A Clinical study on the Efficacy of Virechana karma followed byPathyadi lepa in the management of Kitibha kushta w.s.r to Psoriasis

INTRODUCTION

Skin is highlighted by identifying it as one of the seat of Jnanendriya and its compared to all other seats of Jnanendriya, Skin envelope most part of body surface. In other words to say, remaining Netradi other four indriyas have their seat on restricted parts of body surfaces like Netra is seat for Chakshurindriya, Jivha is seat for Rasanedriya etc. But Sparshanendriya has its seat in Twacha which covers all most all the body surface area. Twak is considered as Upadhatu of Mamsadhathu, Twak is having direct relationship with Rasadhatu to its nourishment and maintenance. And the Kushtaroga¹ is a Tridoshaja vikara. Kitibhakushta^{2, 3} is indicated in same way i.e Kapha is responsible for Kandu, Pitta is responsible for Srava and Shyava indicate the presence of Vata. Despite of its Tridosha origin various Acharyas mentioned different dominancy in Kitibhakushta i.e. VataKapha, Pitta-Kapha and Vata-Pitta Pradhana which also suggest specific symptom complexes. The clinical features of Kitibhakushta are analogous with that of Psoriasis ^4,5 of Modern Science. Psoriasis is the most common chronic, recurrent, inflammatory and non- infectious disease characterised by rounded, circumscribed, erythematous, dry patches of various sizes, Covered by silvery white scales on the skin. It has been grouped under Keratinisation disorder. The main activity leading to Psoriasis occurs in the epidermis, the top five layers of the skin.

Virechanakarma6 fulfils the aim of Samshodhana Chikitsa in elimination of morbid factors, which cause the skin disorders from Raktavaha Srotodushti. Among all samshodhana karmas, Virechanakarma can be said as “VisheshaRechana” to clear different type of toxic materials results due to metabolic activities.The things to be execreted though the intestinal mucosa along with the unabsorbed residues in the G.I tract. Virechanakarma also helps to reduce srava, as Virechana expels agrivated doshas from the body. Daha, Kandu is the symptom present in the Kitibhakushta,and its severity may be reduced by Virechanakarma.

In present study Trikatu churna⁷ is taken for the Amapachana,.Panchatikta Guggulu Ghrita8 is taken for the Arohana Snehapana, due to its Pitta shamak properties. Panchatikta Guggulu Ghrita has been done with Samskara of Tikta Dravyas, which helps in alleviating Kapha and Vatadosha. Murchita Tila Taila is choosen for Abhyanga. Trivrut Avaleha⁹ is selected for the Virechana Karma which has specific modality in the elimination of Pitta but also effective in Kapha and Rakta. As it eliminates Pitta, reduces Daha and Kandu by eliminating morbid kapha. And also Due to its Vatanulomaka properties it reduces Rukshata and Shyavaverna. Thus,Virechana helps in reduction of symptoms of Kitibhakushta.

Lepa has been explained by Acharya Charaka after Raktamokshana and in Twakprapt Kushta. Shodhana and Alepa have been explained by Acharya Sushruta as Sthanik Shamana Chikitsa. Keeping above factors in mind Attempt is been made to prove the efficacy of Pathyadi Lepa ^10,11,12 . As Acharya Charaka described Lepa as “Sadyo siddhi karaka” because external application plays a supportive in treatment of Kitibhakushta,Pathyadi Lepa is taken for a study which is having properties of Vranashodhana,Vrana ropana,Vranahara, and mainly it consists of Kushtaghna dravyas like Pathya, Karanja, Siddartha, Nisha, Avalaguja, Saindhava lavana,Vidanga and Gomutra. hence Pathyadi Lepa is taken and studied with a planned treatment according to methodology as stated in classics.

Aims and objectives

1. To study the Virechanakarma, Pathyadi Lepa, and Kitibhakushta W.S.R to Psoriasis.

2. To evaluate the efficacy of Virechana karma followed by Pathyadilepa in Kitibhakushta

Material and methods method of preparation:

• Trikatu Churna: Shunti, Pippali, Maricha,all drugs are taken and made in to fine powder separately in khalva yantra. And filtered in clean cloth then mixed well in equal quantity.

• Panchatiktaka Guggulu Ghrita: Nimba, Amrita, Vrisha, Patola, Nidigdhika are taken as kalka dravyas, guggulu which has to be suspended in while preparing ghrita and has been prepared as per the classics.

• Murchita Tila Taila: Manjishta, Haritaki, Vibhitaki, Amalaki, Mustha, Haridra, Lodra, Vatankura, Hrivera Nalika, Ketakipushpa Tila taila, Jala. All these ingredients are taken as per quantity and Taila is prepared as per the classics

• Trivrit Avaleha: Krishna Nishota Mula Kwatha,Krishna Nishota, Mula Kalka, Sharkara The above said drugs were mixed together and boiled well. When this attain to tantu paka, then removed from the, cooled it and used.

• Pathyadi Lepa: Pathya, Karanja, Sarshapa, Haridra, Bakuchi, Saindava Lavana and Vidanga, Sukshma churnas of all above drugs are taken in equal quantity and mixed with Gomutra to make paste form and Lepa is prepared, Lepa is applied over affected part.

Method of collection of data

The patients were thoroughly evaluated both subjectively and objectively. The patients who fulfilled the inclusion criteria were subjected for routine investigations. Before subjecting to the clinical trial, informed consent was taken from the patient. Detailed history was collected regarding the demographic data and data related to the disease and recorded as per case record proforma.

Diagnostic criteria

Diagnosis is done by clinical examinations, signs and symptoms of Kitibhakushta are as follows

1. Shyavavarna, Kinakharasparsh, Parushatwa of skin.

2. Roughness and discolouration of skin.

3. Hardness and dryness of skin.

4. Lesions and patches over the body especially on extensor surface of the skin

5. Rudhavranavat sparsh of skin means its hard touch

Inclusive criteria

1. Clinical features like Shyavavarna,Kinakhara sparsha, Parushatva of skin and lesions on the body.

2. Itching, burning, dryness and hardness of skin and lesions.

3. Patient selected those fit for Virechana karma and Lepa application.

4. Candle grease sign and Auspitz sign positive.

5. Age group between 20 and 60 years in both sexes.

Exclusion criteria

1. Patients with other systemic disorder and complications which interferes treatment are excluded.

2. Pregnant women, lactating mother and History of congenital Anomalies are excluded

3. Patients with Metabolic disorders,Cardiac diseases, or any risk factor cases are excluded.

4. Manifestations and Extracutanious Patients and Unfit Virechanakarma cases are excluded.

Research design: Sample size and grouping:

In the present clinical study, the sample size of 30 patients suffering from Kitibhakushta are selected and made in to single group as per the inclusion criteria.

• Study Design: The study design of the present study is ‘Randomized Clinical study’. A clinical study on the efficacy of Virechana karma followed by Pathyadilepa in the management of Kitibhakushta w.s.r. to Psoriasis. The data related to the study was collected and recorded in case record proforma of Kitibhakushta. 

Assessment Criteria: Assessment of Virechana karma wasl be based on

▪ Laingiki shudhi ▪ Vaigiki shudhi ▪ Antiki shudhi

The Overall Assessment and improvement of Psoriatic lesions are from above treatment are based on a Clinical Evaluation and PASI (psoriasis area and severity index scale)

Results

There is a significant reduction in PASI severity index scoring signs of 30 patients selected for study. sA mean score was 0(0%),0(0%),12(40%),18(60%), none,mild,moderate and severe before treatement. After a treatment 28(93.3%),2(6.7%),0(0%),0(0%) got the results respectively. including the wed 1st and 2nd follow-up therapy showed strongly significant changes in the PASI severity. index scoring signs. As shown in above photos before and after Treatment of Psoriatic lesions.

Discussion

Trikatu churna have Katu Rasa, Ushna Veerya, Laghu and Teekshna guna, which does Amapacana and Agnideepana.Through the Deepana and Pachana action Pancreatic and Bile juice plays an important role in digestion and absorption of Sneha. Deepana drugs may be able to secrete those enzymes which are required for digestion and absorption of Sneha. Panchatiktaka Guggulu Ghrita as a Sneha dravya in Kushta roga is mentioned. Kitibha Kushta is a Rakta Dhatu Pradoshaja Vikara predominantly Pitta Dosha involvement. There are so many dravyas are present in Panchatiktaka Guggulu Ghrita, Among them most of having Tikta Rasa, Ushna Veerya, Pitta Shamaka, Kandughna, Kushtagna and Pitta-Kapha Nashaka properties which may help to reduce lakshana of Kitibha Kushta.

Trivrit is Sukhavirechaka with Laghu, Ruksha and Teekshna with Ushna Veerya. Which get absorbed and due to its Veerya, it reaches to the Hrudaya and Dhamanis and reaches to Sthula and Anu Srotas i.e. micro and macro channels of the body. Vyavayi guna helps in quick absorption , then Vikasiguna causes softening and loosening of the bond by Dhatu (Vimoksha to Dhatu Bandhas). Due to Ushna guna,the Dosha Sanghata(compactness) is disintegrated (vishyandanat). Actions of Teekshna guna break the Mala and Dosha in microform. According to Dalhana it is responsible for quick transmission. Due to Sukshma guna by reaching to micro channels, disintegrates androgenic toxins, which are then excreted through micro channels.

Pathyadi Lepa is a external application of medicated drugs, which is literally explained in classical texts of Bhaishajya Ratnavali and Yoga Ratnakara in context of Kushtarogadhikara having Kushtaghna and Kushtahara properties which is indicated in Kitibhakushta. Ingredients of Pathyadi Lepa are Pathya, Karanja, Sarshapa, Haridra, Bakuchi, Saindava Lavana, Vidanga and Gomutra. Most of the drugs in the Pathyadi Lepa are Kaphavatahara, Lekhaneeya Kushtaghna, and Kandughna.As known aspect Kitibha Kushta is Vatakaphajavyadhi therefore Pathyadi Lepa acts more effectively in treatment of Kitibhakushta. The drugs involved in the Pathyadi Lepa are Tikta- Katu Rasa Pradhana and Ushnaveerya. And it is applied with Gomutra which is Ushnaveerya,Tikta- KatuKashaya Rasa pradhana .So the Pathyadi Lepa is suitable choice of lepa in the Kitibha Kushta.

CONCLUSION

On the basis of the present study, came into conclusions. Kitibhakushta is one of the Kshudrakushta which is of Vata-Kapha dosha Predominanent,Though the involvement of Tridosha and Pitta are evident.The results were encouraging after Virechana karma followed by Pathyadi Lepa.Virechana Karma is one of the prime treatment modality in Pittaj rogas. It eradicates vitiated Pitta from the root along with other vitiated Doshas.Along with Virechana,Pathyadi Lepa as application was very effective in reduction of symptoms of Kitibhakushta. Virechana is effective in Kitibhakushta and Pathyadi Lepa is also more effective statistically and clinically as proved in this study. Hence finally it is concluded that Virechana followed by Pathyadi Lepa is more effective in management of Kitibhakushta.