Review-article: CLINICAL EVALUATION OF AYURVEDIC INTERVENTION (MAHAMANJISHATHADI KWATHA, KAISHORA GUGGULU, PANCHATIKTA GHRITA, ERANDA TAILA) IN THE MANAGEMENT OF EKAKUSHTHA W.S.R. TO PSORIASIS
CLINICAL EVALUATION OF AYURVEDIC INTERVENTION (MAHAMANJISHATHADI KWATHA, KAISHORA GUGGULU, PANCHATIKTA GHRITA, ERANDA TAILA) IN THE MANAGEMENT OF EKAKUSHTHA W.S.R. TO PSORIASIS
AUTHORS
*Dr Alpesh Munjani,
Final year PG Scholar
P. G. Department of Kayachikitsa
Government Akhandanand Ayurveda College and Hospital, Ahmedabad
Email – alpeshmunjani2012@gmail.com
**Dr Anamika Soni
Associate professor
P. G. Department of Kayachikitsa
Government Akhandanand Ayurveda College and Hospital, Ahmedabad, Gujarat.
ABSTRACT
Introduction: Psoriasis is a chronic skin condition causing scaly plaques, typically on extensor surfaces, scalp, and nails, and often leads to quality of life impairments, including physical and mental health challenges. Ayurveda offers a holistic approach targeting root causes and balancing body and mind, while conventional treatments focus on symptom management through therapies that may cause side effects and recurrence. Aim and Objectives: The study aimed to assess the efficacy of Ayurvedic treatment in managing psoriasis. Methods: In this study, psoriasis was identified as Ekakushtha due to its similarity to psoriasis in symptoms. An open-label, single-group clinical study was conducted at Govt. Akhandanand Ayurveda College and Hospital, Ahmedabad, with 30 psoriasis patients selected based on inclusion criteria. A detailed history and examination were performed using a specific proforma, and written consent was obtained before treatment. The treatment duration was 6 weeks, with a 2-week follow-up after the trial. Results: The treatment was effective for most patients, with most of patients showing marked to moderate improvement. Conclusion: Findings indicated significant responses to treatment, highlighting its effectiveness for specific symptoms with no side effects and good patient adherence to treatment.
Key words: Psoriasis, Ekakushtha, Panchatikta ghrita, Mahamanjishthadi kwatha, Kaishora guggulu
INTRODUCTION
Psoriasis is a chronic inflammatory skin condition characterized by erythematous, scaly plaques, typically on extensor surfaces, scalp, and nails. It often leads to significant quality of life impairment, including disfiguration, disability, and mental health issues like depression. Ayurveda offers a holistic approach that treats root causes and balances body and mind, providing a comprehensive treatment strategy. In contrast, conventional medicine primarily focuses on symptom management through topical therapies, systemic medications, and phototherapy, which can have serious side effects and may not prevent recurrence.
In Ayurveda, skin diseases are classified under “Kushtha”, further divided into Maha and Kshudra Kushtha. Ekakushtha, a type of Kshudra Kushtha, is characterized by Vata and Kapha dominance and vitiation of Twaka, Rakta, Mamsa and Lasika. Psoriasis was chosen as Ekakushtha in this study due to its similarity in symptoms, including Asvedanam (lack of sweat), Mahavastu (wide skin coverage) and Matsyasakalopama (scaling resembling fish scales), which align closely with the clinical presentation of psoriasis.
While many studies have compared Shamana Chikitsa with standard treatments, Panchakarma procedures like Vamana, Virechana, and Raktamokshana have shown promising results in treating Kushtha roga. However, these procedures may not be suitable for all patients due to co-morbidities or weakness. This study aims to offer a complete Shamana Chikitsa based on classical principles of Kushthachikitsa.
In the present study a complete intervention in the form of treatment protocol was planned for the management of Ekakushtha W.S.R. Psoriasis in which Mahamanjishthadi kwatha was used as raktaprasadaka and Vyadhipratyanika medicine; Panchatikta ghrita was used as Agnideepaka, Balya, Dosha and Vyadhipratyanika dravya; Kaishora guggulu was given Rasayana, Rakta prasadaka, Vyadhi pratyanika dravya; and Eranda taila was given for Koshtha-suddhi and vata-kapha shaman.
RESEARCH METHODOLOGY
Study Design: An open-label, single-group clinical study was conducted at Govt. Akhandanand Ayurveda College and Hospital, Ahmedabad.
Diagnostic Criteria:
Patients were diagnosed based on classical Ayurvedic signs of Ekakushtha, including Aswedanam (lack of sweat), Mahavastu (wide skin coverage), Matsyashakalopama (fish-scale-like scaling), Krushna-aruna varnata (Erythema). Additional symptoms like Raukshya (dryness) and Kandu (itching), associated with vataja and kaphaja kushtha, were also considered, as psoriasis is a vata-kaphaja type of Kushtha. Clinical tests such as PASI score, Auspitz sign, Kobner’s Phenomenon, and Candle Grease sign were used to confirm the diagnosis.
Inclusion Criteria:
Age: 18-60 years
Willingness to participate in the clinical trial
Presence of clinical signs and symptoms of Ekakushtha (Psoriasis)
Chronicity of less than 10 years
Exclusion Criteria:
Age less than 18 or more than 60 years
Chronicity greater than 10 years
Pregnant or lactating women
Patients with psoriatic arthropathy
Uncontrolled diabetes mellitus (DM) or hypertension (HTN)
Patients with a history of severe heart disease, kidney disease, stroke, or liver disease
Patients with severe systemic illnesses like rheumatoid arthritis (R.A.), gout, or S.L.E.
Patients with pulmonary dysfunction or chronic obstructive pulmonary disease (COPD)
Patients with a history of acute or chronic infectious diseases such as TB, AIDS
Patients on medications like corticosteroids, hormonal therapy, anti-depressants, or drugs affecting study outcomes
Patients with alcohol addiction or drug abuse
Intervention:
In the present study, a comprehensive treatment protocol was developed for the management of Ekakushtha (Psoriasis). Mahamanjishthadi Kwatha was used as a blood purifier and dosha-balancing agent, addressing the underlying causes of the condition. Panchatikta Ghrita, administered both orally and topically, served to enhance digestive fire, strengthen the body, and balance doshas while also alleviating disease symptoms. Kaishora Guggulu, known for its rejuvenating and blood-purifying properties, supported overall health and resistance to disease. Finally, Eranda Taila was utilized for its role in koshthasuddhi along with balancing the Vata and Kapha doshas.
Patients enrolled in the clinical trial were given Koshtha Suddhi with Eranda Taila – 10 to 20 ml (as per Koshtha) with lukewarm water at night for the first three days. Following this, the treatment regimen included Mahamanjisthadi Kwath (40 ml) after meals twice a day, Kaishora Guggulu (375 mg, 2 tablets) thrice a day before meal, and Panchatikta Ghrita (10 ml) on an empty stomach twice a day. Additionally, weekly Koshtha Suddhi with Eranda Taila was administered throughout the 6-week trial period. Patients were assessed for signs and symptoms two weeks after completing the treatment.
[Table 1: Treatment given to the patients]
For the first three days, Eranda Taila with luck warm water was administered at night to the patients for koshtha suddhi.
After koshtha suddhi.
No. Medicine Dose Timing Anupana
1 Mahamanjishthadi kwatha 40ml Twice a day, after meal -
2 Kaishora guggulu 2tab.
(375mg each) Thrice a day, before meal Ushnodak
3 Panchatikta ghrita 10ml Twice a day, empty stomach
And for local application Ushnodak
4 Eranda taila 10-20ml
(as per koshtha) For first 3 days
followed by once a week at HS. Ushnodak
RESULTS
In the study, the majority of patients (33.33%) were in the 31-40 age group, followed by 26.66% in the 51-60 age range. The gender distribution showed 56.67% male and 43.33% female. Most patients were married (76.67%), with 100% identifying as Hindu. In terms of education, 40% were graduates, and 46.67% were from middle-class socio-economic backgrounds. Occupation-wise, 40% worked in services, while 36.67% were housewives. A significant majority (83.33%) lived in urban areas, indicating an urban-centric patient demographic.
In this study, key symptoms included Mahavastu, Matsyasakalopama, Kandu, Rukshata and erythema, with all patients showing the first four symptoms and 96.66% having erythema. Auspitz sign was observed in 63.33% of patients, while Koebner’s phenomenon and Candle grease sign appeared in 6.66% and 16.66%, respectively. Most patients (96.66%) had adult onset, with 70% experiencing gradual onset. Half of the patients had a stationary course, 30% relapsing, and 20% progressive. Seasonal triggers were noted in 20%, and 13.33% had a family history of psoriasis. Most of patients (73.33%) were vegetarian, while 26.66% had a mixed diet, while 66.66% were having history of Vishamashana. Regarding lifestyle, 40% had irregular sleep, while 70% didn’t exercise. Hot water baths was common (70%), and 93.33% had regular bathing habits. Bowel habits were regular in 83.33%, with 56.66% having normal consistency.
In this study, 90% of patients had a Lavana rasa dominant diet, followed by Amla and Katu rasa (73.33%), and Madhura rasa (60%). Dadhi was identified as a key nidana in 70% of patients, with Guda and Kshira being prominent in 56.66%. Asatmyahara (70%) and Vishamashana (66.66%) were common dietary habits, while Paryushit and Atigurvanna were found in 23.33%. Fermented foods were linked to 56.66% of cases, with pizza and pickle at 43.33%. Viruddha ahara (Lavana+Dugdha) appeared in 50% of patients. Viharaja nidanas like Shitoshna vyatyas and Diwaswapa were observed in 50% and 46.66%, respectively. Mental factors, especially Chinta (53.33%) was significant contributors to the condition.
Plaque psoriasis was the most common type, affecting 53.33% of patients, followed by Guttate and Scalp psoriasis, each found in 23.33% of patients. Erythrodermic and Scalp psoriasis were observed in 6.66% of patients, while Palmo-plantar psoriasis was seen in 3.33% of patients.
[Table 10: Effect of the therapy on various parameters]
The study results demonstrated significant improvements across various subjective and objective parameters after therapy. Aswedanam showed a 61.29% reduction, Mahavastu had a 49.09% reduction, and Matsyashakalopamam saw a 72.22% improvement. Kandu exhibited an 81.08% reduction, and Rukshata showed a 71.43% improvement. Krushnaruna Varnata was reduced by 60%.
[Table 11: Showing Overall effect of the treatment]
No. Effect of the treatment No. of Pt. %
1 Completely Remission 2 6.66
2 Marked Improvement 11 36.66
3 Moderate Improvement 10 33.33
4 Mild Improvement 7 23.33
5 No Improvement 0 0
DISCUSSION
The study reveals interesting demographic and lifestyle patterns among psoriasis patients. In terms of age, the largest group falls within the 31-40 years of age, with relatively balanced distributions in other age groups. The gender distribution shows a higher prevalence of psoriasis in males compared to females, potentially due to work-related stress and responsibilities. Most patients are married, suggesting that familial stress may contribute to the condition. All patients belong to the Hindu religion, indicating a homogenous religious background in the sample.
Regarding education, most of patients are graduates, though no direct link to psoriasis severity was found. In terms of socio-economic status, the majority are middle class and upper middle class, likely linked to stress from demanding lifestyles. In terms of occupation, most are housewives, and work in the service sector, where stress, irregular habits, and environmental factors like exposure to air conditioning might contribute to psoriasis onset. The study also shows that a majority of patients live in urban areas, possibly influenced by urban lifestyle and diet.
The distribution of patients according to Viharaja Nidana showed that Shitoshna Vyatyassevana, involving habits like consuming hot food with cold beverages or exposure to sunlight after air-conditioned rooms, which can disrupt Swedavaha Srotasa. Diwaswapa was observed in many patients, contributing to an increase in Kapha and Ajirna. Vegadharana, seen in some of patients with busy schedules, while some patients had Atapasevana, leading to skin damage. Drug allergy was found in one patient who developed psoriasis following pneumonia treatment. Manasika Nidana revealed that most of patients had a history of Chinta (stress). Psychological stress triggers inflammation and accelerates psoriasis through cortisol release, cytokine activation, and lifestyle impacts. Thus, stress can worsen existing plaques, impair the skin's barrier, and create a cycle of emotional distress, complicating psoriasis management.
The drug trial began with Koshthasuddhi using Erandataila for three days, with 15 ml administered to most patients (25) with Madhyama Koshtha, leading to loose stools and 2-3 bowel movements daily. Mahamanjisthadi Kwatha caused increased stool frequency and mild abdominal discomfort, relieved after passing stool. For scalp psoriasis, patients were advised to massage Panchatikta Ghrita into the scalp, applying it twice a day due to practical concerns. Kaishora Guggulu was crushed for better digestion and absorption in patients with mandagni. Common instructions to the patients included avoiding day sleep, heavy work after meals, stale food, fast food, and fermented items, using regular-temperature water for baths and to avoid low TFM shops.
The synergistic effect of the selected trial drugs plays a crucial role in the samprapti vighatana of psoriasis. The process of koshtha suddhi, facilitated by eranda taila, helps purify the gastrointestinal tract, ensuring that the active ingredients in the medicines can exert their maximum therapeutic effects. Mahamanjisthadi Kwatha and Kaishora Guggulu contribute significantly to blood purification (raktaprasadana), which is essential for managing the inflammatory processes associated with psoriasis. By enhancing the quality of the blood, these formulations can help reduce skin lesions and promote healing. Additionally, Panchatikta ghrita acts as a vital component by providing strengthening (balya) and rejuvenating (rasayana) properties. It also functions as a vyadhi pratyanika dravya, counteracting the disease process of psoriasis by supporting overall health and resilience. Local application of Panchatikta ghrita provides emollient benefits, alleviating dryness, itching, and scaling in psoriasis. Its nourishing properties soothe irritation and help retain moisture, promoting overall skin healing.
CONCLUSION
This study highlights the importance of understanding the underlying mechanisms and effective treatment strategies for Ekakusththa W.S.R. Psoriasis. Through a thorough execution of clinical trial, this study provides valuable insights into the role of Ayuredic intervention in managing the disease. The findings suggest that the intervention pacifies the sign and symptoms of psoriasis as well as markedly improves PASI and DLQI. However, the study's limitations, such as the small sample size and short duration.
Future research with larger sample sizes and extended follow-up periods is crucial to validate these findings and assess the long-term effectiveness and safety of the interventions.
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Above article has been published in 'Journal of AYUSH: Ayueveda, Yoga, Unani, Siddha, & Homeopathy.
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