Dr.Mahendra Prasad Yadav SDM college of Ayurveda, Hassan, Karnataka

1. Case presentation
Presented by
Dr. Mahendra Pd. Yadav
Final Year PG Scholar
Guided by
Dr. Prakash L. Hegde
Professor & HOD
Department of Dravyguna
SDM College of Ayurveda and Hospital,
Hassan

2. Identification Detail
 Name : XYZ IPD no : 27200
 Age : 32 years DOA : 21/12/2018
 Sex : Male DOD : 31/12/2018
 Place : K.R.Pete, Mandya

3. Chief complains
c/o of flaky reddish white lesions all over the body including
scalp along with itching and peeling off of the greyish skin
since 3 years.

4. ASSOCIATED COMPLAINTS:
• Loss of weight since 1 month.
• shivering since 1 month
•

5. Vedana Vruttanta (History of present illness)
• A male aged 32 years complaints of flaky reddish white
lesions all over the body including scalp along with itching
and peeling off of the greyish skin since 3 years.
• He consulted many allopathic physicians but got only
temporary relief. Since 1 year, he observed spreading of
lesions to both the hands and later to abdomen and legs
associated with severe itching followed by peeling off of
greyish skin

6. Poorva Vyadhi Vruttanta
(History of past illness and treatment)
• No known case of DM and HTN
No history of major surgery
Kula Vruttanta (Family History)
No any specific diseases

7. Vayaktika Vruttanta(Personal history )
Functional history
Bowel- passes hard stools
Appetite- decreased
Micturition- normal
Sleep- disturbed

8. • Personal History
• Diet – veg
• Daily dietary routine
• 9:30am Breakfast Chapati,Uppitu.Chitrana.
• 2:00 pm - Lunch - Rice, Ragi mudde
• 8:00 pm – Dinner – Mude,Rice.
• 9.30-10.00- sleep
• Addiction: – he is not addicted to alcohol, nicotine and other addictive
substance.
• Occupation:- Farmer
• Socio-economic history:- Middle class
• Treatment History:- Taken allowpathy medicine

9. Astha-vidha Pariksha
1. Nadi Kapha Vata++
2. Mala Hard
3. Mutra Frequency per day - N
Gandha - N
Rupa - N
4. Jihwa Normal texture and color
5. Drik Intact
6. Shabda NAD
7. Sparsa Roughness skin
8. Aakriti Average

10. Dashavidha Parikshya
1. Prakriti Kapha++vata+
2. Vikriti vata
3. Sattwa Madhyama sattwa
4. Satmya Madhyama satmya
5. Ahara shakti Madhyama
6. Vyayama shakti Avara
7. Sara Ashthi sara
8. Samhanana Madhyama
9. Agni Madhyama
10. Vaya Madhya vastha

11. General examination
• G.C. – Ill
• B.P. – 110/70 mmHg
• Pulse – 80/min, with regular rhythm and normal volume
• Temp. – Normal
• Respiration – 20/min
• J 0AoC0C0O0D0

12. Systemic examination
• Chest – Clinically NAD
• VS – S1
+S2
+Sm
0
• P/A – NAD

13. SAMPRAPTI GHATAKA
• Dosha :Vata(Vyana vayu),Pitta(Bhrajaka pitta )Kapha(Kapha).
• Dhatu : Rasa, Rakta,Mamsa.
• Upadhatu :Tvacha
• Agni : Jataragni, dhatwagni mandya (Rasa,rakta,mamsa)
• Srotas : Rasa, rakta, mamsa
• Srotas dushti prakara : Sanga
• Udbhava sthana : Amashaya,Pakvashaya
• Sanchara sthana : Sarvasharira
• Adhisthana : Twak, rakta, mamsa, lasika
• Vyakta sthana : Twak
• Roga marga : Bahya
• Swabhava : Chirakari
• Sadhyasadhyata : Krichsadhya

14. DIAGNOSTIC ASSESSMENT
Differential diagnosis-
Ekakushta- – there will be mahavastu(large lesions).
Sidhma - there will be Shweta varna, tamra varna(coppery
whitish lesions), tanu(thin).
Kitibha - there will be shyavata(blackish brown in colour),
kinakhara sparshata(rough in touch like scar tissue),
parushata(hard to touch).
Psoriasis - there will be red patches of skin covered with
thick, silvery scales with typical features of erythema,
desquamation.
Final diagnosis-
• Kitibha (psoriasis)

15. TIMELINE
DATE TREATMENT MEDICINE
22-12-2018 to 23-12-2018 Deepana pachana Agnitundi vati,chitrakadi
vati, panchakola phanta
24-12-2018 to 27-12-2018 Snehapana Panchatikta ghrita
30-12-2018 Virechana Trivrut lehya
11-01-2019 Jalaukavacharana -

16. THERAPEUTIC INTERVENTION
• Deepana pachana for 2 days
S.N. MEDICINE DOSE TREATMENT
1 Agnitundi vati
(1 vati=125g)
2-2-2
(30 minutes before
food)
22-12-2018 to 23-12-
2018
2 Chitrakadi vati
(1 vati=125g)
2-2-2
(20 minutes before
food)
22-12-2018 to 23-12-
2018
3 Panchakola Phanta 50ml-50ml-50ml
(10 minutes before
food)
22-12-2018 to 23-12-
2018

17. Bahirparimarjana chikitsa for 2 days
S.N. TREATMENT TREATMENT DATE
1 Sarvanga parisheka with
Panchavalkala kwatha
22-12-2018 to 23-12-
2018
2 Manjishtadi lepa over ubhaya
janu sandhi
22-12-2018 to 23-12-
2018
3 777 oil for all over the body 22-12-2018 to 23-12-
2018

18. PROCEDURE DOSE TREATMENT
DATE
Snehapana 30ml 24-12-2018
70ml 25-12-2018
120ml 26-12-2018
140ml 27-12-2018
ShodhanangaSnehapanainarohanakarmawithPanchatikta
Ghritafor4days
Panchakarma procedures
PROCEDURE MEDICINE TREATMENT
DATE
Sarvanga abhyanga,
sarvanga nadi sweda
Nalpamaradi taila
for abhyanga
28-12-2018 to 30-
12-2018
Virechana Trivrut lehya 30-12-2018

19. DISCHARGED ON 31-12-2018
Samsarjana karma Peyadi karma 31-12-2018 to 6-1-2019
FOLLOW-UP AFTER 10 DAYS
Jalaukavacharana near ubhaya
gulpha sandhi
- 11-1-2018

20. Dischargemedications
MEDICINE DOSE ANUPANA DURATION
Nimbadi guggulu
(1 guggulu=250g)
1-0-1
(5minutes after food)
Koshna jala 10 days
Gandhaka rasayana
(1tab=250g)
1-1-1
(10 minutes after food)
Koshna jala 10 days
Arogyavardhini vati
(1 vati=125g)
1-0-1
(15 minutes after food)
Koshna jala 10 days
Manibhadra guda 0-0-10g
(30 minutes after food)
Koshna jala 10 days
Patola katurohinyadi
Kashaya
30ml-30ml-30ml
(15 minutes before food)
With equal quantity
of koshna jala
10 days
777 oil FOR EXTERNAL APPLICATION 10 days

21. Follow-up medications
MEDICINE DOSE ANUPANA DURATION
FOLLOW-UP AFTER 10 DAYS
Gandhaka
rasayana
(1tab=250g)
1-0-1
(10 minutes after food)
Koshna jala 14 days
Guggulu tiktaka
ghrita
5g-0-5g
(10 minutes before food)
Koshna jala 14 days
Chitrakasava 30ml-30ml-30ml
(15 minutes before food)
Koshna jala 14 days
Ashwagandha
churna
6g at 6a.m-6g at 6p.m Ksheera 14 days
Triphala churna 0-0-15g
(30 minutes after food)
Koshna jala 14 days
Eladi taila For External Application 14 days

22. FOLLOW-UPAFTER 14 DAYS
Guggulu tiktaka
ghrita
5g-0-5g
(10 minutes before
food)
Koshna jala 15 days
Maha
manjishtadi
Kashaya
30ml-30ml-30ml
(15 minutes before food)
Koshna jala 15 days
Ashwagandha
churna
6g at 6a.m-6g at 6p.m Ksheera 15 days
Eladi taila For external application 15 days
Eladi soap For bathing 15 days
Cap. Puritin 1-0-1
(10 minutes after food)
Koshna jala 15 days

23. BEFORE TREATMENT

24. AFTER TREATMENT

25. DISCUSSION
Initially to remove the amapachana , agni deepana was done.
Snehapana was planned with Panchatikta ghrita as tikta
dravyas are drug of choice in twak vikaras.
Virechana was planned for dosha shodhana based on satva and
bala of the subject.
Jalaukavacharana was done to remove the sthanika doshas of
b/l lower limbs.
Suitable shamanoushadhi was planned for shesha dosha
nirharana.
Rasayana was planned to prevent recurrence.

26. CONCLUSION
 Shodhana is very much necessary in expelling out the doshas
from the body.
Shodhana especially virechana helps remove the root cause of
the disease and prevents from recurrence.
Here an attempt has been made to show the importance of
panchakarma in kitibha kushta (psoriasis).

27. KUSHTA
INTRODUCTION
• Skin that covers the major part of the body when it is
diseased causes social stigma.
• It is important to maintain the health of skin in order toward
off various skin diseases explained under the heading of
‘Kushta’.
• Any disease in Ayurveda is managed with Shodhana,
Shamana & Rasayana chikitsa. The same is true for Kushta.
• It is important to understand the concept, indication and
appropriate use of these to get optimum results

28. • Kustha is a condition in which different body organs ,
dhatus, updhatus, are destroyed & contempted.
• One which produces discolouration over skin region is said
to be kustha.
• During the lapse of time, it makes the entire body look
ugly.
TYPES
• MAHAKUSHTA- 7
• KSHUDRA KUSHTA-11
• TOTAL- 18

29. MAHAKUSHTA:
1. Kapala- vataj
2. Udumbar- pittaj
3. Mandala- kaphaja
4. Rishayajihava- vata-pittaja
5. Pundarika- pitta-kaphaja
6. Sidham- vata-kaphaja
7. Kakanaka- tridoshaja

30. KSHUDRA-KUSTHA
1. Ekakustha- vata-kapha
2. Charmakhaya- vata-kapha
3. Kitibha- vata-kapha
4. Vaipadika- vata-kapha
5. Alsaka –vata-kapha
6. Dadrumandala- pitta-kapha
7. Charmadala- pitta-kapha
8. Pama- pitta-kapha
9. Visphota- pitta-kapha
10.Shataru- pitta-kapha
11.Vicharchika- kaphaja

31. DOSHA-DUSHYA
• DOSHA: Vata
Pitta
Kapha
• DUSHYA:
Twak
Rakta
Mamsa
Lasika

32. DOSHA LAKSHANA
• VATAJ : rokshyam, shosha, shoola,
sankochana, parushayam, khara
bhava, harsha, shayav aruna.
• PITTAJA:
daha, raga, parisarava,paka,visaragandhi,
angapatana.
• KAPHAJA:
shwetaya, shataya, kandu, utsedha,
gaurav, sneha, kleda.

33. SAPTADHATVASHRAYA KUSTHA LAKSHANA
• TWAK: - Toda, vaivarnyam, rukshatwa
• RAKTA: - sweda, swapa, swayathu.
• MAMSA: - Sphota in pani & pada, kledata in
joints.
• MEDSA: - Kounyam & gatikshaya for angas,
dalana of angas.
• ASTHI&MAJJA :- Nasa bhanga, netra raga,
swarakshaya, krimis in kshatas.
• SHUKRA:- Swadara paktya badhanam
(A.H.Ni.14)

34. SAMANAYA CHIKITSA
• All kustha are tridosaja so they should be
treated by knowing there doshobala, abala
& lakshnas.
• First do samana in those kusthas having
there increased doshas than treat apradhan
doshas

35. DHATU-GATANUSARA CHIKITSA
• Twak parapte- Shodhanam,
Alepanam.
• Shonit parapate- Shodhanam,
Alepanam,
Kashayapanam,
Shonitavasechanam.
• Mamsa parapate- Shodhanam,
Alepanam,
Kashayapanam,
Shonithavasechanam,
Arishtapana,
Mantraprayoga.

36. • Medas parapte Shodhanam,
Shonithavasechanam,
Bhallathaka, Shilajatu,
Dhatumakshikam,
Guggulu, Agaru,
Tuvaraka.
• From Asthi onwards- Asadhaya.
• Rest of all dhatugata condition of kustha should be
considered incurable and left untreated.
(Su.Chi 9/6)

37. CHIKITSA SUTRA
• Vata - Sarpi
• Kapha - Vamana
• Pitta - Raktamokshana, Virechana
• Chardana- Pakshatpakshat. (15 – 15)days
• Virechana- Masanmasan.(1 – 1)month
• Rakta mokshanam- Shashte shashte masya.
(6 – 6)months.
• Nasya- Triratrat triratrat. (3 – 3)days.
(Su.Chi. 9/43)
(As.Hr.Chi. 19/96)

38. SNEHANA
Abhyantara snehana: with
• Panchtiktaka ghrita
• Mahatikataka ghrita etc.
Bahya snehana: with
• Yastimadhu taila
• Marichayadi taila
• Nalpamaradi taila etc.

39. SWEDANA
Mridu sweda and ushana jala snana is indicated:
Like:
• Parisheka
• Nadi sweda
VAMANA
Vamana Yogas:
• Kutajaphala, Madhanaphala,Yastimadhu churna +
Patola and Nimba rasa
• Sheetha rasa kashaya with madhu + yastimadhu
churna.

40. VIRECHANA
VIRECHANA YOGAS:
• Trivrut, Danti & Triphala with souveeraka,
tushodaka, alodana & sidhu.
• Manibhadra guda.

41. NASYA
 Kapha pradhana kushta with krimi anubandha.
• Saindhava,
• Danti,
• Maricha,
• Pippali,
• Karanjaphala,
• Vidanga –
 Vairechanika dhumapana with
Manashilla,
Jyotishmati,
Hartala etc.

42. RAKTAMOKSHANA
• Kushta (Sthira, Katina and Mandala) – Nadi &
Prastara sweda
• Rub with Kurcha
• Rakta nirharana with Srunga / Alabu / Jalouka.

43. BASTI
• Acc. To Bruhattrayi Niruha & Anuvasana
basti is contraindicated in kustha.
(Ch.Si 2/14), (Su.Chi. 35/21), (As.Hr.Su. 19/4-6)
• If there is excess of vata even after
shodhana – we can give anuvasana with
sneha – made of madanaphala, madhuka,
nimba, kutaja, patola (CH.Chi.7/47-47).

44. SHAMANA YOGAS
• There are innumerable shamana yogas
mentioned for kushta in the form of
• churna,
• Vati
• Taila
• Ghrutam etc
• It is important to know when to use how to
get good results.

45. GHRITA:
• Vatakushta- Ghrita prepared of
Meshasringi,
Guduchi,
Dwipanchamuli.
• Pittakushta- Ghrita prepared of
Dhava,
Aswakarna,
Kakubha,
Palasa,
Pichumarda,
Parpataka,
Madhuka,
Lodhra

46. • Kaphajakushta- Ghrita prepared of
Aragwadha,
Nimba,
Saptaparna,
Chitraka,
Maricha,
Vacha,
Kushta,
Bhallataka,
Abhaya,
Vidanga

47. • In pitta & Rakta-
• Tikta Ghritas externally & internally. Eg:
Tiktashatpalak ghrita (Ch.Chi.7/140-143)
Mahatiktaka ghrita (Ch.Chi.7/144-150)
Mahakhadira ghrita (Ch.Chi.7/152-156)
Khadira, nimba, darvi ghrita (Ch.Chi.7/135)

48. TAILAS :
• Vatakushta- Taila prepared of meshasringi,
guduchi, dwipanchamuli.
• Kaphajakushta- By taila of priyala,sala,aragwadha,
nimba, saptaparna, chitraka, maricha, vacha,
kushta, bhallataka, abhaya, vidanga.
• Sarvakushta- By bhallataka taila, tuvaraka taila etc.
(Su.Chi.9/7)

49. KASHAYA:
Sonitha prapta & Mamsa prapta.
• Tikta kashayas- For kaphaja, pithaja &
Raktaja kushtas.
• Eg: Laghu Manjishtadi,
• Madhyama Manjishtadi,
• Brihat Manjishtadi Kashayas,
• Patolamuladikwatha

50. CHURNA:
• Mustadi churna(Ch.Chi7/65-67)
• Triphaladi churna (in numbness of skin)
(Ch.Chi.7/68,69)
• Swarnamakshika churna with gomutra
(Ch.Chi.7/70-72)
• Somraji churna
• Bakuchi churna

51. ARISTHA, ASAVA:
In Mamsa prapta kushta. Eg:
Khadirarishta,
Madhwasava,
Kanakabindwarishta,
Triphalasava
• Madvaasava in kustha & kilasa
• Kanakavinduristha
• Triphalasava
• Kashayas made of rasanjan, aragavadha patra, kutaja,
patola mula, nimba bark, khadirsara, triphala.

52. ALEPANA:
Twak prapta ,Shonita prapta ,Mamsa prapta (Su.Chi.9/6)
Eg:
Eladilepa,
Kushtadilepa,
Lodhrabijadilepa,
 Mamsyadilepa etc.

53. LEPAS:
• Sidhma nasak lepa (Ch.Chi.7/117,118)
• Mandala kustha nashak taila (Ch.Chi.7/122-
127)
• Pittakusthan nashak lepa (Ch.Chi.7/130,131)
• Vidangadi lepa
• Dadrurvaadou durvadi lepa (Chakradatta)
• Manashiladi lepa etc.

54. VATI:
Aarogyavardhini vati (R.RS.)
Saptasama gutika
Triphala gutika
 Gandhaka rasayana etc.

55. GUGGULU PREPARATIONS:
• Amrita guggulu
• Ekavimsatika guggulu
• Panchatiktaghrita guggulu etc

56. KSHARA PRAYOGA:
1) Kushtas where sastra karma is
contraindicated.
2) In Sparsanendriyanasa
3) Nipatya
4) After visravana (Ch.Chi.7/54)

57. SNANOPYOGI DRAVYAS:
• Siddharthaka snana churna
• Darvi kwatha
• Patola
• Nimba
• Khadirasara
• Karanja
• Aragwadha (Ch.Chi7/129,130)

58. RASAYAN YOGAS:
Medo prapta kushta
• Navayasa rasayana (chakradatta)
• Brahmiaadi rasayan
• Chitraka rasayan
• Bhallataka rasayan
• Tuvarak rasayan (Ah.Chi.19/53)
For All kushtas Eg:
Tuvarasthi,
Bhallataka,
Bakuchi,
Chitrakamulam,
Silajatu (Ah.Chi.19/53)

59. CONCLUSION
• Selection of chikitsa for kushta depends on
predominant of doshas
• Repeated shodhana is essenstial for bahu
doshavastha other than trying to eliminate it
all at once since it weakens the patient

60. • In excessive vata aggravated condition,
basti chikitsa can be adopted
• Nasya is indicated in kapha pradhana
kushta and dhumapana in kushta affecting
jatrurdhwa
• If doshas are in alpavastha we can treat
with shaman line of treatment.