EKAKUSHTHA (PSORIASIS) Treatment Protocol by Ayush
INTRODUCTION
Ekakushtha is one among eleven Kshudra Kushta with the dominance of Vata and Kapha, which is characterized by silvery plaques like fish scales may be associated with itching and with tendency to spread all over the body. It can be correlated with psoriasis like diseases. Along with faulty dietary habits, psychogenic stress also plays important role in the pathogenesis of Ekakushtha.
Case Definition:
A patient presenting with dry scaling erythematous / maculopapulous patches, covered with adherent silvery white scales which may or may not be associated with itching.
Differential Diagnosis
- Sidhma: White colored shiny patches associated with or without itching along with exfoliation in the form of dust.
- Dadru: Circular patches with elevated periphery associated with severe itching
Line of Treatment
- Nidana Parivarjana should be the first line of treatment.
- Shodhana Chikitsa – Vamana, Virechana, Rakta Mokshana,
- Shamana Chikitsa – Pachana, Raktashodhana, external applications (Lepa, Taila and Dhara Chikitsa)
- Rasayana Chikitsa for Rasa – Rakta Prasadana.
- Treatment according to Doshik involvement
- General line of treatment prescribed for Kushtha
LEVEL 1: AT SOLO AYURVEDIC PHYSICIAN CLINIC / PHC
Investigations: Nothing specific.
Treatment: In the initial stage when the patient is having mild features of Ekakushta, along with diet restriction, two or more of following drugs may be given as per Doshic predominance: Table 8.1: Medicines at level 1 for Ekakushta
Drugs |
Dosage form |
Dose |
Time of administration |
Duration |
Anupana |
Sariva1 |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Madhu / Luke warm water |
Haridra2 |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Madhu / Luke warm water |
Khadira3 |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Madhu / Luke warm water |
Guduchi4 |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Madhu / Luke warm water |
Manjishtha5 |
Churna |
3-6 gm |
After meal / thrice a day |
2-3 weeks |
Madhu / Luke warm water |
Manjisthadi Kwatha6 |
Kwatha |
20-40 ml |
After meal / twice a day |
2-3 weeks |
- |
Mahatiktaka Kwatha |
Kwatha |
20-40 ml |
Before meal / twice daily |
2-3 weeks |
- |
Panchatiktakam Ghrita |
Ghrita |
15 ml |
Before meal |
2-3 weeks |
Luke warm water |
Kaishora Guggulu7 |
Vati |
1-2 Vati |
Before meal / twice daily |
2-3 weeks |
Luke warm water |
Whenever needed, symptomatic treatment of associated conditions can also been done e.g. if patients complains of constipation, Avipattikara Churna or Swadishta Virechana Churna in empty stomach early morning with luke warm water can be given.
External applications:
Kshalana: Tankan Jala / Triphala Kwatha / Panchavalkala Kwatha
Lepa: Jeevantyadi Yamaka Lepa, Vajraka Taila, Mahamarichadi Taila, Gandhaka Malahara, Karanja Taila, Jatyadi Taila, Adityapaka Taila
Pathya - Apathya (Diet and life style education):
Do’s -
- Ahara: Laghu Anna (light food), Tikta Shaka (bitter leafy vegetables), Purana Dhanya (seasoned grain), Yava (barley), Godhuma (wheat), Mudga (green gram), Patola,
- Vihara: Maintain hygiene, follow Dinacharya and Ritucharya properly
Don’t -
- Ahara: Viruddha Ahara, Adhyashana (eating prior to the digestion of previous meals), excessive sour and salty food, exercise after heavy meal, Masha (black gram), radish, refined flour products, fermented food, curd, fish, jaggery.
- Vihara: Mental stress / anxiety, suppression of urges especially of vomiting, day-sleeping, excessive exposure to sun, unhygienic conditions
Referral Criteria:
- Patients not responding to above mentioned management.
- Need further investigations
LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES
Clinical diagnosis: Same as level 1 for a fresh case reporting directly.
Investigation: Nothing specific
Treatment: In addition to the management mentioned in Level 1, few of the following drugs may be added as per the requirement and status of the patient. Rasaushadhi (herbo-mineral drugs) can be used at this level. Patient may be kept under observation while prescribing these kinds of medicines:
Table 8.2: Medicines at level 2 for Ekakushta
Compound formulation |
Dosage form |
Dosage |
Time of administration |
Duration |
Anupana |
Sarivadyasava8 |
Asava |
10-20 ml |
After meal / thrice daily |
2-3 weeks |
Equal quantity of water |
Mahamanjisthadi Kwatha9 |
Kwatha |
20-40 ml |
Before meal / twice daily |
2-3 weeks |
- |
Gandhaka Rasayana |
Vati |
1-2 Vati (125-250 mg) |
After meal / thrice daily |
2-3 weeks |
Luke warm water / Madhu |
Khadirarishta10 |
Arishta |
10-20 ml |
After meal / thrice daily |
2-3 weeks |
Equal quantity of water |
Aragwadharishta |
Arishta |
10-20 ml |
After meal / thrice daily |
2-3 weeks |
Equal quantity of water |
Arogyavardhini Vati11 |
Vati |
1-2 Vati (500 mg) |
After meal / thrice daily |
2-3 weeks |
Madhu / water |
Manibhadra Gudam |
Lehya |
15-30 gm |
Every morning |
For 1 month |
Luke warm water |
procedures indicated for Ekakushtha can be performed.
Shodhana Chikitsa:
- Vamana
- Virechana
- Raktamokshana: Siravedha, Jalookavacharana
Rasayana - Amalaki, Guduchi, Bhringaraja, Ghrita Bhrishta Haridra, Brahmi, Mandukaparni, Triphala, Khadira, Vidanga, Tuvaraka, Bhallataka, Bakuchi
Pathya - Apathya (Diet and life style education): Same as Level 1.
REFERENCES
- Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, part I, Vol. IV (24).
- Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, part I, Vol. III (30).
- Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, part I, Vol. I (46).
- Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, part I, Vol. I (27).
- Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, part I, Vol. III (52).
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (4:24), 2000.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (5:2), 2000.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (1:37), 2000.
- Sharangadhara, Sharangadhar Samhita with commentary of Adhamal’s Dipika and Kashiram’s Gudharth Dipika, edited by Pandit Parshuram Shastry, 5th edition, Madhyam Khanda, Varanasi, Chuakhambha Orientalia 2002; 2/137-142.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (1:14), 2000.
- Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (20:4), 2000.