Original Article

A successful Ayurveda treatment of recurrence severe plaque

psoriasis – A case report
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Sunil Kumar, K. Thiyagaraj, E. M. Thrijil Krishnan, Nisha Maheshwari1

Department of Rachana Sharir, National Institute of Ayurveda, Jaipur, Rajasthan, 1Shri Hari Kamal Skin and Cosmetics Clinic, Lucknow, Uttar Pradesh, India
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Abstract
Psoriasis is one of the most common dermatologic diseases characterized by erythematous, sharply demarcated papules and rounded plaques,
covered by silvery micaceous scale. It is a lifelong disease with a chronic relapsing course and most patients require a long‑term management.
About 80%–90% of people living with psoriasis experience plaque psoriasis, the most common variant of the disease. In spite of its prevalence,
recurrence is making a serious global problem. In Ayurveda, most of the chronic skin disorders are studied under a common heading Kushtha.
In the present case, a 54‑year‑old male was diagnosed with typical symptoms of plaque psoriasis all over the body for a duration of 5 years.
The patient was advised for Samshodhana (therapeutic purgation), followed by Sanshamana (disease specific internal medicine) using drugs
Shuddha Gandhaka, Pancha‑Nimba Churna, Panchtikta Ghrita, and Aragvadha Phala‑Majja Kwatha. Psoriasis area and severity index score
reduced from 65.7 to 0.9 which is a marked significant difference. There is no recurrence even after discontinuing the treatment for the last
2 years which makes it worth reporting.

Keywords: Ayurveda, EkaKushtha, psoriasis area and severity index score, plaque psoriasis, recurrence

Introduction which contribute to causation of Kushtha vitiates all

three Dosha.[4] This ultimately leads to vitiation of Dhatu
Psoriasis is a common, chronic, and non‑communicable skin
and causing discoloration of the skin.[5] Kushtha is also
disease with no clear cause and cure. Evidences are there for
considered under Ashta‑Mahagada (eight fatal disorder)
genetic predisposition and there is a suggestion that psoriasis
and has been discussed under two subtopics, namely
could be an autoimmune disease but no auto‑antigen that could
Maha‑Kushtha and Kshudra‑Kushtha. EkaKushtha is one
be responsible has been defined yet. It can be provoked by
among the Kshudra‑Kushtha which generally is presented
external and internal triggering factors including mild trauma,
by the symptoms of Aswednama (lack of perspiration),
sunburn, infections, systemic drugs, and stress.[1] Psoriasis
Mahavastu (extensively spread), Matsyoshaklopamam (looks
involves the skin, nails, and it is associated with number of
like fish scale), and Aruna Varna (tinge of reddishness along
comorbidities. Skin lesions are localized or generalized, mostly
with discoloration of the skin).[6] Due to similarity in these
symmetrical, sharply demarcated, red papules and plaques,
symptoms, it can be closely correlated with plaque psoriasis. In
and usually covered with white or silver scales. Lesions cause
the management of psoriasis, recurrence is the major challenge.
stinging, itching, and pain. There are several types of psoriasis,
Ayurveda can aid to prevent the recurrence of disease by
namely plaque, guttate, inverse, pustular, and erythrodermic.[2]
eliminating Dosha through Shodhana.[7]
Plaque psoriasis, also known as psoriasis vulgaris, makes up
about 90% of cases.[1] Scale, a white deposit of dead skin cells, Address for correspondence: Prof. Sunil Kumar,
covers the elevated red spots known as plaques. They can be Department of Rachana Sharir, National Institute of Ayurveda,
present anywhere in the body, prominently visible on elbows, Jaipur ‑ 302 002, Rajasthan, India.
knees, scalp, and lower back.[3] E‑mail: drsunilkumarbhu@gmail.com

In Ayurveda, chronic skin disorders are studied under

a common heading called “Kushtha.” Different factors This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix,
tweak, and build upon the work non‑commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms.
Access this article online
Quick Response Code: For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
Website:
www.ayujournal.org How to cite this article: Kumar S, Thiyagaraj K, Krishnan EM,
Maheshwari N. A successful Ayurveda treatment of recurrence severe plaque
psoriasis – A case report. AYU 2023;44:128-32.
DOI:
10.4103/ayu.ayu_71_21 Submitted: 06‑Apr‑2021 Revised: 16‑Aug‑2023
Accepted: 24‑Jan‑2024 Published: 30-Mar-2024

128 © 2024 AYU (An International Quarterly Journal of Research in Ayurveda) |

Official publication of Institute of Teaching and Research in Ayurveda, Jamnagar | Published by Wolters Kluwer - Medknow
 Kumar, et al.: Ayurveda treatment of recurrence severe plaque psoriasis – A case report

Case Report eight Vega (frequency of bowels evacuated) were observed.

A 54‑year‑old‑male nonalcoholic and nonsmoker, medium
built with body weight of 65 kg having Kapha‑Pitta
Prakriti (Kapha‑Pitta psycho‑somatic constitution) came to
the outpatient department of National Institute of Ayurveda,
Jaipur, on December 21, 2019 with erythematous scaly
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After Virechana Karma, patient was advised for Samsarjana
Krama (dietetic protocol) with Laghu Ahara (easy digestible
foods) for 5 days. After Samsarjana Krama, Shamana
Aushadhi, Shuddha Gandhaka (250 mg), and Pancha Nimba
Churna (5 g) was given orally with 5 ml of honey along with
Aragvadhadi Kashaya 10 ml two times a day at the morning

pruritic plaques on the trunk and extensor surfaces of the
limbs. [Figure 1] There was no family history of similar
complaints. In November 2019, the patches were present on
elbows, chest, and back, but within a month, it covered the
entire body including the scalp. The condition was diagnosed
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and evening and Panchatikta Ghrita was given in a dose of
10 ml twice a day with lunch and dinner. Phanta (hot infusion)
prepared with Aragvadha‑Phala‑Majja (pericarp of Aragvadha
fruits) was given at bed time. Along with these medications,

Eladikera Tailam was advised for local application for 1 month.

with plaque psoriasis. The patient was assessed with Psoriasis
Area and Severity Index (PASI) score as a tool to measure the
severity and extent of psoriasis.[8] PASI score was 65.7 before Table 1: The psoriasis area and severity index score of
treatment. [Table 1] For the last 5 years, he had undertaken the patient before treatment
conventional treatment such as methotrexate, cyclosporine, Assessment of lesions Head Upper Trunk Lower
salicylic acid, and got some relief, but when he discontinued limbs limbs
the treatment, the disease remerged. Plaque characteristics
Erythema 1 4 4 3
Therapeutic intervention Induration/thickness 1 4 4 4
The patient was advised for Virechana Karma (therapeutic Scaling 1 4 4 4
purgation). For Poorva Karma, Panchakola Churna 5 g with Lesion score sum (A) 3 12 12 11
lukewarm water twice a day after lunch and dinner for 2 days Percentage area affected
as Deepana‑Pachana (carminative and digestive) was given. Area score (b) 1 6 6 6
After that, Panchatikta Ghrita as Snehapana in quantity of Subtotal (c) 3 72 72 66
100 ml/day followed by lukewarm water was given at 8 am Body surface area ×0.1 ×0.2 ×0.3 ×0.4
for 5 days. After 5 days of Snehapana, Samyaka Snighdha Totals (D) 0.3 14.4 21.6 26.4
Lakshna (signs of proper unctuous) was observed. After that PASI score=0.3+14.4+21.6+26.4=65.7 (before treatment). PASI: Psoriasis
area and severity index
Abhyanga (therapeutic massage) with Eladikera Tailam and
Sarvanga Vashpa Swedana (therapeutic sudation) was done.
On the day of Virechana, the patient was given Trivrita Leha
50 g at 8am with luke warm water. After 2 h of medication,

a b
a b

c d
c d
Figure 1: Raised, red patches of skin that are covered by silvery‑white
scales in a symmetrical pattern on the limbs (a and b), trunk (c and d) Figure 2: No patches of on the limbs (a and b), trunk (c and d) after
and, especially the elbows and knees, before treatment treatment

AYU ¦ Volume 44 ¦ Issue 4 ¦ October-December 2023 129

 Kumar, et al.: Ayurveda treatment of recurrence severe plaque psoriasis – A case report
After that Aragvadha‑Phala‑MajjaKalka 10 g with 100 ml of
hot water as Phanta (hot infusion) was given at bed time.
Along with these medications, Eladikera Tailam was advised
for the local application for the next 3 months. [Table 2] After
1 month of medication, the patient had symptomatic relief in
itching and erythematous plaques completely disappeared after
3 months. The color of the lesion got fainted with subsequent
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follow‑up visits. [Figure 2] After the treatment, PASI score
reduced from 65.7 to 0.9. [Table 3] The patient was observed
for 2 consecutive years and noticed that no recurrence was
occurred during the period.
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Discussion
Plaque psoriasis is a chronic disease, the severity of which
varies among patients. Conventional therapy that is used
to treat plaque psoriasis patients includes phototherapy,
immunosuppressive agents, and targeted biological agents.
However, these therapies are not enough to prevent the
reoccurrence of the disease.[9]
In Ayurveda classics, it is mentioned that after Shodhana (body
purification therapy), the Dosha are removed completely and
the recurrence chances becomes negligible.[7] The Shodhana
given to patient as a treatment plan as indicated in Kushtha
Chikitsa.[10]
The diagnosis of EkaKushtha was based on the symptoms
mentioned in Ayurveda classics such as Mahavastu and
Matsyoshaklopamam (scaly skin).[11] The scaly lesions were
present all over the body accompanied with severe itching.
Vitiated Vata, Pitta, and Kapha Dosha are responsible for
the abnormal color of the skin. In Kushtha, seven factors get
vitiated termed as Saptko‑Dravya Sangraha, namely Vata,
Pitta, Kapha, Twaka, Rakta, Lasika, and Mamsa.[12]
In this present case, the patient had symptoms of Kandu (severe
itching), Utsedha (raised patches) which are the symptoms
of vitiated Kapha Dosha. Along with these patches,
Table 2: The treatment plan including dose and duration of medicines given to the patient
Date Treatment (medicines)
Shodhana Chikitsa
December 22–23, 2019 Panchakola Churna
December 24–27, 2019 Snehapana with Panchatikta Ghrita
December 28, 2019 Abhaynga with Eladikera Taila and Vashpasweda
December 29, 2019 Virechana with Trivrita Avaleha
December 30, 2019–January 4, 2020 Samsarjana Krama
Shamana Chikitsa
January 5, 2020–February 4, 2020 Shuddha Gandhaka with Panch Nimba Churna
Aragvadhadi Kashaya
Panchatikta Ghrita
Aragvadha Phalamajja Phanta
Eladikera Taila
February 2020–April 2020 Aragvadha Phalamajja Phanta
Eladikera Taila
HS: Hora somni
130
Tamra Varna (reddish in color) which denotes dominance
of vitiated Pitta was observed. Although the classical
diagnosis of EkaKushtha was based on Mahavastu and
Matsyoshaklopamam, but in this present case, Pitta dominant
symptoms were observed. We concluded the Dosha
predominance of the disease is Pitta and Kapha. According to
Acharya Charaka, in Kushtha, predominance Dosha should
be treated first.[13] In Pitta Dosha predominance condition
of Kushtha, Virechana Karma is indicated.[14] Moreover, it
is the Yukti (logical management) of the physician to treat
the patient with the most suitable medicines by assessing
the Agni, predominant Dosha and Dhathu involved, and
Avastha of Roga,[15] so the patient was given Virechana
Karma with Trivrita Avaleha. After Shodhana Karma, the
treatment plan was done according to Dosha dominance that
is Pitta and Kapha. Panchatikta Ghrita is Tridoshaghna,
Kushtha, and Visarpanashaka.[16] Shuddha Gandhaka is
known for its Saptadash‑Kushthghna (pacifier seventeen
types of skin diseases) property.[17] PanchaNimba Churna
is indicated in Kushtha, Visarpa (erysipelas), Arsha (piles),
Nadivrana (pilonidal sinus), Dushtavrana (infected wound),
and Kamala (jaundice). [18] The primary components of
PanchaNimba Churna are Nimba (Azadiracta indica
Juss.), Aragwadha (Cassia fistula Linn.), Amalaki (Emblica
officinalis Gaertn.), Maricha (Piper nigrum Linn.), and so
forth. This Churna has Pitta Shamaka, Kushthaghna, and
Kandughna properties. It is useful for pacify the vitiated
Kapha Dosha, Rakta Dushti, and Kandu (itching). [19]
Aragwadadi Kashaya is Kapha‑Pittahara in nature because
its contents are Tikta and Kashaya Rasa Dravyas. It has
Kushthaghna and Kandughna properties and indicated in
Kushtha.[20] Eladiker Tailam has properties such as Vata‑Kapha
Shamaka, Varna‑Prasadana (which enhances complexion),
Kandu (itching), Pitika (papules) Kothanashaka (transient
large circular skin eruptions). [21] Aragvadha Phala
Majja (pulp of Cassia fistula Linn.) has properties of
Sransan, Ruchya (appetizer) and act against Kushtha
Dose and Anupana
5 g with water after lunch and dinner twice a day
100 mL for 5 days empty stomach – morning at 8 am
Local application
40 g at 8 am
Followed for 5 days
250 mg and 5 g, respectively, with honey twice a day
empty stomach
10 mL twice a day empty stomach
10 mL mixed with food twice a day
10 g before sleep (HS)
Local application over the skin lesion
10 g before sleep (HS)
Local application over the skin lesion
AYU ¦ Volume 44 ¦ Issue 4 ¦ October-December 2023
 Kumar, et al.: Ayurveda treatment of recurrence severe plaque psoriasis – A case report

Table 3: The psoriasis area and severity index Score of Conflicts of interest
patient after treatment There are no conflicts of interest.

Assessment of lesions Head Upper limbs Trunk Lower limbs

Plaque characteristics
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AYU ¦ Volume 44 ¦ Issue 4 ¦ October-December 2023 131

 Kumar, et al.: Ayurveda treatment of recurrence severe plaque psoriasis – A case report

हिन्दी सारांश
गंभीर चिरकालिक पुनरावर्ती प्लेक सोरायसिस का सफल आयुर्वेद� उपचार - एक केस रिपोर्ट
सुनील कुमार, के. त्यागराज, ई. एम. थ्रिजिल कृष्णन, निशा माहे श्वरी

सारांश
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सोरायसिस, एक प्रकार का त्वचा संबंधित सामान्य विकार है , जिसमें रक्तिम, स्पष्ट रूप से उत्सेधित पीड़िका और वृत्तीय चकत्ते पाये
जाते हैं जो चां दी के शल्क से आच्छादित जैसे प्रतीत होते हैं । यह एक दीर्घकालिक पुनरावर्ती विकार है , जिसमें चिरकालिक चिकित्सा
व्यवस्था की आवश्यकता होती है । सोरायसिस से पीड़ित रोगियों में से लगभग 80 से 90 प्रतिशत लोग प्लाक सोरायसिस से ग्रसित होते
हैं , जो इस बीमारी का सबसे सामान्य प्रकार है । इसकी व्यापकता के अतिरिक्त इसकी पुनरावृत्ति, एक गंभीर वैश्विक समस्या है ।
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 05/04/2024

आयुर्वेद� में, अधिकतर त्वचा विकारों को कुष्ठ के अंतर्गत समावेश किया जाता है । वर्तमान लेख में, एक 54 वर्षीय रोगी जो कि पां च साल
से पूरे शरीर में प्लाक सोरायसिस के विशिष्ट लक्षणों से पीड़ित था, को वर्णित किया गया है । रोगी को संशोधन (विरे चन) क्रिया के बाद,
संशमन चिकित्सा हे तु शुद्ध गंधक, पंचनिंब चूर्ण, पंचतिक्त घृत और आरग्वध फल मज्जा क्वाथ आदि औषधियों का उपयोग करने की
सलाह दी गई थी। इस रोगी का पीएएसआई स्कोर 65.7 से घटकर 0.9 हो गया जो उल्लेखनीय महत्वपूर्ण परिणाम है । पिछले दो वर्षों
में उपचार बंद करने के बाद भी इस रोगी में इस रोग की कोई पुनरावृत्ति नहीं हुई है , जो इसे प्रस्तुत करने योग्य बनाती है ।

मुख्य शब्द: आयुर्वेद�, एककुष्ठ, पीएएसआई स्कोर, प्लाक सोरायसिस पुनरावृत्ति

132 AYU ¦ Volume 44 ¦ Issue 4 ¦ October-December 2023