Dept. of Samhita and Siddhanta, Gurukul Campus, Uttarakhand Ayurved University, Haridwar 4 Associate Professor, Dept. of Samhita and Siddhanta, Gurukul Campus, Uttarakhand Ayurved University, Haridwar ABSTRACT Skin is vital organ of human body. It is the largest organ of the integumentary system guards the underlying muscles, bones, ligaments and internal organs, seat of complexion, conscientious for ones personality, which maintains beauty, provides identity in society, envelopes internal vital organs, protect us from exterior invasion. In Ayurveda almost all skin disorder are explained under Kustha Rogadhikara. Ekakustha is a type of Kshudra Kustha. It is Vata Kaphaj disorder. It can be correlated with psoriasis both of these have similar sign and symptomatology. Psoriasis is long lasting autoimmune inflammatory papulosquamous disorder characterized by patches of abnormal skin. These skin patches are typically red, itchy and scaly. Its symptoms often worsen during winter and with certain medication, such as beta blockers etc. Psychological stress can also play a role in manifestation of psoriasis. Both males and females are equally affected by this disease. Approximately 1- 2% of World’s total population is affect ed by psoriasis. Due to its chronic recurrent nature. It is a challenge to treat this disease In Ayurveda both Shodhan and Shaman Chikitsa are mention ed for Kushtha In this case study first Deepan-pachan then Virechana as Shodhan Chikitsa and Shaman yoga were given, which showed good result in Ekakushtha. Keywords: Ekakushtha , Psoriasis, Virechana Karma , Shodhan, Shaman yoga, Panchkarma. INTRODUCTION Psoriasis is a common dermatologic disease, affecting up to 1% of the World’s population, both males and females suffering equally [2] . The word Psoriasis is derived from Greek word ‘Psora’ means ‘itch’ and ‘sis’ meaning ‘acting condition’ Psoriasis is a non-infectious, chronic inflammatory disease of skin, characterized by well-defined erythematous plaques with silvery white scale with a predilection for the extensor surface and scalp, and a chronic fluctuating course [3] . Its symptoms often worsen during winter and with certain medication, such as beta blockers etc. Psychological stress can also play a role in manifestation of psoriasis In Ayurveda , almost all the skin disorders are explained under Kushtha Rogadhikara . The term Kushtha can be defined as the state in which disfigurement of body occurs. Ekakushtha is a type of Kshudra Kustha . It is Vata Kaphaj disorder [4] . It can be correlated with psoriasis both of these have similar symptoms. It has symptom like Aswednam (anhydrosis) Mahavastu ( spreding over large area of body), Matsyosklopam (silvery scales lesions), Mandal ( round and with scaling like mica) [5] . In Ayurveda both Shodhan and Shaman Chikitsa are mention ed for Kushtha [ 6] . which are cost effective having no side-effects. So we can hope for a holistic A yurvedic tratment in this disease The case study is as follow: A 30 years old male patient came to OPD of Panchkarma with chief complaint of - 1 Reddish scally patches on right elbow and right leg 2 Itching on the patches 3 Erythma 4 Dryness on the patches Patient had above complains since 5 years.

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140 Journal of Ayurvedic and Herbal Medicine|July-September|2020 Presenting Concern A 30 years male patient was apparently asymptomatic before 5 years. He got very small papule on right hand then slowly it converted into a patch (Red colour) with Scaling, itching and dryness. After that similar patches appeared on right leg. Scaling was more in Winter session. The Ayurvedic diagnosis is considered as Ekakustha which is a Vata and Kapha Predominant Kshudra Kustha. Here an effort was made to treat a thirty years old male patient, well diagnosed case of Ekakustha (psoriasis), by Ayurvedic regimen. As the principle of treatment of all types of Kustha is Sanshodhan along with Sanshamana drugs. In this study initially Virechana Karma was performed. After virechan , Sanshamana drugs were given for 1 month. No H/0 HTN, DM, Asthma, no any other Namexxxxxxx Age – 30 OPD/COPD No- 5415/26649 Date – 15/11/2019 Address – Jwalapur, Haridwar Occupation – Pharmacist Religion – Hindu Marital status- Married Personal history Addiction- No addiction Bowelregular Appetite – good Sleep Sound sleep Urinerest micturation General examination Pallor- Not present Icterus- - Not present Oedema- Not present Clubbing - Not present Blood pressure- 120/80 mmhg Systemic examination Respiratory – B/L Equal air entry Gastrointestinal- NAD Cardiovascular -NAD Central nervous- NAD O/E Ashtavidha Pariksha Dashvidha Pariksha 1 . Nadi = 74/min. Regular 1 . Prakriti = Vata Kaphaj 2 . Mala = Samanya 2 . Vikriti =Kapha Vata 3 . Mutra =Samanya 3 . Sara =Medasara 4 . Jihva =Ishathasaam/Niram 4 . Samhanan =Madhyama 5 . Shabda =Samanya 5 . Pramana =Madhyama 6 . Sparsha =Snigdha 6 . Satva =Pravra 7 . Drika =Samanya 7 . Satmaya =Madhyama 8 . Akriti =Madhyama 8. Aharashakti = Madhyama 9 . Vyayamashakti =Madhyama 10 . Vaya =Yuvaavstha Investigation – Table 1 : Blood investigation reports Parameter Values Hb% 15.4 ESR 27 TLC (/cu mm) 8800 Neutrophils (%) 71 Lymphocytes (%) 24 Eosinophils(%) 04 Basophils (%) 0 Monocytes (%) 01 RBS 99.04 MATERIAL AND METHODS ▪ As the patient was having Mahavastu, Matsyasaklopamam, Kandu, Rukshta, Raga etc. from last 5 years. He was registered for present study in OPD of Gurukul Campus,Uttarakhand Ayurveda University,Haridwar in Panchkarma Department on 15/11/2019. Depending upon signs and Symptoms the patient was diagnosed as Ekakushtha (Psoriasis). Virechana Karma Was given to the patient and followed by Shamanausdhis for 1 month ▪ Simple single case study Assesment Criteria Subjective parameter Mahavastu Matsyashaklopamam (Scaling) Raga(Erythma) Rukshata(Dryness) Kandu(itching)

[Find the meaning and references behind the names: Dosha, Normal, Mild, Pradhan, Pasi, Seeta, Nail, Grade, Rasa, Ambu, Back, Severe, Parts, Rupa, Line, Bright, Ritu]

141 Journal of Ayurvedic and Herbal Medicine|July-September|2020 Table 2: Grading of Mahavastu Mahavastu Grade Matsyashaklopamam (Scaling) Grade No lesions 0 No scaling 0 Lesion on partial parts of hand, leg, neck, scalp, back 1 Mild scaling by rubbing/by itching (scaling from some lesions) 1 Lesion on most parts of hand, leg, neck, scalp, back 2 Moderate scaling by rubbing/by itching (from all lesions) 2 Lesion on whole parts of hand, leg, neck, scalp, back 3 Severe scaling by rubbing / by itching (from all lesions) 3 Whole 4 Scaling without rubbing / by itching (from all lesions) 4 Table 3: Grading of Raga (Erythma), Rukshata (Dryness) and Kandu Raga (Erythma) Grade Rukshata (Dryness) Grade Kandu Grade Normal skin 0 No line on scrubbing with nail 0 No itching 0 Very faint erythema 1 Faint line on scrubing by nail 1 Mild/occasional itching 1 Faint erythema 2 Lining & even words can be written on scrubbing by nail 2 Moderate (tolerable ) infrequent 2 Bright erythema 3 Excessive Rukshta leading to kandu 3 Very severe itching disturbing sleep and other activity 3 Very bright 4 Rukshta leading to crack formation 4 Objective parameter PASI SCORE Table 4: Nidan Panchak Nidana Virudh aahar, Snigdha aahar , Seeta-usna ahara kramam muktva sevana, Vegadharna, Purvarupa Rukshta, Kandu, Raga . Rupa Mahavastu, Matsyashaklopamam, Raga, Rukshata, Kandu. Upasaya Symptoms that relief in Grishma ritu Samprapti Due to Nidana sevana there was some Khaviguna and Prakupita dosha Are came and vitiates Tridosha, Twak, Rakta and Lasika and create Ekakushtha symptom like ( Mahavastu , Matsyashaklopamam, Raga, Rukshata, Kandu ) Table 5: Samprapti Ghatak Nidan Virudh aahar, Snigdha aahar , Seeta-usna ahara kramam muktva sevana, Vegadharna, Doshas Tridosha ( Vata kapha pradhan ) Dushya Twak, Rakta, Lasika(Ambu), Sweda Srotas Rasa, Rakta, Mamsavaha, Svedhvaha Adhishthana Twacha Rogamarga Abhayantra Vyadhi Vinischaya (Diagnosis) Ekakushtha Treatment 1. Nidhana Parivarjana 2. Sodhana Karma A. Deepan-Pachana B. VirechanaKarma

[Find the meaning and references behind the names: Luke, Fig, Vega, Dose, Nov, Days, Tila, Tab, Ras]

142 Journal of Ayurvedic and Herbal Medicine|July-September|2020 C. ShamanChikitsa (Two follow – up) Table 6: Showing the Drugs used for Deepan – Pachana for 3 days S N . Darvya Dose Duration Anupana 1. Chitrakadi vati 2 tab BD Luke warm water 2. Ajmodadi Churna 3 gm BD Luke warm water Table 7: Showing Snehapana for VirechanaKarma S.N. & Days Procedure Medicine Date Dose Observation 1. Snehapana Panchtiktaghrita 19/11/19 50 ml Felt good 2. 20/11/19 100 ml Itching Reduce 3. 21/11/19 150 Ml Itching completely absent 4. 22/11/19 200 ml Bowel clear Scaling, dryness reduced 5. 23/11/19 250 ml Redness reduced andSnigdha Varchas observed 6. Sarvanga Abhyanga(45 minute) & Swedana (20 minutes) Abhyang(Tila taila) & swedana ( Dasmoola kwatha) 24, 25, 26 OF Nov 2019 Itching Reduced Redness Reduced Sleep Sound 7. 8. Table 8: Showing Virechana karma and Samsarjana Karma S.N. Procedure Medicine Vega 1. Virechana karma Trivrita avleha 40 gm + 1 tab. of Itchabhedi Ras given at 10:00 AM 20 2. S amsarjana Karma advised for 5 days Shamana Chikitsa: Table 9: Showing Drugs used for 1 st follow S.N. Mdicines Duration 1. Panchnimbhadi choorna 3 gm + Shudh Gandhak 250 mg BD + Giloy satva 250 mg Anupana - luke warm water 1 month 2. Aarogyavradhini Vatti 2 BD Panchghrita guggulu 2 BD 1 month 4. Mahamanjishthadi Kashayam 40 ml 1 month Fig 1: Before the treatment (A, B) A B

[Find the meaning and references behind the names: Head, Lower]

143 Journal of Ayurvedic and Herbal Medicine|July-September|2020 Fig 2: After Virechana Karma and after 1 st follow-up (A, B) RESULT With above mentioned line of treatment patient got complete relief from the symptom of Ekakushtha (psoriasis) Table 10: Comparing the symptoms before after treatment of Ekakushtha (psoriasis) Symptoms Before TT After TT Mahavastu 3 1 Matsyashaklopamam (Scaling ) 3 0 Raga( Erythma) 2 0 Rukshata (Dryness) 3 0 Kandu (Itching) 2 0 Table 11: Pasi score assessment before treatment Head Upper limb Trunk Lower limb Erythema 0 4 0 4 Thickness 0 3 0 3 Scaling 0 3 0 2 Lesion score (A) 0 10 0 9 %of area involvement (B) 0 3 0 3 Subtotal © A X B 0 10 X 3= 30 0 9 X 3= 27 Body surface area (D) C X 0.1 C X 0.2 C X 0.3 C X 0.4 D 0 X 0.1 = 0 30 X 0.2 = 6 0 X 0.3 = 0 27 X 0.4 = 10.8 PASI SCORE = 16. 8 Table 12: Pasi score assessment after treatment Head Upper limb Trunk Lower limb Erythema 0 1 0 1 Thickness 0 0 0 0 Scaling 0 0 0 0 Lesion score (A) 0 1 0 1 %of area involvement (B) 0 1 0 1 Subtotal © A X B 0 1 X 1= 1 0 1 X 1= 1 Body surface area (D) C X 0.1 C X 0.2 C X 0.3 C X 0.4 D 0 X 0.1 = 0 1 X 0.2 = 2 0 X 0.3 = 0 1 X 0.4 = 4 PASI SCORE = 6 A B

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144 Journal of Ayurvedic and Herbal Medicine|July-September|2020 DISCUSSION All Acharya mentioned that Kushtha is the Raktaj Vyadhi . In all the Twaka Vikara , the vitiation of Rakta and Pitta is mentioned. Virechana Karma is taken as it acts on all Dosha in general and Pitta and Rakta in particular. Deepana, Pachana, Snehapana followed by Virechana is the sequential order which was followed. Deepana and Pachana was administered with Chitrakadi vati and Ajmodadi Churna which had enhanced the digestive power and also facilitated for the early digestion of Sneha . Panchatikta Ghrita was administered in Vardhamana krama . During the Snehapana kala itself, some of the symptoms were deteriorating. Virechana was performed by Trivrit avhleha . Due to Vata Kaphaghna property it reduces symptoms of Ekakushtha . All skin disorders there is accumulation of Kleda . Virechana has Pitta Shodhana and Rakta Prasadana property lead to Kleda Harana . Due to the Manaprasadana property it reduces stress and stress related symptoms [10] . Shaman yoga has Kushthaghna as well as Rasayana effect on skin Panchnimbhadi Choorna - Nimba has Tikta and Kashaya rasa , Laghu, Ruksha guna, Sheeta veerya, Pitta kapha hara, Kandugna, Kusthagna, Vruna hara, Krimihara and Rakta shodaka The ingredients of Maha Manjistadi Kwath a are Manjistha , Haritaki , Vibhitaki, Amalaki, Katuki, Vacha, Devadaru, Haidra and Nimba Twak which have the properties like Agnidipaka , Raktashodaka , Samsrana , Pitta Kaphahara , Kusthaghna, Kashaya , Tikta , Katu Rasa , Laghu Ruksha Guna , Usna Virya, Pittakapha Shamaka, Kusthaghna etc. Panchtikta ghrita guggulu – This is very potent drug indicated exclusively by Chakradutta in Kustha Adhikar . Giloy satva - Giloy specially acts on micro circulation and helps in homoeostasis of all the three doshas which are the prime culprits in any skin disease. Aarogyavardhini vati - Aarogyavardhini vati is herbomineral formulation primarily advised in Kushtha vikaar . Its primarly site of action is Grahani and Pakwashaya . It is very important ingredient to correct the multiple dusya levels in Kushtha . Shudh gandhak-is very usefull in all type of skin disease. CONCLUSION In this case study we got good result of Virechana karma and Ayurvedic medicine. The treatment given for Ekakushtha (psoriasis) was Deepan- Paachan, Shodhan , Shaman yoga; which helped an Aampachan, removal of vitiated dosha from body and to bring Samyavastha (balanced condition) of Doshas . So above treatment help to relieve symptoms of disease and also an attempt to provide safe and effective treatment of the patient [11] REFERENCES 1 Editor- Dennis L Kasper et al . Harrison’s Principle of internal medicine; 16 th edition 2 Lee Goldman, Andrew I Schafer, Goldman’s Cecil medicine. 24 th Edition; Elsevier Saunders. Eczemas, photodermatoses, Papulosquamous diseases. 3 Editor- Christopher Haslett, Davidson’s principle & practice of medicine , 18 th edition , Harcourt publisher Ltd 2000. 4 Shastri, Kashinath Chaturvedi, G.N. (Trans.) (2009 A.D.). Vidyotini (Hindi.Com.) Charaka Samhita - uttarardh (Rep. ed.). Varanasi, India: Chaukhamba Bharti 5 Antiwal Meera and Singh Jai Prakash. Role of Samshaman theraphy in the management of Ekakushtha (psoriasis): A case report int. Res. J. Pharm. 2013; 4(4):238-240 6 Shastri, Kashinath Chaturvedi, GN. (Trans.) (2009 A.D.). Vidyotini (Hindi.Com.) Charaka Samhita - uttarardh (Rep. ed.). Varanasi, India: Chaukhamba Bharti 7 Triphati, Indradeva (Trans) (2015 A.D). Chakradatta . Varanasi, India: Chaukhmbha Sanskrit Bhawan. 8 Gupta, Atridev, Upadhyaya, Yadunandana (Trans.) (2016 A.D.). Vidyotini (Hindi Trans .) Astang Haridya (Rep.ed.). Varanasi, India: Chaukhmba Prakhsan. 9 Gupta Piyush, Sharma Uttam Kumar, Sharma Ashok Kumar. A clinical study to eualuate the effect of shiddharthak yoga as kwath, lepa & virechana karma in the management of ekkustha with special reference to psoriasis. Int. Res. J. Pharm. 2015; 6(11):765-774 http://dx.doi.org/10.7897/2230-8407.0611149 10 Ujwala Rodge, Vd. D.N. Khahalekar, Vd.V.E. Gogate, Vd. M.W. Nalkande. Case study on Ekakushtha (psoriasis) with Ayurvedic Management. ISOR-JPBS, www.journals.org . HOW TO CITE THIS ARTICLE Kumar Y, Bhatkoti M, Kumar V, Varma S. Efficacy of Virechana Karma Along with Shaman Yoga in Ekakushtha W.S.R. Psoriasis: A Single Case Study. J Ayu Herb Med 2020;6(3):139-144.

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Raga, Ayurveda, Vata, Pitta, Kapha, Kandu, Kushtha, Tridosha, Rakta, Ekakushtha, Rukshata, Virechana, Mahavastu, Snehapana, Ayurvedic treatment, Samsarjana Karma, Shodhana Karma, Virechana Karma, Case study, Psoriasis, Shodhan Chikitsa, Ayurvedic regimen, Shaman Chikitsa, Panchkarma, Virechanakarma, Skin disorder, Deepan Pachan, Kshudra Kustha, Panchkarma Department, NIDHANA PARIVARJANA, Shaman Yoga, Vata Kaphaj, Deepan Pachana, Ekakushtha (Psoriasis), Kushtha Rogadhikara.