A case study of Ayurvedic management of Kitibha Kushtha with special reference to

Palmoplantar Psoriasis
Sachinkumar Sahebrao Patil *, Vijayalaxmi Sujay Patil and Komal Prabhu Manwar

M.A.M.’s Sumatibhai Shah Ayurved Mahavidyalaya, Malwadi, Hadapsar, Pune-411028, Maharashtra, India.

World Journal of Advanced Research and Reviews, 2023, 18(01), 893–899

Publication history: Received on 05 March 2023; revised on 16 April 2023; accepted on 18 April 2023

Article DOI: https://doi.org/10.30574/wjarr.2023.18.1.0662

Abstract
People suffering from Autoimmune diseases is increasing day by day. The exact cause of the autoimmune disease is still
unknown. Psoriasis is one such disease. Dry thick raised itchy patches on the skin are the sign of Psoriasis. They are
covered with silvery-white scales. It is triggered by infection stress and cold. Psoriasis is one of the most common clinical
conditions encountered in clinical practice majority of the dermatological disorders have described under the roof of
Kushtha in Ayurveda Kitibha is a type of Kshudra Kushtha described in different Ayurvedic classics is Vata-Kaphaaja the
clinical symptoms of Kitibha described in Ayurveda resembles with symptoms of Psoriasis the current treatment
modalities have their own limitations and the drugs have considerable side effects when using for longer period.
According to Ayurveda Psoriasis is treated with both Shodhana and Shamana Chikitsa. lt affects almost 2% worldwide
population. The high chances of recurrence and its reluctant nature makes it a matter of concern for modern medicine
as they have a limited line of treatment. including Snehpana, Vamana, Virechana and Raktaamokshna etc.

Keywords: Kitibha; Kshutha; Shodhanaa; Snehapana; Vamana; Virechana; Raktaamokshna.

1. Introduction
Psoriasis is a common, chronic, non-communicable skin disease with no clear cause or cure. Skin is the mirror which
reflects the harmony of internal functions of the body. Any change in skin color disturbs the patient both mentally and
physically. The negative impact of this condition on people's lives can be immense. Psoriasis affects people of all ages,
and in all countries. It is uncommon under the age of 5 years. More than 50% of patients present before the age of 30
years. The reported prevalence of Psoriasis in countries ranges between 0.09% and 11.43%.[1]

Psoriasis is a chronic inflammatory, hyper- proliferative skin disease. it is characterized by well defined, erythematous
scaly plaques, particularly affecting extensor surface, scalp and nails and usually follows relapsing remitting course.[2]
It is a common dermatologic disease, affecting up to 1% of the World's population.[3]

The word Psoriasis is derived from Greek word 'Psora' means 'itch' and 'sis' meaning 'acting condition'. In Psoriasis,
main abnormality is of increased epidermal proliferation due to excessive multiplication of cells in the basal layers. The
transit time of keratinocyte is shortened and epidermal turnover is reduced to 5-6 days from 28-30 days.[4] Even though
the etiology is unknown, the factors involved are genetic, biochemical and immuno-pathological.[5]

Precipitating factors like trauma, infections, sunlight, some drugs and emotions may flare up.

Kitibha Kushtha manifests due aggravation of Tridosha especially dominance of Vata and Kaphaa.[6] Mithya Ahara and
Vihara vitiate Tridosha which further lead to the affliction and aggravation of Rasa, Raktaa Mamsa and Lasika.


Corresponding author: Sachinkumar Sahebrao Patil
Copyright © 2023Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0.
 World Journal of Advanced Research and Reviews, 2023, 18(01), 893–899

Predominance of Vata can be elicited with symptoms like blackish discoloration hardness, dryness and roughness to
touch. Kaphaa predominance can be appreciated with the presence of severe itching as a cardinal symptom.

Vitiation of Tridosha followed by affliction of four entities viz. Twaka, Raktaa , Mamsa and Lasika leads to Kushtha. These
seven are called as the seven morbid factors

(Sapta-Dravya-Sangraha) of Kushtha[7]. No Kushtha manifests itself due to the aggravation of only on Dosha [8]. Modern
medical science treats Psoriasis with Puva, Retinoids, Methotrexate and Cyclosporine and Corticosteroids. But the
disease recurrence and gives serious side effects like liver, kidney failure and bone marrow depletion. Hence Ayurveda
plays important role. Present study is undertaken to provide safe and effective remedy for Psoriasis.

2. Material and methods

2.1. Case study

A 40 years male patient approached in Kayachikitsa O.P.D. presenting with the following complaints,

 Ubhaya Hast Pradeshi-Twaka Vaivarnya, Kandu

 Ubhaya Pad Pradeshi - Twaka Daran, Kandu Shoola, Shweta Strav and intermittently Raktaastrav.
 Ubhay Ansa Sandhi (Shoulder Joints), Karpur Sandhi (Wrist) Pradeshi - Shoola Vama (left) more than Dakshin
(Right).
 Nidranasha (Insomnia).

All symptoms occurred since 4-5 years.

2.2. Past History

Patient was all right before 4-5 years. Then blackish discoloration, itching, dryness occurred on the skin of both palms,
both legs sole . He was diagnosed as Psoriasis. He had taken Allopathic and Homeopathic treatment for same complaints.
There was recurrence in his complaints. Hence, he came to Kayachikitsa O.P.D. for treatment

History: No history of any previous surgical or medical illness.

Allergy: No any drug/food allergy.

Family History: Not specific.

2.3. Examination
Pulse - 80/min
BP - 110/70 mm of Hg
RS - B/L Clear
CVS - S1 S2 Normal
CNS - Conscious Oriented
P/A - Soft

2.4. Ashtavidha Pariksha

Sparsha - Ruksha
Kshudha - Mandya
Mala - Asamyak
Shabda - Spashta
Akruti-Sthoola
Jivha - Sama
Druka - Prakrut

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Table 1 Shamanaa Chikitsa

Date Symptoms Treatment Given

25/03/2021 Tawaka Vaivarniya - Ubhaya Hastpad Swayambhu
Pradeshi Guggul 500 mg TDS
Kandu - Ubhaya Hastpada Pradeshi Aroghyavardhini Vati 500 mg TDS
Twakaa Darana, Shoola – Ubhaya Hastpada Mahamanjishtadi Kwatha 20 ml BD
Pradeshi
Aragwadh Kapila Vati 4 Tablets HS
Shoola - Ubhaya Ansa Sandhi Pradeshi.
Shodhana Tail + Bhimseni Kapur -Kandu Pradeshi
2/04/2021 Kandu decrease Same as above with
Jalwat strav Raktaa strav Rasamanikya Rasa 30 mg + Chopchini Churna +
20% Upshaya Yashtimadhu Churna + Vidanga (500 mg) each
Anupana Goghrit
12/04/2021 Kandu, strav decrease, Ubhaya hastpada Same as above
predeshi Vaivarnya, Sarva Sandhishoola except Arogyawardhini Vati
25% Upshaya
10/05/2021 Ubhay padpradeshi Krushna, Shwetavarni Gandhak Rasayana 500 mg 2 TDS
Twaka Vaivarnya , Twakarukshata Sukshma Triphala Vati 500 mg 2 TDS
30% Upashaya Rasaapachaka Vati 500 mg 2 TDS
Mahamanjishthadi Kwatha 20 ml BD
Rasaamanikya Rasa (30mg) + Chopchini Churna +
Yashtimadhu Churna + Vidanga Churna + Nimba
Churna + Sariva Churna + (500 mg) each
Anupana- Goghrit
Shatdhaut Ghruta for local application
15/06/2021 75% Upashaya decrease in all symptoms Same as above
Amalki Mashi 1 gm BD, Anupana - Madhu

Shodhana Chikitsa: - Shodhana Chikitsa was given by Raktaamokshana through leech theropy. Leech therapy was given
twice a month to both upper and lower limb two leeches were applied. Patient was relieved and improved clinically up
to 70% in all the symptoms.

Pathya: Avoid oily, spicy, junk, food, bakery.

3. Mode of action
Table 2 Mode of action of drugs

Drug Action Effect

Arogyavardhini Vati Kleda Shamanaa & pacify Tridosha Kushthaghna
Shodhana Tail Raktaa - Mamsagat Kleda Shoshana by Tikta, Twakaroghna
Ruksha Guna
Aragwadha Churna Reduces Raktaagata Vata - Pitta Raktaashuddhikara
Vidanga Reduces Twaka Dushti Kushthaghan, Krumighna,
Raktaashuddhikara
Sariva Rasa - Raktaagat Vata Pitta Shamana Daha Shamana
Karpur Dilate Blood vessels Kandughna ,swedjanana

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Mahamanjishthadi Raktaagata Kaphaa -Pitta Pachan,& Shamana Raktaaprasadana

Kwatha by Tikta ,Kashay, Madhura Rasa & Ruksha
Guna
Rasaamanikya Tridoshaghan by Snidha, Guru Guna Kushthaghna
Gandhak Rasayana Raktaagata Pitta -Kaphaa Shamana Raktaaprasadnan, Dahashamak
,Rasayana Kushthaghna
Nimba Raktaa -mamsgat kleda Shodhana by Tikta Raktaashuddhikar
,Ruksha guna
Chopchini Rakta, Kapha, Vataghan Raktaashuddikar
Yashtimadhu Rakta, Kapha, Vataghan Shonitshtapan, Raktaapittaghna
Sookshm Triphala Tridoshahar + Raktashudhikar Raktaashodhak
Swayambhuv Guggul Kapha - Vata Shamana then Shoola Shamana Kushthaghna, Shwitraghna

4. Discussion
[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place
this text box anywhere on the page, just drag it.]

Figure 1 Palm region Psoriasis before and after treatment

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Figure 2 Sole region Psoriasis before and after treatment

 Arogyavardhini Vati: - Kushtha Vyadhi vitiates Tridoshas and then Twaka, Mansa, Rakta and Lasika
(Dravyasangrahsaptak). As we see from modern pathophysiological aspect, Kushtha is mainly caused due to
Grahani Vikruti. Due to malfunctioning of Grahani, Malavrodha happens. Vata Dosha between the Grahani and
Pakwashaya vitiates due to that Malavrodha and overall prokinetic and propulsive action of Grahani becomes
defective. Due to this, some organic toxins formed and get absorbed resulting in Dhatu Dushti and finally
Kushtha Vyadhi. Arogyavardhini overall works on functioning of Grahani and Pakwashaya and makes it [9]
smooth and fine."
 Aragwadha: -Charak has described Aragwadha in Kushthaghna and Kandughna Mahakashaya. Aragwadha has
good Anulomaka activity. Kushtha is Rakta Pradoshaja Vyadhi.Pitta and Rakta lives in association. So by doing
Pitta Anuloman, Aragwadha indirectly dose Raktadosha Shamana.
 Jatamansi: -Charak has described Jatamansi in Kandughna (Anti-pruritic) Mahakashaya. As Jatamansi does Vata
Shamana by Snigdha Guna and Kapha Shamana by Tikta Kashaya Rasa."
 Vidanga: -In Kitibha Kushtha, there is vitiation of Kapha and Pitta Doshas. Vidanga has Ushna Veerya and
therefore acts as good Kaphaa Vatashamak. Vidanga acts as Krumighna by its Prabhav. Charak has described
Vidanga in Kushthaghna Mahakashay[12] (Antidermatotic)." All types of Kushtha Vyadhi are caused due to
Vitation of one of the Tridosha or due to Krumi. Dosha which vitiates heavily, dominates in Kushtha[13]
 Nimb: -Charak also described Nimb in Kandughna (Anti-pruritic) Mahakashaya. Nimb acts as Kapha Vatashamak
by its Tikta Kashay Rasa, and also acts as very good Krumighna (Anthelmintics) because of Tikta Rasa. Tikta
Rasa is best for Raktadushti and it removes all Raktadushti which is one of the major pathophysiological events
in Kushtha. [14]
 Saraiva: -As Daha and Vaivarnya is one of the symptoms and sign respectively of Kushtha Vyadhi. Charak has
described Sariva in Dahaprasahamana (Refrigerants) and Varnya (complexion promoting) Mahakashaya. It
also works as Raktapachaka as described by Charak.
Manjishta: -Charak has described Manjishtha in Varnya and Vishaghna Mahakashaya and in Pitta Shamana
Mahakashaya by Sushrut. As it has Tikta Kashaya Madhura Rasa, It works as Kaphapittashamaka which gets
Vitiatated in Kitibha Kushtha and Kushthaghna also. In Pachansansthan it acts as Krumighna.
 Chopchini: Chopchini is Tridoshaghna it has Tikta Rasa, act as a good blood purifier (Raktashuddhikar) it has
specific action on Rasagranthi, Twacha and Snayu also acts as Shothahar and Vednashamak
 Karpur: -Karpur has Tikta Katu Madhura Rasa and Sheeta Veerya. It does Kapha Shamana by Tikta Rasa does
Vata Shamana by Madhura Rasa and Pitta Shamana by Sheeta Veerya. So it acts as Tridoshaghna Karpur is good

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local anesthetics, dilates blood vessels and promotes sweat glands to produce sweat and hence acts as
Swedajanan and Dahaprasahamana.
 Yashtimadhu: -Charak has described Yashtimadhu in Varnya Kandughna Mahakashaya it has Madhura Rasa,
Madhura Vipak and Sheeta Veerya. So it is good Vatapittashamak and Dahashamaka, Varnya and Kandughna.
 Swayambhuv Guggul:- as the patient was complaining of Ansa-Sandhi Shoola (shoulder joint pain) to reduce
pain as well as Kushthagna properties Swayambhu Guggul is used. Swayambhu Guggul is described by
Bhavprakash in Kushtha Vyadhi. Swayambhu Guggul reduces Kapha Dosha and then pacifies Vata Dosha it also
has digestive action on Ama and helps to reduce Ama dosh formation. Swayambhuv Guggul has Bavachi as its
main content. Bavachi acts as good Kaphavatashamak by its Ushna Veerya. It also acts as Kushthaghna,
Jantughna, Vran Shodhana and Vranropak
 Rasaapachak: -As Samprapti of Kushtha Vyadhi starts- with Rasa ie Twaka so to inhibit the progression of
Samprapti Rasaapachak is used.It contains Indrayava Patol and Kutaki. Charak has described Indrayava in
Kandughna (anti-pruritic) Mahakashaya. It also acts Vranropak (healing agent) locally. Patol acts as
Raktaashodhak and Shothahar.
 Rasaamanikya Rasa - Rasaamanikya Rasa has Arsenic as its main content. Arsenic has good Mamspachak as well
as Medopachak action. It also removes Twaka and Raktadushti and also removes Krumi along with Mala. Along
with Kushtha, it also works good in other skin diseases like Visarpa, Vipadika, Vicharchika etc.(22)

5. Conclusion
With the help of both Shodhana and Shamana Chikitsa patient got relief. Clinically patient 70% improved.

Compliance with ethical standards

Acknowledgments
We express our gratitude to the Department of Kayachikitsa and Hospital Authority for giving us this opportunity to
study this case of palmoplantar Psoriasis (Kitibha Kushtha) patient. Special thanks to Secretary of Maharashtra Arogya
Mandal’s Secretary, Hon’ble Mr. Anil Gujar, Hon’ble Principal Dr. Nilesh Phule and Faculty members for co-operating,
also thanks to the teachers Dr. Yogesh Kotangale, Dr. Vijayalakshmi Patil, Dr. Ritesh Damle, Dr. Kiran Ubhe, for guiding
throughout to provide better management.

Disclosure of conflict of interest

This work is not published anywhere. The authors declare no conflict of interest.

Statement of informed consent

Informed consent was obtained from all individual participants included in the study.

References
[1] Global report on Psoriasis, World Health organization, 2016, chapter!Introduction.pg. No.5
[2] Z. Zaidi and S. W Lanigan; Dermatology in clinical practice, 2010 springer Verlag London limited, Immune system
of the skin, pg.185
[3] Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, Loscalzo Harrisons Principle of Internal Medicine, Vol-1;
U.S.A.: 17th edition; McGraw Hill Companies; pg. 315.
[4] Davidson's Principles and Practice of Medicine, 21st edition, Churchill Livin Stone publication, 2010, Chapter-
Diseases of the skin;
[5] Michael Hertl; Autoimmune diseases of skin; third edition, Springer Wein New York; Pg.no. 328-331.
[6] Charak Samhita Vd Y.G. Joshi, Vaidyamitra Prakashan, Chikitsasthana Kushtha Chikitsa Adhyaya Shlok No. 22,
Page No. 192.
[7] Charak Samhita, Vd Y.G. Joshi, Vaidyamitra Prakashan, Chikitsasthan, Kushtha Chikitsa Adhyaya, Shlok No. 9. Page
No. 190

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[8] Charak Samhita, Vd Y.G. Joshi, Vaidyamitra Prakashan, Chikitsasthana, Kushtha Chikitsa Adhyaya, Shlok No. 31,
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[9] Ayurvediy Aushadhigunadharmshastra, Vaidya Gune shastri, edition 2008,page no 208.
[10] Dravyaguna vigyan, Acharya Priyavat Sharma,edition 2012, page no 170
[11] Dravyaguna vigyan Acharya Priyavat Sharma,edition 2012, page no 31
[12] Dravyaguna vigyan,Acharya Priyavat Sharma,edition 2012, page no 503
[13] Sushrut Samhita, Kaviraj dr Ambikadatt shashtri, NIgan sthan, Adhay 5, Shlok 6,Page no 320. 5
[14] Dravyaguna vigyan Acharya Priyavat Sharma,edition 2012, page no 149.
[15] Dravyaguna vigyan,Acharya Priyavat Sharma,edition 2012, page no 798.
[16] Dravyaguna vigyan,Acharya Priyavat Sharma,edition 2012, page no 800.
[17] Dravyaguna vigyan Acharya Priyavat Sharma,edition 2012 page no 803.
[18] Dravyaguna vigyan Acharya Priyavat Sharma,edition. 2012 page no 198
[19] Dravyaguna vigyan ,Acharya Priyavat Sharma,edition 2012 page no 253
[20] Sarth Bhavprakash, Ayurvedacharya purushottam ganesh nanal Vaidya, chikitsa prakaran, Kushtha chikitsa,page
no 660.
[21] Dravyaguna vigyan Acharya Priyavat Sharma,edition 2012 page no 463
[22] Dravyaguna vigyan ,Acharya Priyavat Sharma,edition 2012,page no 698
[23] Ayurved-sar-sangrah,Baidyanath,edition 2018,page no 445.

Author’s short biography

Dr. Sachinkumar Sahebrao Patil M.D. (Kayachikitsa) Medicine, Ph.D. (Kayachikitsa) Medicine, M.B.A.
(H.R.), M.A. (Sanskrit), P.G.D.E.M.S., D.Y.A. Professor and H.O.D., Ph.D. Guide, M.D. Guide, Department of
Kayachikitsa, M.A.M.’s Sumatibhai Shah Ayurved Mahavidyalaya, Malwadi, Hadapsar, Pune – 411028,
Maharashtra State, India. He is working as an Ayurved Physician and Panchakarma Specialist since last
18 Years. He is a BOARD OF STUDIES MEMBER for Paraclinical Ayurved Board of Maharashtra
University of Health Sciences (M.U.H.S.), Nashik. He is a FACULTY MEMBER for Post Graduate
Paraclinical Ayurved Board of Maharashtra University of Health Sciences (M.U.H.S.), Nashik. He is
working as a Research Faculty for Research Methodology and Medical Statistics for M.U.H.S., Nashik. He
is a Ph.D. GUIDE for 08 Ph.D. Kayachikitsa (Medicine) students and M.D. GUIDE for 28 M.D. Kayachikitsa
(Medicine) students out of which 21 M.D. Kayachikitsa (Medicine) students have been already passed
out. His research experience is 15 Years. His research interests in Anxiety disorder, Diabetes Mellitus,
Obesity, Hyperacidity, Diarrhoea, Anaemia etc.

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