Case Study on Eka Kustha- Principle to Practice

[Find the meaning and references behind the names: Ghana, Range, Four, Shyama, Doi, Class, India, Sangram, Vata, Broad, Male, Kesa, Plane, Round, Body, Deals, Wide, Present, Eka, Keshari, Ayu, Krishna, Show, Mohanty, Organ, Head, Data, Snigdha, Patient, Days, Sense, Nails, Member, Back, Hair, Goa, Area, Fall, Severe, Given, Chandan, Centre, Kesha, Due, Med, Non, Case, Pitta, Author, Past, Study, Strong, Black, Roga, Aruna, Small, Herb, Patch, Common]

64 Journal of Ayurvedic and Herbal Medicine 2022; 8(2): 64-67 Case Report ISSN: 2454-5023 J. Ayu. Herb. Med. 2022; 8(2): 64-67 Received: 10-05-2022 Accepted: 07-06-2022 © 2022, All rights reserved www.ayurvedjournal.com DOI: 10.31254/jahm.2022.8202 *Corresponding author: Dr. Bishnupriya Mohanty Professor and Head, Department of Sanskrit Samhita and Siddhanta, Gomantak Aurveda Mahavidyalaya and Research Centre, Shiroda, Goa 403103, India Email: drbishnupriyadas@gmail.com Case Study on Eka Kustha- Principle to Practice Bishnupriya Mohanty 1 , Sangram Keshari Das 2 1 Professor and Head, Department of Sanskrit Samhita and Siddhanta, Gomantak Aurveda Mahavidyalaya and Research Centre, Shiroda, Goa 403103, India 2 Professor and Head, Department of Dravyaguna Vijnana, Gomantak Aurveda Mahavidyalaya and Research Centre, Shiroda, Goa 403103, India ABSTRACT The disease Kustha Roga occurs due to the vitiation of Vata, Pitta and Kapha Doshas. It shows symptoms like Ugrakandu (Severe itching either generalised or localised), Twaksphutana (breaking or cracking of skin), Kharasparsha and lesions are Vritta (round), Snigdha and Ghana (thick). The colour is Krishna or Shyama Varna (brownish black). EkaKustha(Psoriasis) is one among the wide numbers of Kustha Roga. It is a chronic inflammatory skin disease which usually localised in the extremities, trunk, scalp, hairs, etc. This case study deals with a sixty-five years old male patient suffering from Sarwanga Kandu (itching all over the body), Shyava Aruna Vaivarnyata, patches in Sarwanga, Keshachyuti (hair fall). In this case Ayurvedic formulations of Arogyavardhini Vati (orally), Yashtimandhu Churna, Chandan churna and Yashadapuspha mixed with Shatadhauta Ghrita is given for external application Keywords: Kustha Roga, EkaKustha, Psoriasis, Case Study. INTRODUCTION The skin (Twak) is the largest organ of our body. In Ayurveda it is described as one of the ‘Gyanendriyas(Sense Organ)’ which is responsible for touch sensation. The disease Kustha Roga has potential to destruct body tissues with gangrenous changes so that it is decomposed. The disease has a broad spectrum skin presentation; starting from hypo-pigmented patch or a plane discolouration up to the extreme range towards decomposition; if it is not well managed. Psoriasis is one of the most common dermatological diseases affecting the people. It is usually localised in the extremities, trunk, scalp, nails and may also involve genitalia and the anus. It is non-infectious and a chronic inflammatory skin disorder. CASE STUDY This case study deals with a sixty-five years old male patient having a chief complaint about 1 Sarwanga Kandu – Itching all over the body. 2 Twak Vaivarnya (shyava-Aruna Varna) – Reddish blackish discolouration of patches on skin which are round, thick and Snigdha including head area too. 3 Kesha Chyuti – Hair fall. History of present illness Patient had first experienced itching all over the body four years back. After some days patient noticed a reddish blackish discoloration of the skin in patches which are round, thick and Snigdha. Initially small patches got developed on the leg, later appears on all over the body and presently the larger patches are detected on the leg. The patient also has a complaint about the hair fall. History of past illness The patient had no history of such past illness neither any other family member had such illness.

[Find the meaning and references behind the names: Dosha, Fruits, Daily, Natural, Fish, New, Less, June, Vegas, Karma, Act, Day, Normal, Vega, Anna, Kotha, Hot, Pain, Time, Diet, Aha, Large, Hour, Bad, Sleep, Guru, Sun, Mala, Vidhi, Blood, Gram, Ambu, Madhu, Ama, Get, Rise, Papa, State, Place, Visha, Agni, Sour, Table, Cold, Esr, April, Milk, Wrong, Hours, Salt, Heat, Lustre, Astha, Pana, Sama, Father, Nadi]

65 Journal of Ayurvedic and Herbal Medicine|April-June|2022 Table 1: Showing Personal history of the Patient Nadi 70 per minute Mala 1 to 2 times per day Mutra 5 to 6 times in a day Jihva Sama Shabda Spashta Sparsha Ruksha Drika Samanya Akruti Mashyama Ahar/diet Mixed diet Appetite/Agni Moderate Sleep Disturbed Addiction No The blood test reports revealed that the haemoglobin was in normal units whereas ESR was found to be 38 mm/hour which exceeded the limiting range of 0 to 9 mm/hour. The total cholesterol which is supposed to be in a range of 0 to 200 mg/dl was found to be 216 mg/dl. Also, serum LDL cholesterol which should be less than 100 mg/dl was reported to be 140 mg/dl. Etiopathogenesis of Eka Kustha Etiopathogenesis consists of Aharaja Nidana and Viharaja Nidana. Aharaja Nidana consists of investigating about the food intake. Intake of opposite/wrong combination of food and drinks such asmilk with fish; Madhu and Phanita; milk and jaggery; and milk and sour fruits is bad for health. The intake of all these things daily, in large quantities when there is indigestion and without following the Pathya and Apathya together causes Virodhi Anna Pana. The intake of drinks which are unctuous and heavy to digest causes Snigdha Guru Pana. Alternatively, intake of cold and hot things in Ahara causes Snigdha Guru Pana [1] . Excessively intake of freshly harvested grains, curd, fish, excessive intake of salt and sour substances, excessive intake of black gram, radish, items prepared from flours like pastry, sesame seeds and jaggery and milk products affects the digestive system. Consuming excessive food causes Amotpatti and can manifest Eka Kustha [2] . Eating before complete digestion of previous food is called Adhyashana and eating food in state of indigestion is called Ajirnashana. Ajirna and Adhyashana both causes Agnimandya and ultimately produces disease. Both can vitiate the Rakta Dhatu. If this is continued for longer time it may cause Eka Kustha Roga [3] . Vishamashana means the intake of food at irregular time and in irregular quantity. Any irregularities may produce Agni Vaishyamyata. One should avoid eating intake of uncooked or not properly cooked food. By not following the codes of conduct of eating (Astha Ahara Vidhi Vishesha Ayatana and Dwadashaashan Vidhi) mention in Aurveda can produce Ama which gives rise to Ama Visha. Viharaja Nidana constitutes investigating about the suppression of the natural urges especially Chhardi and other Vegas like Mala, Mutra and Vayu. Doing physical exercises immediately after having food or after having heavy meal, doing physical exercise in excessive heat and doing exercise in abnormal postures, excessive exposure to sun, exposure to conditioned air, over exertion, use of the cold water immediately after exposure to sun heat, exertion or exposure to frightening situation, sleeping in day hours, late night sleep, performance of sexual act while suffering with indigestion, improper administration of Panchakarma therapies, behavioural misconduct/ ignorance to mother, father, Bhrahmana, Guru (teacher) etc., and also by doing Papa Karma individual may get affected [4] . This patient have around 60% of above mentioned Aharaja & Viharaja Nidana. Pathogenesis of Eka Kustha Etiological factors give rise to three Dosha Prakopa especially Kapha dosha. It spreads all over the body. Twak, Rakta, Mamsa and Ambu (Lasika) Shaithilyata which occurs due to the Jatharagni Mandya also due to the Dhavtagni Mandya giving rise to less amount of nutritive portion formation and more amount of waste products. Further, where the vitiation of the Doshas occur at the place of Dhatu Shaithilyata the Doshas get accumulate. Kledotpatti occurs, Dosha and Dushya Samurchhana occurs Kotha(patches) may get generate on skin; which eventually give rise to EkaKustha . Here, Dosha means Kapha Pradhana Tridosha and Dushya means Twak, Rakta, Mamsa, Lasika and later all Dhatus are involved. Assessment Criteria: 1 Itching(assessed on basis of Frequency and degree) 2 Pain 3 Bleeding on Patches after itching 4 Lustre of Skin 5 Any new lesion appear/Disappear 6 Healing of Patches 7 Appearance of New skin

[Find the meaning and references behind the names: Parada, Chandana, Lepa, Care, Iron, Rind, Juice, Dose, Flour, Mercury, Mica, Tamra, Fruit, Part, Size, Oral, Person, Copper, Shata, Parts, Bath, Lemon]

66 Journal of Ayurvedic and Herbal Medicine|April-June|2022 Treatment Prescribed detail: The treatment prescribed to the patient for three months with other instructions of routine Pathyapathya were. Table 2: Showing The Details Of Treatment Prescribed S. No. Drug Dose Anupana Route 1. Arogya VardhiniVati 250 mg Lukewarm water after food Oral thrice a day 2. YasthimadhuChurna, Yashadapuspha and Chandana Churna As required Shata Dhauta Ghrita Lepa(External Application) 3. Bath Soap was replaced by Flour of Bengal gram As required Lemon Juice Udvartana(External Application) RESULT Eka Kustha can be correlated with Psoriasis based on the signs, symptoms and Pathophysiology. It is caused by vitiations of Doshas in the person indulging in wrong food, eating style, cooking style and faulty lifestyle adaptation. This patient had such many Nidanas since years together. In his initial days of suffering he was not taken care systematically; which made the disease comparatively complex. After taking above medication for 3 months the patient was assessed on basis of declared assessment criterias. Table 3: Showing the result of Treatment Assessment Criteria Relief Assessed Itching(assessed on basis of Frequency and degree) The itching was totally absent Pain No pain on the site of lesion Bleeding on Patches after itching No Bleeding as the itching was stopped Lustre of Skin The lustre starts to regain Any new lesion appear/Disappear No new skin lesion continue to appear Healing of Patches Small patches on leg , abdomen were disappears with brownish black spots. The patches on head size was reduced Appearance of New skin New skin starts to appear DISCUSSION Table 4: Showing ingredient of Arogya Vardhini Vati The ingredient of Arogya Vardhini Vati is like- S. No. Ingredients Botanical Name Amount 1 Shuddha Parada (Herbal purified Mercury) - 1 part 2 Shuddha Gandhaka (Herbal purified Sulphur) - 1 part 3 Loha Bhasma (Purified and processed Iron) - 1 part 4 Abhraka Bhasma (Purified and processed Mica) - 1 part 5 Tamra Bhasma (Purified and processed Copper ) - 1 part 6 Triphala Haritaki- Chebulic Myrobalan fruit rind. Bibhitaki – Belliric Myrobalan fruit rind. Amalaki – Indian gooseberry fruit. Terminalia chebula Retz. Terminalia bellirica Roxb. Emblica officinalis Gaertn. 2 parts

[Find the meaning and references behind the names: Kumar Gupta, Kumar Sharma, Mode, Shri, Pharm, Surinder, Sharman, Sharma, Makes, Local, Better, Gum, Cite, Gupta, Edema, Fatty, Sutra, Worm, Shastri, Pur, Brain, Hook, Int, Low, Kumar, Poor, Shoshana, Neem, Fever, Liver, Acharya, Sandeep, Royle, Carbon, Fats, Kanthi, Gajendra, Original, Future, Madhav, Under, Linn, High, Lot, Rat, Pitch, Mula, Open, Yogendra, Bhavana, Cell, Delay, Famous, Ajmer, Free, Take, Srivastava, Chita, Prakashan, Stocks, Mukul, Amita, General, Need, Mental, Property, Gopal, Rajasthan, None]

67 Journal of Ayurvedic and Herbal Medicine|April-June|2022 7 Shilajatu (Mineral Pitch) Asphaltum 3 parts 8 Purana Guggulu – Indian bedelium (Gum resin). Commiphora mukul Hook ex stocks 4 parts 9 Chita Mula-Rroot of Indian led word. Plumbago zeylanica Linn. 4 parts 10 Tikta – Katuki Picrorhiza kurroa Royle ex Benth. 4 parts 11 Juice of Neem leaves Azadirachta indica A. Juss As required Mode of Action in Brief Haritaki is astringent and laxative and indicated in relieving fatty liver and cirrhosis of liver . Bibhitaki is laxative and effective in digestive disorder as well as anthelmintic, it has styptic property and hence useful in arresting bleeding. Amalaki is antibacterial, carminative, hypoglycaemic, stomachic, hypotensive, astringent agent and it has anti oxidative, anti-hepato toxic and immune modulator properties. Shuddha Shilajit is an effective agent for renewing vitality, powerful antioxidant, helps to delay the process of aging, useful in relieving kidney diseases, liver diseases, digestive disorders and mental illness. Puratana Guggulu helps in reducing cholesterol, helps to remove unwanted fats. Chitraka Mula is effective in digestive disorders and useful in indigestion, piles, worms, colitis and various liver diseases. Katuki is effective in liver disorders and useful in liver damage caused by chemicals such as carbon tetrachloride, paracetamol, alcohol and even in Non-alcoholic cirrhosis of liver. Therefore Arogyavardhani Vati is in general beneficial in Cirrhosis of liver, jaundice and poor liver functioning. It has a wide range of application in skin disease, oedema, obesity, jaundice, various types of hepatic disorders, indigestion and irregular bowel movements, chronic fevers, water retention, low or high hormonal production, accumulated cholesterol in the body, hepatitis and famous classical product for multiple system like circulatory, respiratory, excretory, reproductive and skeletal system. Along with the external applications help to give symptomatic relief, do local Shodhana, do Shoshana (assimilation) of different excess Snigdha dravyas (unctuous substances) present on the skin, activate Bhrajaka Pitta , new cell generation as well and to get over all desired effect [5-10] . CONCLUSION The case is mainly focused on the different aspects of the etiology and pathogenesis of the Kustharoga. Patient with the skin disorder always experience the physical, mental and social embarrassment in the society. So there is lot of mental pressure on the patient which again makes the worst condition of the existing disease. For such patient the surrounding people/society also need to support. It is better to take care of the health. So that there are less chances to manifest the disease in future. Conflict of Interest None declared. Financial support None declared. REFERENCE 1 Sushruta Samhita, Acharya Priyavrat Sharma, Nidansthan 5,5, Chaukhamba Vishwabharti, Varanasi. 2018;37. 2 Charaka Samhita (Chakrapani Commentary). Jadavaji Trikamji Acharya, editor. 1 st ed. Sutra Sthana Chapter no-1, verse no-68. Varanasi: Chaukhamba Sanskrit Sansthan. 2009;p.36. 3 Madhavkar, Madhav Nidan, Madhukosh Vyakhya Vibhushit Ayurvedacharya Shri Yadunandopadhyaya, Vol 2, Adhyaya 49, 31-32, Varanasi, Chaukhamba Prakashan. 2009. 4 Yogaratnakar of Acharya Laxmipati Shastri, Editor Shri Brahmashankar Shastri, KushthaNidan, 373, Chaukhamba Prakashan, Varanasi. 5 Ayurvedic Formulary of India. Part I and II. Ministry of Health and Family Welfare, Govt. of India. 2005. 6 Ambikadatta Shastri. Rasaratna Samuchchya. 9 th edition. Chapter no-20. Verse no-87. Varanasi: Chaukhamba Sanskrit Publisher. 1994;p.400. 7 Kumar G, Srivastava A, Sharma SK, Gupta YK. Safety evaluation of an Ayurvedic medicine, Arogya Vardhini vati on brain, liver and kidney in rats. J Ethnopharmacol. 2012;140:151 – 60. 8 Rasatantrasara and Siddhayoga Sangraha. 1 st edition. Ajmer, Rajasthan: Krishna Gopal Ayurveda Bhavana Publisher. 2015;p.150-53 9 Gajendra Kumar, Amita Srivastava, Surinder Kumar Sharma, Yogendra Kumar Gupta. The hypolipidemic activity of Ayurvedic medicine, Arogyavardhini vatiin Triton WR-1339-induced hyperlipidemic rats: A comparison with fenofibrate. J Ayurveda Integr Med. 2013;4(3):165 – 70. 10 Sarashetti RS, Simpi CC, Sandeep NM, Kanthi VG. Screening of free radical scavenging activity of Arogyavardhini vati. Int. J. Res. Ayurveda Pharm. 2013;4(4):555-559. HOW TO CITE THIS ARTICLE Mohanty B, Das SK. Case Study on Eka Kustha- Principle to Practice. J Ayu Herb Med 2022;8(2):64-67. DOI: 10.31254/jahm.2022.8202 Creative Commons (CC) License- This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY 4.0) license. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. (http://creativecommons.org/licenses/by/4.0/).