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“CLINICAL EVALUATION OF “DINAMALLIKA- CESTRUM
DIURNUM” OIL IN KITIBHA KUSHTA WITH SPECIAL
REFERENCE TO PSORIASIS”
BY
DR. LAKSHMI PRASANNA BANDI (B.A.M.S.)
Dissertation submitted to the Rajiv Gandhi University of Health Sciences,
Bengaluru, Karnataka.
In partial fulfillment of the requirements for the degree of
“AYURVEDA VACHASPATI”
DOCTOR OF MEDICINE (AYU)
IN
KAYACHIKITSA
GUIDE
Dr. SHRIPATHI ACHARYA M.D (AYU), Ph.D. PROFESSOR & H.O.D
DEPT OF P.G STUDIES IN KAYACHIKITSA
Co-Guide
Dr. VEERAJ HEGDE M.D (AYU)
ASSOCIATE PROFESSOR
DEPT OF P.G STUDIES IN KAYACHIKITSA
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA
MUNIYAL INSTITUTE OF AYURVEDA MEDICAL SCIENCES MANIPAL
2017 - 2018
iii
LIST OF ABBREVATIONS
A.H - Ashtaanga Hridaya
A.S - Ashtaanga Sangraha
A. T - After Treatment
B.P - Bhaava Prakasha
B.R - Baishajya Rtnavali
B.S - Bhela Samhita
B.T - Before Treatment
C.S - Charaka Samhita
Chi - Chikitsa
G.N - Gada Nigraha
H.S - Haritha Samhitha
K.S - Kashyapa Samhita
M.N - Madhava Nidana
Ni - Nidana
S.S - Sushruta Samhita
Su - Sutra
Vag - Vagbhata
V.S - Vangasena
Y.R - Yogaratnakar
iv
LIST OF TABLES
TABLE
NO.
CONTENTS PAGE
NO.
1. AHARAJA NIDANA OF KITIBHA KUSTHA 20-21
2. VIHARAJA NIDANA OF KITIBHA KUSTHA 22-23
3. DAIVA PACHARAJA NIDANA OF KITIBHA KUSTHA 23
4. POORVA ROOPA OF KITIBHA KUSTHA 26
5. LAKSHANA OF KITIBHA KUSTHA 27-28
6. CORELATION BETWEEN KITIBHA KUSTHA AND
PSORIASIS
35
7. INFECTIONS IN PSORIASIS 48
8. STATUS OF 40 SUBJECTS OF PSORIASIS – AGE WISE
DISTRIBUTION
89
9. STATUS OF 40 SUBJECTS OF PSORIASIS – GENDER
DISTRIBUTION
90
10. STATUS OF 40 SUBJECTS OF PSORIASIS – OCCUPATION
WISE DISTRIBUTION
91
11. STATUS OF 40 SUBJECTS OF PSORIASIS – MARITAL
STATUS WISE DISTRIBUTION
92
12. STATUS OF 40 SUBJECTS OF PSORIASIS – RELIGION
WISE DISTRIBUTION
93
13. STATUS OF 40 SUBJECTS OF PSORIASIS – SOCIO-
ECONOMIC STATUS
94
v
14. STATUS OF 40 SUBJECTS OF PSORIASIS – EDUCATION
WISE DISTRIBUTION
95
15. STATUS OF 40 SUBJECTS OF PSORIASIS – APPETITE 96
16. STATUS OF 40 SUBJECTS OF PSORIASIS – DIET 97
17 STATUS OF 40 SUBJECTS OF PSORIASIS – QUANTITY OF
FOOD
98
18. STATUS OF 40 SUBJECTS OF PSORIASIS – AGNI 99
19. STATUS OF 40 SUBJECTS OF PSORIASIS – KOSTHA 100
20. STATUS OF 40 SUBJECTS OF PSORIASIS – PRAKRITHI 101
21. STATUS OF 40 SUBJECTS OF PSORIASIS – SATVA 102
22. STATUS OF 40 SUBJECTS OF PSORIASIS – SARA 103
23. STATUS OF 40 SUBJECTS OF PSORIASIS – ONSET OF
DISEASE
104
24. STATUS OF 40 SUBJECTS OF PSORIASIS – DURATION OF
DISEASE
105
25. STATUS OF 40 SUBJECTS OF PSORIASIS – SITE OF
ONSET OF DISEASE
106
26. STATUS OF 40 SUBJECTS OF PSORIASIS – COURSE OF
DISEASE
107
27. STATUS OF 40 SUBJECTS OF PSORIASIS –
AGGRAVATING FACTORS
108
28. STATUS OF 40 SUBJECTS OF PSORIASIS – RELIEVING
FACTORS
109
vi
29. STATUS OF 40 SUBJECTS OF PSORIASIS – FAMILY
HISTORY
110
30. STATUS OF 40 SUBJECTS OF PSORIASIS – RASA OF
FOOD TAKEN
111
31. STATUS OF 40 SUBJECTS OF PSORIASIS – GUNA OF
FOOD TAKEN
112
32. STATUS OF 40 SUBJECTS OF PSORIASIS – ADDICTION 113
33. STATUS OF 40 SUBJECTS OF PSORIASIS – SROTAS 114
34. EFFECT ON SYMPTOMS OF PSORIASIS - ITCHING 115
35. ITCHING (COMPARISON) 117
36. EFFECT ON SYMPTOMS OF PSORIASIS - REDNESS 118
37. REDNESS (COMPARISON) 119
38 EFFECT ON SYMPTOMS OF PSORIASIS - BURNING 120
39. BURNING (COMPARISON) 121
40. EFFECT ON SYMPTOMS OF PSORIASIS -
DESQUAMATION
122
41. DESQUAMATION (COMPARISON) 123
42. EFFECT ON SYMPTOMS OF PSORIASIS - DRYNESS 124
43. DRYNESS (COMPARISON) 125
44. EFFECT ON SYMPTOMS OF PSORIASIS – EPIDERMAL
THICKENING
126
45. EPIDERMAL THICKENING (COMPARISON) 127
46. EFFECT ON SYMPTOMS OF PSORIASIS – AUSPITZ SIGN 128
vii
47. AUSPITZ SIGN (COMPARISON) 129
48. EFFECT ON SYMPTOMS OF PSORIASIS – CANDLE
GREASE SIGN
130
49. CANDLE GREASE SIGN (COMPARISON) 131
50. EFFECT ON SYMPTOMS OF PSORIASIS – PASI SCORE 132
51. PASI SCORE (COMPARISON) 133
52. EFFECT ON SYMPTOMS OF PSORIASIS – KASI SCORE 134
53. KASI SCORE (COMPARISON) 135
54. RELIEF FROM SYMPTOMS IN SUBJECTS 136
55. TOTAL EFFECT OF THERAPY AT A GLANCE 137
viii
LIST OF FIGURES
FIGURE
NO.
CONTENTS PAGE
NO.
1. SAMPRAPTHI FLOW CHART 30
2. STATUS OF 40 SUBJECTS OF PSORIASIS – AGE
WISE DISTRIBUTION
89
3. STATUS OF 40 SUBJECTS OF PSORIASIS –
GENDER DISTRIBUTION
90
4. STATUS OF 40 SUBJECTS OF PSORIASIS –
OCCUPATION WISE DISTRIBUTION
91
5. STATUS OF 40 SUBJECTS OF PSORIASIS –
MARITAL STATUS WISE DISTRIBUTION
92
6. STATUS OF 40 SUBJECTS OF PSORIASIS –
RELIGION WISE DISTRIBUTION
93
7. STATUS OF 40 SUBJECTS OF PSORIASIS – SOCIO-
ECONOMIC STATUS
94
8. STATUS OF 40 SUBJECTS OF PSORIASIS –
EDUCATION WISE DISTRIBUTION
95
9. STATUS OF 40 SUBJECTS OF PSORIASIS –
APPETITE
96
10. STATUS OF 40 SUBJECTS OF PSORIASIS – DIET 97
11. STATUS OF 40 SUBJECTS OF PSORIASIS –
QUANTITY OF FOOD TAKEN
98
ix
12. STATUS OF 40 SUBJECTS OF PSORIASIS – AGNI 99
13. STATUS OF 40 SUBJECTS OF PSORIASIS –
KOSTHA
100
14. STATUS OF 40 SUBJECTS OF PSORIASIS –
PRAKRITHI
101
15. STATUS OF 40 SUBJECTS OF PSORIASIS – SATVA 102
16. STATUS OF 40 SUBJECTS OF PSORIASIS – SARA 103
17. STATUS OF 40 SUBJECTS OF PSORIASIS – ONSET
OF DISEASE
104
18. STATUS OF 40 SUBJECTS OF PSORIASIS –
DURATION OF DISEASE
105
19. STATUS OF 40 SUBJECTS OF PSORIASIS – SITE
OF ONSET OF DISEASE
106
20. STATUS OF 40 SUBJECTS OF PSORIASIS –
COURSE OF DISEASE
107
21. STATUS OF 40 SUBJECTS OF PSORIASIS –
AGGRAVATING FACTORS
108
22. STATUS OF 40 SUBJECTS OF PSORIASIS –
RELIEVING FACTORS
109
23. STATUS OF 40 SUBJECTS OF PSORIASIS –
FAMILY HISTORY
110
24. STATUS OF 40 SUBJECTS OF PSORIASIS – RASA
OF FOOD TAKEN
111
x
25. STATUS OF 40 SUBJECTS OF PSORIASIS – GUNA
OF FOOD TAKEN
112
26. STATUS OF 40 SUBJECTS OF PSORIASIS –
ADDICTION
113
27. STATUS OF 40 SUBJECTS OF PSORIASIS –
SROTAS
114
28. EFFECT OF SYMPTOMS OF PSORIASIS - ITCHING 116
29. ITCHING (COMPARISON) 117
30. EFFECT OF SYMPTOMS OF PSORIASIS -
REDNESS
118
31. REDNESS (COMPARISON) 119
32. EFFECT OF SYMPTOMS OF PSORIASIS -
BURNING
120
33. BURNING (COMPARISON) 121
34. EFFECT OF SYMPTOMS OF PSORIASIS -
DESQUAMATION
122
35. DESQUAMATION (COMPARISON) 123
36. EFFECT OF SYMPTOMS OF PSORIASIS -
DRYNESS
124
37. DRYNESS (COMPARISON) 125
38. EFFECT OF SYMPTOMS OF PSORIASIS –
EPIDERMAL THICKENING
126
39. EPIDERMAL THICKENING (COMPARISON) 127
xi
40. EFFECT OF SYMPTOMS OF PSORIASIS –
AUSPITZ SIGN
128
41. AUSPITZ SIGN (COMPARISON) 129
42. EFFECT OF SYMPTOMS OF PSORIASIS – CANDLE
GREASE SIGN
130
43. CANDLE GREASE SIGN (COMPARISON) 131
44. EFFECT OF SYMPTOMS OF PSORIASIS – PASI
SCORE
132
45. PASI SCORE (COMPARISON) 133
46. EFFECT OF SYMPTOMS OF PSORIASIS – KASI
SCORE
134
47. KASI SCORE (COMPARISON) 135
48. RELIEF FROM SYMPTOMS IN SUBJECTS 136
49. TOTAL EFFECT OF THERAPY AT A GLANCE 138
xii
LIST OF PHOTO PLATES
SR. No Content Page No
1. Dinamallika and Streekutaja 203
2. Patients before and after treatment – Group A 204
3. Patients before and after treatment – Group B 205
xx
ABSTRACT
“CLINICAL EVALUATION OF “DINAMALLIKA- CESTRUM DIURNUM”
OIL IN KITIBHA KUSTHA WITH SPECIAL REFERENCE TO PSORIASIS”
Objectives:
To study Etiopathogenesis of psoriasis / Kitibha Kustha.
To evaluate the efficacy of DINAMALLIKA taila in the management of Psoriasis.
To statistically analyze the efficacy of Dinamallika patra taila by comparing the
efficacy of Streekutaja taila in the management of Psoriasis.
Methods:
40 Subjects diagnosed with Kitibha Kustha who fulfil the inclusion criteria were
randomly selected from OPD and IPD of M.I.A.M.S, Manipal and from referral
sources and special camps, conducted for the purpose. Registered patients were
allotted randomly by lottery method into two equal groups of minimum 20 subjects in
each as group A and B.
Group A:
Patients of the Group A were treated with Dinamallika patra taila external
application twice daily.
Group B:
Patients of the Group B were treated with Streekutaja taila external application
twice daily.
Duration: 60 days. Follow up: 61st and 90
th days.
Results & Interpretation:
Assessment was done with the following parameters
xxi
Subjective
1. Itching
2. Redness and burning
3. Size of lesion
4. Desquamation
5. Dryness
6. Epidermal Thickening
Objective
1. Auspitz Sign
2. Candle Grease Sign
3. PASI Scoring
4. KASI Scoring
In GROUP A, 14 subjects got 80-100% relief from symptoms and 6 subjects
got 60-80% relief. While in GROUP B, 7 subjects got 40-60% and 13 subjects got 20-
40% relief in symptoms.
Conclusion:
The patients had shown improvement in most of the criteria of assessment of Kitibha
Kustha in both the groups with a better effect in group A when compared to group B.
According to this study, Dinamallika taila external application is very effective as
compared to Streekutaja Taila in the management of Kitibha Kustha.
Key Words: Kitibha Kustha, Psoriasis, Dinamallika taila, Cestrum Diurnum,
Streekutaja taila, Wrightia Tinctoria, PASI, KASI.
Introduction
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 1
INTRODUCTION
Shrishthi, Sthiti and Laya are the basic and fundamental laws of the universe.
These are associated with both the situations, pathological and non-pathological.
Diseases generate, exist and vanish either by their own or with certain technical
approach. But this is the partial truth of the nature; total truth is beyond the limit of
this circle. Diseases themselves become major causative factor for destruction of
human beings. But medical scientists are always working to search for certain
remedies to get complete success over fatal pathological disorders and with curious
mental attitude, they are engaged in such type of scientific deeds but tragedies are
remaining with those scientists because of their unsuccessful efforts against certain
pathological situations and physical conditions for all aged victims.
Ayurveda is one of the most ancient systems of medicine and health sciences
practiced in India since antiquity. It is based on the sound fundamental principles and
unique approaches for the purpose of life, preservation of health and treatment of
various diseases.
Ayurveda is eternal and never remains static. Ayurveda adopts to the need of
time. It is the knowledge which is important and not the language or the form in
which it is imparted. Ayurveda is not a historical relic which had its relevance in the
past. It is important at the present and for the future.
Ayurveda advocates many, simple, natural, preventive and therapeutic
measures for keeping or restoring good health. In an ideal case, a person could lead a
life that accelerates his or her personal development an ensures pleasant social
relationship.
Introduction
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 2
The object of Ayurveda is to assist nature and not to disturb the natural
process of living or healing. All the therapeutic measures used for cure, support the
natural process. They do not initiate, substitute or suppress what the body can do for
itself.
Ayurveda consider man as a microcosmic unit of macrocosmic world.
Inspite of the fact that Ayurveda has laid great stress on repeated
observation (Bhuyodarshana) data has been accepted and being reliable only based on
anvaya (uniform consistency) unmanned by any Vyatireka (contradiction).
Skin reflects our emotions and it is a link between internal and external
environment. It provides an individual identity in the society & maintains beauty and
personality. Changes in skin colour may indicate homeostatic imbalances in the body.
Many interrelated factors affect both the appearance and health of the skin, including
nutrition, hygiene, circulation, age, immunity, genetic traits, drugs and psychological
state. So important is the skin to one’s image that people spend much time and money
to restore skin to a more normal or youthful appearance.
Skin disorders are one of the burning problems of modern scientific era.
Kustha includes wide spectra of skin diseases, among them Kitibha Kustha was
selected for present study. Kitibha can be correlated with Psoriasis based on similarity
in etio-pathogenesis & symptomatology. It is one among the Kshudra Kustha which
has dominance of Kapha & Vata Dosha in particular and Rakta in general is vitiated
in its pathogenesis1.
Psoriasis2 is a common chronic non-infectious skin disease said to be
idiopathic, characterized by well-defined slightly raised dry Erythematous lesions
with silvery scales and typical extensor distribution.
Introduction
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 3
Comparing the features of Psoriasis & Kitibha lakshanas as per Susrutha
Samhita, Caraka Samhita and Ashtanga Sangraha, both the diseases can be correlated
to each other. It is estimated that 2-3% of world population suffer from Psoriasis.
Among them 35% of the people suffer from moderate to severe forms of Psoriasis. In
the year 2008, National Psoriasis foundation did a survey of 426 Psoriasis sufferers,
among them 71% reported that the disease was causing significant problem in day to
day life3.
Patients with Psoriasis often experience a diminished quality of life. Itching
and pain can interfere with basic functions such as self-care, walking and sleep.
Psoriasis affects quality of life similar to other chronic diseases as HT, DM &
Depression. The disease Kustha causes discoloration of the skin, which is the cause of
social stigma, brings down the cosmetic value of a person, and hampers the persona.
More than physical suffering, patient suffers psychologically. Complications in
Psoriasis are infrequent, the condition which can cause complicated Psoriasis are joint
involvement (Psoriasis Orthopathica) which can cause disability, even crippling4.
Treatment for Psoriasis in Allopathy is more palliative than curative. The First
line of treatment for most of skin diseases is topical application which holds good in
Psoriasis too. The topical application such a Coal Tar, Dithranoll & Cortico steroids
are the drugs of choice. Most of them are messy, irritants, not suitable to apply in
sensitive areas, having lot of side effects in a long run. With the limitations of these
Allopathic procedures; a more skin friendly, non- irritant, long lasting, easily
available, economical and a potent therapeutic agent is the need of the hour.
Many efforts have been done to treat Psoriasis / Kitibha in Ayurveda line of
treatment using different modalities, like Siravyada and Jaloaka which are not so
friendly or easily acceptable by patient, which needs direct supervision by a
Introduction
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 4
Physician. Lepa, one among the Bahya pradhana upakrama5 which could be easily
employed with effective results. As it is the first line of treatment for Kustha,
according to Susrutha many Lepa like Aragvadha Patra lepa6, have been tried in
Kitibha. Results have shown moderate to good response as high as 40% and 60%, but
no total cure was observed in any of the studies.
Dinamallika leaves external application in different forms has been
traditionally used by members of many families since ancestors and also very much in
vogue in some parts of Andhra Pradesh. In this regard another group of study, the
management of the Kitibha with Streekutaja7 bhanupaka taila
8 shall be taken up as
standard, which has been already established in the previous study with a success rate
of 60%.
It is not a new phenomenon to include new drugs into Ayurveda and under the
category of “Anuktadravya” i.e., unlisted/ non-narrated drugs (extra-pharmacopoeia
medicine). However, before any such medicine which is already in use elsewhere or
found to have merit by a Vaidya, is subjected to examination based on the fivefold
basic parameters which qualify any substance before it is put to medicinal or edible
use. The fivefold parameters are: a. rasa, b. guṇa, c. vīrya, d. vipāka and e.
prabhāva9,10
.
Ayurveda ka Vaijnanika Itihasa provides details of 121 new therapeutic
entities, which were introduced to Ayurveda in different phases. Among the reported
54-plant drugs, 7-flowers, 26-fruits, 12-vegetables, 14-food grains, 8-animal origin
ingredients. (PV Sharma, 1975: 338-372)
In similar lines a non-native ornamental plant “Cestrum diurnum” know as Din-
ka-raja has been in use with some of the traditional Ayurvedic Vaidyas who by trial
and error found out that the leaves of the plant are useful in the treatment of Kitibha
Introduction
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 5
kushta11
. Further review of literature based on the methodology of Anuktadravya, the
drug has been found suitable for therapeutic use in Skin ailments such as Kitibha
Kustha (Psoriasis) and there is a need to conduct appropriate clinical trials to establish
the same Further, as the plant is very easy to cultivate and the useful part being the
leaves it is an ideal choice to prevent adulteration and employ it for therapeutic usage.
Keeping in view, this burning problem of the present era and its associated
devastating disease, it has been decided to do research on Kitibha Kustha (Psoriasis)
with certain Ayurvedic remedies.
There are some new researches, some new efforts and some new paradigms in
the path of solution of the disease Kitibha Kustha (Psoriasis). In the pathway of this
solution some create milestones, some make new hypothesis and there are others who
are trying to make money from this burning problem. This research work is a
paradigm in the pathway of solution of the disease Kitibha kushta (Psoriasis). A trial
has been made in the present study to make some new dimensions in respect to
Rogabala, Dehabala, Agnibala, Chetasabala and overall effect of therapies were
obtained based on the above four said criteria.
Previous Works Done:
1. Tangoria C S S. Management of Kitibha (Psoriasis) By an Indigenous Drug
Streekutaja (Wrightia Tinctoria). Kayachikitsa. Faculty of Ayurveda, Institute
of Medical Sciences Banaras Hindu University, Varanasi. 1990
2. Ankem M K. Concept of Kitibha (Psoriasis) In Ayurveda and Modern
Medicine and Its Treatment by Streekutaja: A Further Study.
Kayachikitsa. Faculty of Ayurveda, Institute of Medical Sciences Banaras
Hindu University, Varanasi. 1991
Introduction
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 6
3. Harine A. A Clinical Study of the Effect of Nirgundi Taila Both Internally and
Externally in The Management of Kitibha-Kushtha. Kayachikitsa. Dr BRKR
Govt Ayurvedic College, Hyderabad. 2004
4. Thorat Namrata K. Comparative Study of Vajraka Ghrita Orally and
Externally in the Management of Kitibha Kustha. Kayachikitsa. Poona District
Education Association’s, College of Ayurved & Research Centre, Pune. 2007
5. Kircik L,
Efficacy and safety of topical calcitriol 3 microg/g ointment, a new
topical therapy for chronic plaque psoriasis, J Drugs Dermatol. 2009 Aug;8(8
Suppl): s916.
6. Lohith B H. A Clinical Evaluation of Efficacy of Kushtaghna Maha Kashaya
In the Management of Kitibha Kustha With Special Reference to
Psoriasis. Kayachikitsa. Ashwini Ayurvedic Medical College,
Davanagere. 2011
7. Abhinav Khare.Clinical Assesment Punaranava Lepa in the Management of
Kitibha Kushta. Kayachikitsa. Dr. Basavaraj Nagur Memorial Rural Ayurveda
Medical College and Hospital (Dr. B N M R), Bijapur. 2012
8. G. Raghurama Rao, Cestrum diurnum extract Ointment containing Natural
Calcitriol in the treatment of Mild to Moderate Plaque Psoriasis. 2014
9. MITRA, Puchalapalli, Processes for the preparation and estimation of
enriched Calcitriol containing extracts from Cestrum Diurnum and
compositions there of (pat - wo2007066355 &wo 2007066355 a1 )2015
Objectives of the study
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 7
OBJECTIVES OF THE STUDY
Keeping in view the above concepts, research work entitled “CLINICAL
EVALUATION OF “DINAMALLIKA- CESTRUM DIURNUM” OIL IN
KITIBHA KUSTHA WITH SPECIAL REFERENCE TO PSORIASIS”
Objectives of Study were:
1. To study Etiopathogenesis of psoriasis / Kitibha Kustha.
2. To evaluate the efficacy of DINAMALLIKA patra taila in the management of
clinical Psoriasis.
3. To evaluate the efficacy of STREEKUTAJA taila in the management of
Psoriasis.
4. To statistically analyze the efficacy of Dinamallika patra taila by comparing
the efficacy of Streekutaja taila in the management of Psoriasis.
Review of literature
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 8
REVIEW OF LITERATURE
In Ayurveda almost, all skin diseases have been described under the umbrella
of Kustha. Skin disorders are one of the major problems of modern scientific era. In
modern text skin diseases are mentioned descriptively. Ayurvedic Acharyas also
mentioned Kustha Vyadhi which covers wide range of skin diseases. Detail study of
all Samhita is necessary for prevention and treatment of skin diseases; so here we
review description of Kustha Vyadhi found in ancient time of Vedakala, Puranakala
and Samhita kala. The study of Indian classics reveals that skin disorders are afflicting
the human being since time immemorial.
Origin of Kustha: During the destruction of Yajna of Daksha raja different diseases
have been emerged out, amongst them Kustha is the one which has taken birth due to
the Haviprasha (intake of ghee). Which was supposed to be used for the Yajna.12
HISTORICAL REVIEW
VEDAKALA (2500BC-1000BC)
Rigveda:
There are some examples in Rigveda which show that Kustha was prevalent in
that period also. The Charma Roga of Apala was cured by Lord Indra13
(8-91). Gosha
was suffering from „Kustha Roga‟. She was disliked by her husband because of her
ugly looks due to Kustha. By administration of proper medication, she got cured &
accepted by her husband14
. (1-1/7-7)
Yajurveda:
Shukla Yajurveda mentioned various medicines having Kusthaghna
properties15
. (1-23, 1-4, 1- 24, 10 – 13/30, 8-10).
Review of literature
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 9
Atharvaveda:
As Ayurveda is upaveda of Atharvaveda, the various diseases have been
described in Atharvaveda. Amongst them Skin has been mentioned as one of the chief
site of diseases. Kustha has been mentioned as 'Kshetriya Roga'. There is description
of some herbs like, Nili, Asuri, Shyama, Rama etc16
. for the treatment of Kustha.
Atharvaveda defines the word "Kustha" as 'Kutshita Rupavarna'. The most effective
drug in the treatment of Kustha according to Atharvaveda is Trivrut (operculina
turpethum). It has advocated a special drug 'Kustha' for its management (Ath. Ved.
1:2:4). Atharvaveda has recorded the miseries of Doshas which were inflicted by
Kustha (Ath. Ved. 1:117:7). The word Kustha appears in different places but it again
seems to be used for the drug Kustha. The commentator of Atharvaveda considers
Kustha as one of the localized disease (Ath. Ved. 24)17
. In historical back ground,
Kustha Vyadhi was described in Vedic Period, so the importance of skin diseases is
very clear.
Mahabharata:
In Mahabharata, it has been mentioned that the person suffering from „Twak
Dosha‟ is not fit to be a king. Vichitra veerya was a victim of Kustha.
Agnipurana:
Kusthaghna preparations are mentioned under the heading of “Nana Rogahara
Aushadhani” 18
(Ag.Pu. 120/3). There is a reference regarding the internal use of
Khadira and external use of Hartala & Manashila in Kustha Vyadhi.
Garuda Purana:
Full account of the etiopathogenesis and treatment of Kustha Roga is given in
the DhanvantariSamhita division of the Garuda Purana. Kustha is classified based on
involved Dosha as Vataja, Pittaja, Kaphaja, Vatapittaja, Vatakaphaja, Pittakaphaja
Review of literature
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special reference to Psoriasis” 10
and Sannipataja. The text also admitted Maha Kustha and Kshudra Kustha as types of
obstinate skin disorders. The symptomatology of all the types of Kustha is given as in
the Ayurveda literatures.
Koutilya Arthashastra:
Many diseases are mentioned such as Kustha, Unmaada, Apasmara, Prameha
etc.
Yadnyavalkal smriti:
Kustha is mentioned as 'Paparoga' due to its chronicity.
Manu Smriti:
Skin disease has been considered as a serious problem and differentiation has
been done between the two diseasesKustha and Svitra. Marriages were avoided to the
families, where a person suffered from Kustha or Rajayakshma. Avoiding papakarma
is advised as a line of management of the disease Kustha.
Panini (700 BC):
Athisara, Arshas and Kustha are explained under major diseases. Maha Kustha
is regarded as Anuvamshika doshaja Vyadhi.
SAMHITA KALA (1000BC-100AD)
Charaka Samhita
Acharya Charaka was the first to describe a long range of skin diseases in
detail. Acharya Charaka described all the skin diseases with their etiology,
pathogenesis and classification under the heading of Kustha. Acharya Charaka has
described 18 types of Kustha, out of which seven types of Kustha have been described
as a 'MahaKustha' in detail in Nidana Sthana. In the Chikitsa Sthana 18 Kusthas are
classified as 7 MahaKustha and 11 KshudraKustha. Some other references which are
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“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 11
related to Kustha in different Adhyayas (chapter) of Charak Samhita are as follows:
Kustha is mentioned as the Samanya Hetu of NijaShotha 20
(C.S. Chi.12/5, 6). Kustha
is considered as a Santarpanjanya Vyadhi 21
(C.S. Su.23/ 6). It is included as one of the
disease caused by Rakta Dhatu Dushti22
(C.S.Su.28/11). Sthambhana of Raktapitta in
amavastha causes Kustha. Sthambhana of Amatisara causes Kustha. Kustha is noted
in Lekhana Yogya & Pachana Yogya Vyadhi23
(C.S.Chi.25/58,59). In Kusthaja Vrana
Agnikarma is contraindicated24
. (C.S.Chi. 25/106).
Sushruta Samhita
Acharya Sushruta also gave 18 types of Kustha. Apart from Acharya Charaka
he mentioned Dadru as MahaKustha and Siddham as Kshudra Kustha. In list of
Aupasargika Roga (communicable diseases), Sushruta mentioned the name of Kustha
25(S.S.Ni. 5/32). He was the first to describe hereditary and Krimija (infectious) cause
of the Kustha26
(S.S.Su.5/21-26). Acharya Sushruta also explained Dhatugata Avastha
of Kustha (S.S.Ni. 5/26-31). Treatment of Kustha is given in 2 chapters that are
Kustha Chikitsa and Maha Kustha Chikitsa. Sushruta mentioned Rasayana drugs in
treatment of Kustha.
Ashtanga Sangaraha:
Kustha has been mentioned to be of 7 types depending on the Dosha involved
and Kitibha Kustha has been defined as Vata Kapha Pradhana Kustha27,28
(A.S. Ni.
14/9-10, A.S. Ni. 14/19).
Ashtanga Hridaya
Vagbhata has followed Susrutha regarding classification of Maha Kustha &
KshudraKustha29
(A.H.Ni. 14/6, 20- 30). But Kitibha has been mentioned under
Kshudra Kustha with same Lakshanas as described by Acharya Charaka30
(A.H.Ni.14/19, 28).
Review of literature
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special reference to Psoriasis” 12
Kashyapa Samhita:
Kashyapa has given the classification of Kustha based on its Sadhyata &
Asadhyata. There by 9 Kusthas are described as Sadhya while other 9 are Asadhya.
Kashyapa mentioned some differrent Kustha that are Shvitra, Vishaja Kustha and
Sthularushka. He didn't mention Charma Kustha, Alasaka & Visphotaka. Kitibha
Kustha has been labeled as Sadhya Kustha.
Harita Samhita:
Kustha has been described in Tritiya Sthaana of Harita Samhita. „Kitibha
Kustha‟ is mentioned as one of its varieties
Bhela Samhita:
Acharya Bhela has mentioned Dushita Jala (polluted water) as an etiological
factor of Kustha; and described Kustha Roga in Nidana & Chikitsa Sthana.
SANGRAHA KALA (800-1700AD)
Madhava Nidana
Madhava has described Nidana Panchaka of Kustha according to the Acharya
Charaka & Vagbhata. While Dhatugatatva, Sadhya-Asadhyata & Sankramakata
(contagious) have been described as Sushruta. The description of Kitibha Kustha is
mainly based on the Charaka Samhita31
(Ma. Ni. 49).
Vangasena (1210 AD)
Special causes of Kustha are mentioned by Vangasena that are: a) Tila b) Taila
c) Kulattha d) Valmika e) Linga Roga f) Mahisha Dugdha, g) Mahisha Dadhi32
.
Sharngadhara Samhita (13 AD):
Described Kustha in Purvakhanda. Sharngadhara mentioned Tamra which is
the fourth layer of the skin is the Adhishthana (site) of all types of Kustha.
Review of literature
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special reference to Psoriasis” 13
Basavarajiyam (15 AD):
Some other types of Kustha are described like Prasuti Kustha, Galat Kustha
etc.
Bhava Prakasha (16 AD):
Classification & nomenclature of Kustha as Acharya Charaka. The
Dhatugatatva & Sadhya-Asadhyata are described as Acharya Susrutha. Arishta
Lakshana of Kustha has also been described (B. P. 54/44). But differs with Sushruta
in which these were Asadhya Lakshanas33
(S.S. Su. 23).
Yoga Ratnakara (17 AD):
Yoga Ratnakara also described the contagious aspect of Kustha Bhaishajya
Ratnavali: Marichyadi Taila and Rasamanikya are mentioned in treatment of Kustha.
Chikitsa Chandrodaya:
Rajeshwar Dutta Shashtri has tried to correlate different skin disorders with
different types of Kustha. He correlated Psoriasis with Kitibha Kustha
Raja Martanda:
Bhojaraja has described the treatment of Kustha in chapter 8. Some recipes
increase the luster of skin and to get rid of body odour has also been described.
Anjana Nidana:
In shloka no 196-201 description of Kustha is obtained. Causative factors and
classification are described but still it is as per Charakas classification. The only
difference is that, here 8 Maha Kustha are described, 8th one is Dadru34
.
Bhaishajya Ratnavali:
Detailed description of the disease has been explained in the separate chapter
of KusthaChikitsa. General line of treatment told for Kustha is same as that of
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special reference to Psoriasis” 14
Charaka samhita. Sarva Kusthahara lepa has been mentioned and for Kitibha, pama
etc. also lepa has been told like Marichadi taila and manashiladi lepa35
.
Gadanigraha:
Vaidya Shodhala has given description of Kustha roga in the 36th
chapter of
Dvitiya Khanda. Classification of the disease is as per Charaka Samhita and
dhatugatatva is described as per Sushruta36
.In a nut shell from the period of Vedic era
until up to the Laghutrayi there is progressive addition of disease details in relation to
obstinate skin disorders. The information available is limited to Vaivarnya and
Romashatana in Rig-Veda, adding up of more information about Charma Roga in
Atharva Veda. Role of sinful activity in the causation of disease is cited in the Purana.
Tangible description of etiology; clinical expression; types; prognosis and treatment
in Bruhatrayi and Laghutrayi unraveled the understanding of Kustha/Kitibha Kustha
Review of literature
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special reference to Psoriasis” 15
DISEASE REVIEW
INTRODUCTION:
Ancient text of Ayurveda has described many diseases elaborately and they
can be found even today. Kustha is one of the commonly affected diseases to
mankind. Kustha has been described in detail in terms of its Etiopathogenesis,
Symptomatology, complication and management. As far as the chronicity of disease
is concerned, Kustha has been considered as the most chronic among all the
diseases37
.
ETYMOLOGY:
Kustha is a Sanskrit noun in masculine gender, singular form and nominative
case38. Following are the etymological derivations of the same.
The word “Kustha‟ is derived from - „Kus nishkarshane‟ + „Kta‟ which
implies „to destroy‟, „to scrap out‟ or to deform, by adding the suffix „kta‟ which
stands for firmness or certainty.
Thus, the word Kustha means that which destroys with certainty39
.
DEFINITION:
• Siddhanta Kaumadi:
kushnati nishsheshena karshati vilekhan karoti angapratyangani dhatu updhatuni
iti Kustham l
Author has described that Kustha is the condition in which different body
organs, Dhatus, Upadhatus are destroyed40
.
• Sabdakalpadruma:
kushnati rogam l
It is mentioned the Kustha means which causes despise or contemptible
situations41
.
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special reference to Psoriasis” 16
• Halayudh Kosha:
kushnati sharistha shonitam vikrute l
Vitiated Rakta leads to the destruction of body, so it is called Kustha42
.
kushnati vapu iti Kustham l
i.e. which disfigures the body is known as Kustha43
.
All the 18 types of skin diseases, if left untreated in a long run; eventually
ends up in discoloration of the skin and hence is generally called as Kustha44
.
The disease characterized by the morbid Dosha circulating in the skin is called
as Kustha45
.
All the diseases characterized by accumulation of morbid Dosha circulating in
the Twak, Mamsa and Rakta and afflicting the same are termed as Kustha46
.
All the types of Kustha involve the Twak, Mamsa, Rakta and Lasika and
destruct the skin and if progresses lead to disfigurement47
.
CLASSIFICATION:
Kustha is broadly classified in to MahaKustha & KshudraKustha48
.
(A) MahaKustha
1 Kapala
2 Audumbara
3 Mandala
4 Rishyajihva
5 Pundarika
6 Sidhma
7 Kakanaka
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(B) Kshudra Kustha
1 Eka Kustha
2 Kitibha
3 Charmadala
4 Pama
5 Vicharchika
6 Charmakhya
7 Vipadika
8 Alasaka
9 Dadru
10 Visphotaka
11 Sataru
Kitibha Kustha is Vata-Kapha Kustha. Both Charaka and Susrutha Acharya
described the symptoms of Kustha based on dominance of Dosha.
According to Dosha:
Vataja
Rukshata, Shosha, Toda, Shula, Sankochana, Ayama, Parushya, Kharabhava,
Harsha, Shyavarunatva49
.
Pittaja
Daha, Raga, Parisrava, Paka, Visragandha, Kleda, AngaPatana50
Kaphaja
Shwaitya, Shaitya, Kandu, Sthairya, Utsedha, Gaurava, Sneha, Kleda,
Jantubhih Abhibhakshanam51
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According to Dhatugatatva52
: (Su. Ni 5/22-28)
Rasagata Sparsahani, Sveda, Alpakandu, Vaivarnyam, Rukshata
Raktagata Sunnata, Romaharsa, Svedadhikya, Kandu, Durgandhita Puya
Mamsagata Sthula, Mandala, Mukhasosha, Karkashata, Pidika, Toda, Sphota,
Sthira Mandala
Medogata Durgandha, Malavriddhi, Puya, Krimi, Angabhedana
Asthi Nasabhanga, Raktanetrata, Svarabhanga, Ksate Krimisambhava
Majjagata Nasabhanga, Raktanetrata, Svarabhanga, Ksate Krimisambhava
Shukragata Kaunya, Gatisaya, Angaanam Sambheda, Ksatasarpanam
NIRUKTI AND DEFINITION OF KITIBHA KUSTHA
Vyutpatti of the word Kitibha
‘Kitiriva bhati | kesha keetah |’ 53
The term Kitibha is constituted by the combination of “Kiti” and “Bha”. The
word kiti refers to a variety of insect, which is black in colour and stays in kesha
pradesha or in hair54
.
The word “Kiti” is also termed as Akuna by Hemadri. According to Monnier
Williums „ukuna‟ means „a bug‟. This indicates that it is either a louse or some other
insect, which is like louse55
.
According to Monnier Williums – Kitibha means a bug or a louse.56
Hence the
word Kitibha means, the one which resembles the insect which is black in colour.
(Kesha keeta – Black in colour) or similar to the colour of varaha
In Ayurveda, skin diseases are included under the heading of Kustha and
kshudra rogas. Out of them amongst Kshudra Kustha is the KITIBHA KUSTHA.
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Ketathi shatrum prativegena gacchati iti Kitibhah |
Attack the person very fast, as one will destroy his enemy very fast without
delay. It will furnish trouble, treat to the patient and make him afraid of.
The person suffering from Kitibha Kustha looks terrible. Thus, threating others
because of its ugly look. This condition can be embracing, socially disabling and even
affect the relationship of the patient.
Kitibha Kustha is very old disease mentioned in ancient science among the
Kustha. It is categorized as Kshudra Kustha and Sadhya Kustha. All Kustha are
having Tridoshaja origin so, Kitibha Kustha can be said in same way that is 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 Dosha
domination in Kitibha Kustha.
Nidana Panchaka:
Nidana:57,58,59,60,61
As the detail description of Kitibha Kustha is not available in the texts, only
the symptom complex is mentioned, being one of the Kustha, the general description
of Kustha in terms of Nidana, Purvarupa, Upshaya/Anupshaya, Samprapti, Chikitsa
and Upadrava may be consider for Kitibha Kustha.
Nidana of Kustha mentioned in different classical texts
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• Aharaja Nidana:
TABLE NO: 1
AHARAJA NIDANA OF KITIBHA KUSTHA
Sl.No NAME Cha Su. Vag B.S. Ha.S
1 Viruddhahara + + + + +
2 Ajeerna, Adhyashana + + - + -
3 Matsyati sevana + + - + -
4 Dugdati sevana + = - - +
5 Amlati sevana + - - - +
6 Guru ahara + - - - +
7 Gramyodaka with Anupamasa sevana - + - + -
8 Dadhi sevana + - - + -
9 Snehati sevana + - - + -
10 Lakucha and kakamachi + - - + -
11 Matsya with Payasa + - - + -
12 Ahitashana - + - - -
13 Drava, Snigdhara sevana + - - - -
14 Uddalaka, Kusumba + - - - -
15 Nava anna, Yavakaa Kulattha + - - - -
16 Lavana, Hayanka, Atasi + - - - -
17 Moolaka, Satata madhu sevana + - - - -
18 Tilapishta, Guda + - - - -
19 Chilichima with milk + - - - -
20 Madyamladravya with Milk - - - + -
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21 Guda with Milk - - - + -
22 Matsya, Nimba with Milk - - - + -
23 Mamsa with Madhu - - - + -
24 Papodaka (dushta jala) - - - - +
25 Pippali, Haritashakha, Vidagdhahara
sevana
- - - + -
26 Guda with Moolaka - - - + -
27 Haviprashana (Ghrita type) + - - - -
Ati Sevana: It can be categorized based on following factors:
Rasa Amla, Lavana Katu & Kshara
Pickle, jam and sauce, Chinese.
Guna Guru SnighdhaAhara
Sweets, cakes, chocolate, Dairy products, Payasam, Milk and its derivatives -
like curd, cheese, paneer etc.
Grains Navdhanya, Nishpava Hayanaka, Udalaka Etc. Recent mellowing grains like
wheat, polished rice, Bajara, Barley Pulses Kulatha, Masha Black gram, Pigeon, Peas,
Lentil Anupa mamsa Matsya, Gauaya, Varaha etc Fish, Pig, Dear, Rhinocerous, Ox,
Prasah mamsa Marjara, Lopaka, Jamdook etc Chicken, mutton, pigeon, peacock, etc.
Sweet substance, Madhu, Phanita, Honey, Phanita, Guda, Jaggery, Oil, Tila, Sarshapa,
Kusumbh, castor oil
Vegetables Mulaka, Lakuch, Kakmachi Radish Others Pishta Anna, Tila, Kola,
MITHYA AHARA:
Mithya Ahara is related with food articles, faulty food patterns and sequences,
excessive intake of alcohol and psychological disturbance during meal.
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special reference to Psoriasis” 22
Foods Vidahi, Vidagdha, Upaklinna, Puti Anna
Food pattern Ajirna bhojana, Asatmya bhojana, atibhojana
Faulty dietary sequence Shitosnaviparyaya Langhana Ahara, Santarpana
Aptarpana
Psychological Disturbance During the meal Santapa Papodaya
Viharaja Nidana
Shitoshna Vyatyasa Sevana and Anupurvya Sevana, Use of Santarpana and
Apatarpana diet without sequence Sudden diving into cold water or drinking cold
water after fear, exhaustion & coming from sunlight.
Practice of physical exercise & sunbath after heavy meals.
vyavaya in Ajirna
Suppression of Vegas like Chhardi, Mutra, Purisha
Kupathya in Panchakarma
Divaswapna after lunch
TABLE NO.2
VIHARAJA NIDANA
Sl.No Nidana Cha Su. Vag B.S. Ha.S
1 Chardinigraha + + - + -
2 Vegaavarodha + + - + -
3 Sheetaambhu Snana after atapa
sevana
+ + - + -
4 Diva swapna + - - + +
5 Mitya vihara - + + - -
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6 Vyayamam atisantaapa bhuktopa
sevanam
+ - - - -
7 Shrama bhayartanam Sheetambhu
sevanam
+ - - - -
8 Ratri jagarana - - - - +
9 Ajeernapi Vyayamam + - - - -
10 Sneha pitaasya Vantasyeva
vyayaman
- + - - -
11 Vyavaya after vidahi ahara sevana - - - + -
12 Gramya Dharma sevanam - + - - -
TABLE NO. 3
DAIVAPACHARAJA NIDANA
Sl.No DAIVAPACHARAJANYA KARMANI Cha Su. Vag B.S. Ha.S
1 Papakarma + + + - -
2 Vipram garshayatan + + + - -
3 Purvakruta Akarma + + + - -
4 Gohatya - - - - +
5 Use of money or material acquired
through theft
- + + - -
6 Sadhu ninda, apamana and vadha - + + - -
Achaara Hetu
Papa Karma
Vipra Guru Tiraskara
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special reference to Psoriasis” 24
Saadhu Ninda
Use of money & material acquired by unfair means
Killing the virtuous persons.
Others Nidana:
Some scattered references regarding Nidana of Kustha are also
found in the classics, which are as follows:
• Samsargaja Hetu:
Kustha is Aupasargika Roga and stated that Kustha spreads from one Man to
another due to Prasanga, Gatrasamsparsha, Nishwasat, Sahabhojanat62
.
• Kulaja Nidana:
Kulaja Nidana is due to Beejadushti. Sushruta has mentioned Kustha as
Adibalapravritta Vyadhi3 i.e. the original cause of the disease is attributed to defects
of Shukra and/or Shonita. Sushruta has also explained that the children of Kustha
patients may also suffer from Kustha.
• Krimija Hetu:
Acharya Sushruta has mentioned that all types of Kustha originate from Vata,
Pitta, Kapha and Krimi.4 Charaka has also indicated that causative factors &
treatment of Raktaja Krimi is as same as Kustha63
. Ch vi 6
• Chikitsa Vibharamsajanya Hetu:
Stambhana in initial stage of disease like Raktarsha, Rakta Pitta and
Aamatisara cause Kustha.
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special reference to Psoriasis” 25
Panchakarma Apacharaja:
Improper administration of Panchakarma or the misconduct of the patient
during Panchakarma treatment may lead to Kustha.
Kustha has been mentioned as Rakta-Pradoshaja and Santarpanajanya Vyadhi.
So, the Rakta-Pradoshaja and Santarpaka Nidana can be attributed to produce Kustha.
Miscellaneous Factors
Samsargaja - Contagious
Abhighataja - Due to trauma, positive Koebner phenomenon
Anyasya Haranam - Economical crime, stealing or snatching the property Sajjana
vadha, Bramhana Hatya, Stri Vadha- All criminal actives like Lethal assault,
shooting, stabbing murder etc.
Vangasena has given 7 specific etiological factors as Tila Taila, Kulattha,
Valmika, Linga Roga, Mahisha Dadhi and Vruntaaka for Kustha64
.
Charaka indicated that the water of the rivers which are originated from
Vindhya, Sahya and Pariyatra hills may cause Kustha.
POORVA ROOPA OF KITIBHA KUSTHA65,66,67,68,69
The poorva roopa is defined as the stage where premonitory symptoms appear
immediately after sthana samshraya. Clinical manifestation of the disease starts
during this stage. As there is no mentioning of specific poorva roopas, general poorva
roopas explained in the context of Kustha can be considered here.
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TABLE NO.4
POORVA ROOPA
Sr.
No.
Name of the
poorva roopa
Charaka Susrutha Vaghbhata Kasyapa Bhavapra
-kasha
1 Aswedanam + + - + +
2 Atiswedanam + + - + +
3 Parushyam + + - - +
4 Atislakshna + - + + +
5 Vaivarnyata + - + + +
6 Kandu + + + - +
7 Supta + + + - +
8 Nistoda + - + - +
9 Lomaharsha + + + + +
10 Kharatwam + - + + +
11 Gouravam + - + + +
12 Swayathu + - - + -
13 Rukshata + + + + +
14 Pipasa + + - + +
15 Saraga - - - + -
16 Daurbalya + - - + +
17 Pidaka - - - + +
18 Daha - - - + -
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LAKSHANAS OF KITIBHA KUSTHA70,71,72,73,74
The lakshanas of Kitibha Kustha explained by acharayas have variations
among which majority of acharyas opine that Kitibha Kustha is Vata Kaphatmaka,
while some acharyas considered it as pittadhikyam. The lakshanas of Kitibha Kustha
explained by different acharyas are as shown in the following table;
Table no. 5 below shows all lakshanas mentioned by different acharyas.
TABLE NO. 5
LAKSHANAS
Sr.
No.
Name of the roopa C.S.B.P.
Y.R.&M.N.
S.S A.H B.S K.S
1 Shyava + - + + -
2 Kinakhara sparsha + - + + -
3 Khara sparsha + - + + -
4 Parusha + - + + -
5 Kandu - +(Adhika) + + -
6 Ahitam - - + + -
7 Sravi - + - - -
8 Vrttam - + - - -
9 Ghanam - + - - -
10 Snigdham - + - - -
11 Krishnam - + - - -
12 Drudham - - - - -
13 Punaha prasravathi - - - + -
14 Roodhanvi tam cha - - - + -
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15 Vardatechasamutpannam - - - + +
16 Aruna - - - - +
17 Vriddhimanthi - - - - +
18 Guruni - - - - +
19 Prashantanicha
Punarutpadyante
- - - - +
SAMPRAPTI
According to Vagbhata75
the provoked Doshas reach to the Tiryaka Siras &
then vitiate Twaka, Rakta, Mamsa and Lasika and by making them deranged & weak,
then passes to the external surface of body, causing discoloration of the skin.
VATA: • Udana Vayu: It is responsible for normal colour of skin. Twak pathogenesis
is seen in Avarana of Prana by Vyana and Vyana by Udana.
• Samana Vayu: Its action is Agni Sandhukshana. In pathological state, it creates
Mandagni which leads to Vyadhi.
• Vyana Vayu: It may be also responsible for its whole-body function and Tridhagati.
PITTA: • Pachaka Pitta: It is responsible for digestion and Sara and Kitta Vibhajana.
So, when Nidana creates vitiation in its functions, pathogenesis will start.
• Bhrajaka Pitta: Kitibha Kustha is a disease of skin, which is formed by Bhrajaka
Pitta. It is responsible for skin metabolism and Varna formation.
KAPHA: • Prakruta Kapha helps in maintenance of Oja and Bala in the body. The
Kandu and Bahalatva are due to the involvement of Kapha Dosha.
• Kledaka Kapha: Here Kledaka Kapha may be involved as its Prakruta karma is
Kledana which helps in digestion. “Sarve Rogah api Mandagni‟, looking at this
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concept the involvement of Jatharagni in Kustha cannot be denied. Hence it can be
said that the disturbance of Kledaka Kapha may be the root cause of Kitibha Kustha.
Dushyas:
Charaka has described that seven Dravyas are vitiated in Kustha i.e. Tridosha
& four Dushyas (Twak, Rakta, Lasika & Mamsa). While commenting on this
Chakrapani point out that in the initial stage only above four Dhatus are vitiated but in
the later stage deeper Dhatus also became vitiated. Chakrapani has also described that
if only four Dhatus are vitiated then it is Samanya Dushti‟ (General Pathogenesis).
While on the vitiation of deeper Dhatus, it may be considered as “Vishesha Dushti”
(Specific Pathogenesis). Samanya Dushti occurs mainly in Kshudra-Kustha while
Vishesha Dushti occurs in MahaKustha.
Srotas:
Mainly the Srotodushti of Rasavaha, Raktavaha, Mamsavaha and Svedavaha
Srotas are found in Kitibha Kustha.
Aama & Agni:
Angnimandya is the root cause of all the diseases, causing Aama &
Aamavisha formation. The Aamavisha spreads to whole body & disturb the normal
physiology of the Dhatus, thereby rendering them Shithila. The Dhatvagni is also
deranged. Thus the Dhatu Shithilata further progresses. The three Doshas & Poshaka
Amsha of 4 Dushyas reach the Shithila Dushya & settle there to start the pathology in
that tissue.
Udbhava Sthana:
The Udbhava Sthana is Amashaya & Pakvashaya.
Sanchara: This is through the Tiryak Sira.
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Adhisthana: In Kitibha Kustha, the Twak is the main Doshadhisthana. Susrutha
mentioned that the whole skin is deranged by the vitiated Doshas. Latest research
report indicates a demonstrable abnormality in uninvolved skin of the psoriatic
patients.
• GENERAL SAMPRAPTI OF KUSTHA: MENTIONED IN SAMHITAS
Due to the indulgence of various Nidanas simultaneous aggravation of Dosha
in general and Vata-Kapha in particular in the production of Aama & Dhatu
Shaithilyata occur. Then the vitiated Dosha along with Aama, move through
Tiryakgata Sira and get settled in to the Twak & Mamsa along with vitiated Rakta &
Lasika, this cause obstruction in Rasavaha, Raktavaha, Mamsavaha & Svedavaha
Srotas producing the symptoms like Aswedana, Twak Vaivarnyam, Mahavastum etc.
If Kustha is not treated at this stage it further progress to the deeper Dhatus.
NIDANA
Dooshivisha Utpatti Agnimandhya
Dhatu Shaithilya Vata pradhana tridosha prakopa Amotpatti
Srotodushti Srotorodha
Stana samshraya of Dosha in twak
Stanika Dosha Prakopa
Dusti of Rakta, Mamsa, Lasika
Dosha Dushya Sammoorchana
Kitibha Kustha Utpatti
FIGURE NO:1 – SAMPRAPTI FLOW CHART
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Upadrava77
:
Prasravana, Angabheda, Anga-Avayava Patanam, Trisha, Jvara, Atisara, Daha,
Daurbalya, Arochaka, Avipaka.
• PATHYA – APATHYA78
:
The drugs & regimes which do not adversely affect the body & mind are
regarded as Pathya & those, which adversely affect them, are considered as Apathya.
Pathya:
• Ahara:
Rasa : Tikta
Guna : Laghu
Shuka : Purana Dhanya, Shastika Shali, Yava, Godhuma
Kudanya : Koradusha, Shyamaka, Uddhalaka
Shimbi : Mudga, Adhaki, Masura.
Shaka : Tikta Shaka e.g Patola.
Ghrita : Medicated Ghee prepared with Bhallataka, Triphala & Nimba.
Mamsa : Jangala Mamsa (without Meda).
Mishra : Mudga mixed with Patola.
• Apathya:
Guna : Guru
Rasa : Amla
Dravadravya : Dadhi, ksheera.
Ahara : Pista vikara, Viruddha Ahara, Navanna, Adhyashana, Ajeernashana.
Shimbi : Kulattha, Masha, Nishpava, Tila
Ikshu varga : Guda, Ikshu Vikara
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Shaka : Mulaka
Mamsa : Anupa mamsa, Vasa, Oudhaka mamsa, Anupa matsya
Vihara : Diwaswapna, Vyavaya, Vegarodha, Vyayama
CHIKITSA OF KUSTHA79,80,81
:
The principle of treatment is three-fold in Ayurveda as Nidana Parivarjana,
Apakarshana and Prakriti Vighata -this treatment given by Charaka in krimi chapter.
This treatment is given based on Rogabala, Rogabala, Kala, Vayu, Agni, etc.
Nidana Parivarjana:
Nidana are main causative factors to increase the disease because Samprapti
starts by Nidana. Therefore, first step for management is to avoid the Nidana. It stops
the further progression of the disease by restricting vitiation of Doshas.
Apakarshana (Shodhana):
The therapy which aims at the radical removal of the causative morbid factors
of somatic disease is called as Samshodhana.
Acharya Sharangadhara says that, among the Pancha Shodhana, Vamana,
Virechana, and Raktamokshana are indicated in the Kustha. Vamana is to be applied
in the treatment of Kapha predominant Kustha, Virechana and Raktamokshana in the
treatment of Pitta predominant Kustha81
.
• Snehana: Acharya Vagbhatta says that Kustha Rogi should be given Snehapana in
the stage of Purvarupa Avastha82
.
• Swedana: Swedana is generally done by Nadi Sweda or Bashpa Sweda. This
procedure liquefies the Doshas.
• Shodhana: Kustha is Tridoshaja Vyadhi. Therefore, first prominent Doshas should
be treated and then Anubandhya Dosha should be treated, Acharya Charaka also says
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in Vata dominance Ghrita Pana, in Kapha dominance Vamana and in Pitta dominance
Virechana and Raktamokshana are to be carried out.
According to Harita:
When the morbid Doshas are rarer potent, the patient should be treated with
Shodhana. For this purpose, Raktamokshana is to be done at every six months83
.
Virechana is to be given at every one month. Vamana is to be given at every 15th day.
• Basti: Acharya Charka says in Vata Dosha Pradhana Kustha first give Virechana,
Niruha Basti and then give Anuvasana -Basti of Madhuphaladi siddha taila84
.
• Raktamokshana: Sushruta have described to perform Siravedha from five main
superficial veins. Charaka have advised siravedha by classical instrument Alabu
Shringa etc.
• Nasya: it is used in Krimi, Kustha & Kapha Vikara, Nasya is also indicated. The
Nasya is prepared with rock salt, Danti, black pepper, and fruit of Pongamia pinnata
and of Embelia ribes.
• Dhumapana: Charaka described that Dhumapana with Shirovirechana drugs are
mentioned. They may be used collectively or singly for Dhumapana, in the cases
where krimi or parasites are located in the head as well as in the case of leucoderma.
Shamana: Acharya Vagbhata says that Shamana therapy is very useful in treatment
of Kustha. After completing the Shodhana karma, Shamana Chikitsa is indicated to
subside the remaining Doshas. In present life style when people do not have enough
time from their busy schedule for Shodhana therapy in such cases Shamana therapy is
to be advised. Charaka has described Shamana therapy with Tikta and Kashaya
Dravyas.
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Shamana Chikitsa is given for two specific purposes –
• To subside Kustha in the patients who are unfit or contraindicated for Shodhana
Karma.
• To subside the remaining Doshas after Shodhana Karma.
Lepana: External application should ideally be applied when the patient of Kustha
has satisfactorily undergone the purificatory procedure and whose vitiated blood is
removed from the lesions. External application of anti-Kustha drugs will be effective
in the disease. Sushruta has suggested Shodhana lepa for the management of
Twakagata Kustha. No curable form of Kustha recurs if the following measures are
taken at the appropriate times.
Shamana Drugs:
For the treatment of Kustha Roga, the selection of the drug is based upon
below mentioned principles – Drugs having the properties of;
• Rasa, Rakta Prasadana.
• Rasa, Rakta Shuddhikara, rakta prasadaka
• Rasavaha, Raktavaha & Svedavaha Sroto Sodhana.
Vyavachedaka nidana (Differential diagnosis)
Before confirming the diagnosis of Kitibha Kustha it should be differentiated
from the other diseases, which mimic Kitibha Kustha with some specific symptoms.
For this one should do proper examination as well as investigations to differentiate it
from other diseases, which have some similar and specific symptoms. For this the
following can be considered.
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COMPARISON BETWEEN KITIBHA KUSTHA LAKSHANA AND
PSORIASIS
Kitibha Kustha and Psoriasis:
It is difficult to have one to one co-relation for psoriasis with that of Kustha.
All research workers included psoriasis under Kshudra Kustha; further co-relation
was done with Sidhma, Mandala, Kitibha & Kitibha Kustha. After critical analysis of
symptoms complex, nearest co-relation is possible between Kitibha Kustha &
Psoriasis which is as follows:
TABLE NO. 6
CORELATION BETWEEN KITIBHA KUSTHA AND PSORIASIS
Sr.No. Kitibha Kustha Psoriasis
1 Rooksha Dry
2 Kina, Ruda vrana Granulation site of healing wound
3 Khara Rough
4 Kandu Itching
5 Parush Hard
6 PunarUtpadyante Subsides and relapses
7 Vriddhimanthi Spreading in nature
8 Vrittam Round or coin shape lesions
9 Ghanam Well defined borders
10 Snigdham Sticky, unctuous
11 Krishnam Black
12 Shyava Bluish Black
13 Aruna Reddish brown
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KASI – KUSTHA AREA SEVERITY INDEX
This was one of the objective parameters used to assess Kitibha Kustha.
Details included in the case performa
PSORIASIS
Etymology85
:
The word psoriasis is derived from the Greek word “Psora” and “iasis” Psora
means Itch or scale and Iasis means condition.
Synonyms:
Schuppenflechte, Healthy man‟s disease, Scaly disorders of skin.
Definition86
:
Psoriasis is a noninfectious chronic inflammatory disease of skin characterized
by well-defined erythromatous plaques with silvery scale which have a predilection
for extensor surface and scalp and by a chronic fluctuating course.
History
Psoriasis is one of the oldest recorded skin diseases. The famous Hippocrates
and his school (460–377 B.C.) produced objective and meticulous descriptions of
many skin disorders. Dry scaly eruptions grouped together under „lopoi‟ (epidermis) -
Includes psoriasis and leprosy.
Galen was the first who used the word „Psoriasis‟. The confusion between
Psoriasis and leprosy remained for many centuries. From 1000 – 1400 A.D. Patients
of Psoriasis were diagnosed as Leprosy and isolated. The Church declared them
officially dead. In 1313 Philip, ordered them to be burned at the stake.
Robert William (1809) was the first to give an accurate description of
psoriasis and its different manifestations. In 1841, Hebra definitively separated the
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clinical picture of psoriasis from that of leprosy. In 1977 –78 Seville has investigated
the relationship between psoriasis and psychological stress
Psoriasis Statistics by General Population
• The prevalence of psoriasis in general population varies from 0.1% to 8%.
• According to psoriasis stats from various resources, about 2-3% of general
population on the Planet Earth suffers from psoriasis. In other words, approximately
120 – 180 million people have psoriasis!
1. About 4% of the population in the most developed countries suffers from psoriasis.
Exceptions are Japan and Australia.
2. The incidence of this skin disease in Japan and China and in Eskimos and Native
Americans is less than 1%.
Psoriasis Statistics by Locations
• Statistical data shows that psoriasis is more frequent in moderate to cold climates,
and less frequent in tropical climates.
• The frequency of this skin disease in rural areas is usually 3-4 times less than in
urban
areas.
Psoriasis Statistics by Age
• Statistically, there are 2 age peaks when psoriasis is likely to start: 13-25 year old
and 50-60 year old.
• The greatest risk to develop Psoriatic Arthritis is at age 30-50 (more than 70%).
Psoriasis Statistics by Family
• Family history of psoriasis was found in 30-60% of patients.
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Psoriasis Statistics by Psoriasis Type
• Plaque Psoriasis is encountered in about 80% (the most common type of psoriasis).
• Psoriatic Arthritis is encountered in about 5-30%.
• Palmoplantar psoriasis is encountered in about 10%.
• Pustular Psoriasis is encountered in less than 5%.
• Psoriasis of the Mucous Membranes is encountered in 1-2% (the least common type
of psoriasis).
Pathology:
Psoriasis appears to be largely a disorder of keratinization.
The basic defect is rapid replacement of epidermis in psoriatic lesion (3 to 4
days instead of 28 days in normal skin.) In addition, there are marked vascular
changes in upper dermis in the form of tortuosity and dilatation. Recently, the
presence of abnormal neural cells has been demonstrated in psoriatic plaques.
Histology is characteristic and consists of
i) Parakeratosis
ii) Thinning of Supra-papillary portion of the stratum malpighi,
iii) Elongation of ridges
iv) Oedema and clubbing of papillae,
v) Micro-abscesses of Munro.,
vi) Dilated and tortuous capillaries in upper dermis
vii) Oedema and round cell infiltration in the papillae and upper
dermis.
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T cell dependent mechanism: The evidence that T lymphocytes are important in the
pathogenesis of psoriasis includes: infiltration of lesions with activated T cells. The
efficacy of T-cell targeting therapies such as cyclosporin, anti-CD4 monoclonal
antibody and a lymphocyte-selective toxin. raised serum levels of soluble interleukin
2 receptor protein, which signifies T-cell activation, during active phases of disease.
the presence of proliferating T cells in association with dendritic antigen presenting
cells in lesions. the ability of lesional epidermal cell suspensions to drive autologous
peripheral blood lymphocyte proliferation, suggesting local antigen presentation. and
the demonstration that T-cell clones propagated from lesional biopsies release growth
factors that induce keratinocyte proliferation. Furthermore, analysis of T-cell antigen
receptor gene expression in lesions versus that in peripheral blood has provided
evidence for selective infiltration of subpopulations of T cells. This has suggested the
existence of a specific cellular immune response in psoriatic lesions, due either to
putative auto-antigen or in guttate psoriasis to superantigen, perhaps related to
haemolytic streptococci. These and other data indicate that psoriasis may be a T-cell-
mediated autoimmune disease, justify a search for autoantigens, and suggest a
possible role for novel immunotherapeutic approaches.
Mechanism of T-Cell proliferation: The finding of greatly enhanced keratinocyte
proliferation in psoriasis was initially thought to be due at least in part to a reduced
cell-cycle time. However, accumulating evidence now indicates that basal epidermis
contains a mixture of cycling and resting cells, and that there is no major difference
between normal and hyperproliferative epidermis with respect to cell-cycle time. The
abnormality in psoriatic epidermis appears to be the result of an increased recruitment
of cycling cells from the resting fraction, thus producing an increased growth fraction.
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These observations have important implications for the study of the mechanism of
action of keratinocyte growth factors in psoriasis.
Etiology of Psoriasis87
1. Infection: The role of streptococcal infection, especially in the throat, in
provoking acute guttate psoriasis has long been recognized. Past and more
recent evidence suggests that continuing, subclinical streptococcal infection
might also be responsible for refractory chronic plaque psoriasis.
2. Endocrine factor: The early report that there are peaks of incidence at puberty
and at the menopause has been supported by more recent findings. Generalized
pustular psoriasis may be provoked by pregnancy and may exacerbate
premenstrually, and may also be provoked by high-dose oestrogen therapy.
3. Sunlight: Although sunlight is generally beneficial, small minorities of
psoriatics are provoked by strong sunlight and suffer summer exacerbations in
exposed skin. May be polymorphous light eruption with secondary exacerbation
of psoriasis, or direct aggravation by sunlight.
4. Metabolic factors: Hypocalcaemia (e.g. following accidental
parathyroidectomy) have precipitated psoriasis.
5. Drugs:
• administration of lithium, adrenergic blocking agents and antimalarials,
• Psoriasiform reactions to practolol apparent aggravation of pre-existing
psoriasis by practolol and provocation of new episodes of psoriasis by a range
of beta blockers.
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• Exacerbation due to clonidine, potassium iodide, amiodarone, digoxin, the
antidepressive, trazodone, the hypolipidaemic agent, gemfibrozil, penicillin
and terfenadine.
• The possible exacerbating effect of non-steroidal anti-inflammatory drugs is of
particular importance, as many patients with psoriatic arthropathy are likely to
encounter these drugs.
6. Psychogenic: It is possible that psychological stress may be associated with a
diminished capacity to cope with regular treatment, and that this may lead to
deterioration, especially in severe cases.
7. Alcohol and smoking; It is possible that excessive alcohol consumption may
lead to reduced therapeutic compliance, and also that it is a symptom of stress
caused by severe skin disease. in chronic smokers suggest an increased risk for
both palmoplantar pustulosis and chronic plaque psoriasis
8. AIDS: The association between severe psoriasis, psoriatic arthropathy and
human immunodeficiency virus (HIV) infection is well recognized. Genetics
Recently, linkage of psoriasis to loci on the long arm of chromosome and of
chromosome 4 have been reported in selected large kindreds.
Factors Associated with Psoriasis88
The cause of psoriasis has not been clearly determined, but there are many
factors associated with it, such as food allergies, metabolic problems, liver and colon
problems, hypothyroidism and severe stress.
1. Decreased cAMP to cGMP Ratio
2. Abnormal Plasma Homocysteine
3. Abnormal Fumaric Acid Metabolism
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4. Hypothyroidism
5. Abnormal Elimination of Toxins: Dr. John Pagano’s Work
6. Structural Problems
Even one vertebral subluxation can cause psoriasis because of the effect of the
related nerve(s) on normal blood circulation in certain areas of the intestinal tract.
7. Emotional Triggers
8. Diet and Digestive Enzymes
Any undigested food can cause problems. There are many foods that can
aggravate psoriasis; including undigested proteins in general, refined sugar, pork and
alcohol. Murray says that bacteria convert partially digested proteins into toxic
metabolites, called polyamines, which decrease cyclic AMP and contribute to
excessive cell proliferation.
9. Lipid disturbances and psoriasis
10. Zinc Deficiency and Psoriasis
CLINICAL FEATURES
Manifestation with special localizations:
1. Scalp:
The scalp is the most common localization in psoriasis. Psoriasis may be
localized to the scalp with no involvement elsewhere. There may be discrete plaque or
there may be confluent patches covering large of the scalp, or the whole of the scalp
may be affected. The lesions may advance over the hair margin on the facial skin.
Eventually hair growth may be impaired.
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2. Palms and soles:
Palmoplantar Psoriasis may occur with or without lesions at other
localisations. The lesions are characterized by their sharp demarcation. The scales are
firmly attached and often fissuring occurs. Sometimes the lesions are scattered in
smaller units over the palms and soles. There may be a relationship to trauma or
occupational irritants.
3. Flexural Psoriasis:
The typical distribution of Psoriasis is extensor. Occasionally Flexural
Psoriasis may occur when flexures like the groins, axillae and intra-mammary regions
are involved. The lesions lose their dryness in these areas; hence scaling is reduced.
Some degree of itching is present in this variety.
4. Sacral region:
This is a predilection site for psoriasis. Chronic plaques of psoriasis here may
be fissured and lack the characteristic scaling.
5. Napkin Psoriasis:
Psoriasis localized in the napkin area is not infrequent. This manifestation is
probably triggered by irritation under the napkin. This may give first hint of Psoriasis
in an infant.
6. Mucosal membrane:
The mucosal membranes are occasionally involved in psoriatic patients.
Involvement of the oral cavity is associated with Psoriasis Pustulosa.
7. Penis:
The localization on the penis was seen in 2% of male psoriatics. The lesion is
characterized by a sharp erythematous plaque with a variable degree of scaling. The
glans of penis is the most common site.
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8. Ocular localization:
It is reported in about 10% of cases. The most common presentations are
scaling of the eyelids and blepharitis. However, conjunctivitis, keratitis, disturbances
in lacrimation and crystalline micro-opacities have also been reported.
9. Nails:
The incidence of pathology of the nails in psoriasis varies from 10 to 55%.
The finger nails are more often involved then the toe nails. Pitting is the commonest
nail abnormality with resulting malformation of the plate.
10 Psoriatic Arthritis:
Psoriatic arthritis is a lifelong condition that causes deterioration, pain, and
stiffness in the joints. Some people experience only joint problems and never develop
psoriasis. About 70% of people who get psoriatic arthritis develop psoriasis first.
Psoriatic arthritis most commonly involves the fingers and toes. Joints in the
neck, back, knees, ankles, and other areas also may be affected. Children also can
develop psoriatic arthritis. A pediatric form may appear as early as 2 to 4 years of age
in girls. A peak time for psoriatic arthritis to occur in both boys and girls is 11 to 12
years of age. In rare cases, the arthritis appears before lesions on the skin.
Signs and Tests:
The diagnosis is usually based on the appearance of the skin.
I. A skin biopsy, or scraping and culture of skin patches, may be needed to rule out
other disorders.
II. An x-ray may be used to check for psoriatic arthritis if joint pain is present and
persistent.
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General signs and symptoms:
The appearance of a typical lesion is characteristic for psoriasis. The typical
lesions are coin-shaped: by confluence, big plaques of the size of the palm of a hand
or figurate areas may not be present at the same time or in every case, and are
sometimes obscured.
The colour: A full, rich red (salmon pink) with a particular depth of hue and opacity.
This quality of colour is at special diagnostic value in lesion on the palm, soles and
scalp.
Scaling: The amount of scaling is variable. It may, as in Rupoid forms, be waxy
yellow or orange brown. A similar colour occurs in nails (oil drop sign). In Guttate
lesion, a single waxy scale may be present, inviting confusion with Pityriasis
lichenoides chronica, but most psoriatic lesions are surmounted by the very
characteristic silvery white scaling which may exceed in thickness the erythematous
lesion beneath it.
Auspitz sign: This sign occurs only in psoriasis. Psoriasis can be diagnosed when
there is a classical silvery white scaling and the Auspitz sign. When hyperkeratosis
scale is mechanically removed from a psoriatic plaque by scratching, within few
minutes, small blood droplets appear on erythamatous surface. This phenomenon is
called Auspitz sign.
Koebner’s Phenomenon89
: Koebner (isomorphic) phenomenon is defined as a non-
specific skin stimulus eliciting a disease skin reaction66. Various diseases exhibiting
this interesting phenomenon include psoriasis, lichen planus, erythema multiforme,
vitiligo, warts, molluscum contagiosum, pyoderma gangrinosum, pityriasis rubra
pilaris and so on. This phenomenon is called the artificial production of the psoriatic
lesion. It is better known as the ‟Isomorphic‟ or Koebner phenomenon.
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Candle grease sign: When a psoriatic lesion is scratched with the point of a
dissecting forceps, candle grease like scale can be repeatedly produced even from the
non-scaling lesions. This is called the candle grease sign (Tache de bougie).
QUALITY OF LIFE:
Psoriasis ravages the quality of life (QOL) of afflicted individuals. It is a
disease with profound impact on the psychological and social aspect of the patient,
particularly because of its visibility.
The impact of psoriasis on patients' physical, social and psychological
functioning and HRQOL has been well documented. Many patients report moderate
to extreme feelings of anxiety, anger and depression.
THE PSORIASIS DISABILITY INDEX
This is a questionnaire addressing fifteen aspects including daily activities,
personal relationships, vacation, work as well as the effects of actual treatment. This
has been used in many clinical studies.
The Dermatology Life Quality index was used as a measure of improvement
in studies with alefacept (Amevive). This is a questionnaire relating to the previous
weeks activities and feelings. Work, school, leisure, daily activities as well as the
symptoms and feelings are measured as well as personal relationships and the impact
of treatment.
PASI – The Psoriasis Area and Severity Index90
National Psoriasis Foundation physician forum in the summer of 2002
suggested a scale by which patients could indicate improvement or worsening of their
condition and specific treatments. At the baseline visit a patient was asked to rate their
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psoriasis on a scale of 1 to 10 with 10 being the worst episode of psoriasis ever and 1
as being completely clear. This is a practical way of dynamically assessing the
patients‟ perception and can be used in combination with the physician assessment of
PASI. This is the Psoriasis Area and Severity index.
This measures surface area which is broken into the head, upper extremities,
and trunk and lower extremities. The lesions are given a score for redness, thickness
and scaling. A formula is then applied to give a score which can be used for following
improvement or worsening during a clinical trial.
Severity of Psoriasis-
• Mild psoriasis is defined as less than 2% of the body‟s surface area being affected
by the disease.
• Moderate psoriasis is defined when 2% to 10% of the body‟s surface area is affected
by the disease.
• Severe psoriasis is defined when more than 10% of the body‟s surface area is
affected.
• If the palms of hands or soles of feet are affected, which is approximately 4% of
total body surface, even though the area may be less than 10% of body surface,
psoriasis will be classified as severe since psoriasis in these areas can affect your
ability to do everyday activities.
• Prevalence of mild, moderate and severe conditions in psoriasis patients.
TRIGGERING FACTORS
Classifications of factors that may trigger psoriasis are divided into two groups
i.e. local factor and systemic factor.
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Local Triggering Factors: Local factors are very important in the pathogenesis of the
lesion. The best-known example of a local triggering factor is the appearance of a
psoriatic lesion following an injury of the skin. It occurs in about one half of all
psoriatics at some time during the disease (Hellgren, 1967).
Systemic Factors:
The relation between some systemic disturbances and psoriasis is well
established. If these precede the aggravation of psoriasis, they may be considered as
systemic triggering factors. The following are well documented.
• Infection:
The significance of infection in the pathogenesis of psoriasis is well established.
Holzmann et al (1974) reviewed the literature on this subject and presented some of
his own data. In following table an overview is presented of different infections in
psoriasis.
TABLE NO.7
INFECTIONS IN PSORIASIS
INFECTION MANIFESTATION
Fever Psoriasis vulgaris
Viral Infection Guttate Psoriasis
Tonsillitis Psoriasis Psutulosa
Revaccination & Febrile tonsillitis Generalized Psoriasis Vulgaris
Tonsillitis +Penicillin Guttate or Erythrodermic Psoriasis
Diphtheria Vaccine Relapse over whole body
Catarrhal infection Guttate Psoriasis
Pharyngitis Guttate Psoriasis
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From this review we may conclude first, that the site of infection is mostly the
upper respiratory tract, and secondly, that Guttate Psoriasis is mostly encountered in
association with focal infection. The role of streptococcal infection especially in the
throat, in provoking acute Guttate Psoriasis is long established. Beta-haemolytic
streptococcal throat inflections or tonsillitis can trigger Guttate Psoriasis. (Hunter,
1995; Solomons, 1988)
• Metabolic Factors:
• sunlightLight:
• Drugs:
Drug eruptions may be significant, because elderly patients are likely to be
taking many medications. Several drugs are known to aggravate psoriasis, particularly
beta blockers such as propranolol. Other drugs implicated in flares of psoriasis are
listed in the table.
Beta blockers - Nadolol, Propranolol
Antimalarial - Mepacrine, Chloroquine, Quinine
Clonidine
Corticosteroids (Rebound phenomenon when stopped)
Digoxin
Gold
Indomethacin
Lithium (Probably by effect on cyclic AMP levels)
Potassium Iodide
Climate:
In psoriasis, attacks are more common in winter than summer; the eruption has
a natural tendency to clear up with warm weather. In the tropics, a fair number of
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attacks develop in the monsoon (rainy season). (P.N. Behl 1998). Psoriasis is most
commonly seen in northern hemisphere areas and is linked to winter months when
duration of sunlight is shortened (Solomons, 1988)
Smoking:
An increased risk of chronic plaque psoriasis exists in persons who smoke
cigarettes.
• Alcohol:
Alcohol is considered a risk factor for psoriasis, particularly in young to
middle-aged males.
Dialysis: It was reported that dialysis precipitates Psoriasis.
DIFFERENTIAL DIAGNOSIS
The diagnosis is not difficult in patients with a classical manifestation.
However, the macromorphology of several skin disorders may sometimes look like
psoriasis. A critical and correct description of the skin disorder is of the utmost
importance to reach the correct diagnosis. In cases of doubt histopathology may be
helpful.
COMPLICATIONS OF PSORIASIS
1. Infections
2. Eczematization
3. Pustulization
4. Itching
5. Burning and Tightness
6. Hypocalcaemia.
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7. Amyloidosis
8. Arthritis.
9. Hepatic /Renal failure
10. Tumour formation
TREATMENT91
:
There can be substantial variation between individuals in the effectiveness of
specific psoriasis treatments. Medications with the least potential for adverse
reactions are preferentially employed. If the treatment goal is not achieved then
therapies with greater potential toxicity may be used. Medications with significant
toxicity are reserved for severe unresponsive psoriasis. This is called the psoriasis
treatment ladder. As a first step, medicated ointments or creams are applied to the
skin. This is called topical treatment. If topical treatment fails to achieve the desired
goal then the next step would be to expose the skin to ultraviolet (UV) radiation. This
type of treatment is called phototherapy. The third step involves the use of
medications which are ingested orally or by injection. This approach is called
systemic treatment. Over time, psoriasis can become resistant to a specific therapy.
Treatments may be periodically changed to prevent resistance developing and to
reduce the chance of adverse reactions occurring. This is called treatment rotation.
• Topical treatment: -
(a) Corticosteroids
(b) Tar therapy
(c) Dithranol
(d) Keratolytic agents
(e) Bland
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(f) X-ray and Grenz-ray therapy
(g) Radiation therapy
(h) Photo therapy.
(i) Vita. D3 analogues
(j) Topial cytostatic therapy
(k) Climate therapy
(l) Intra – lesional steroids.
SYSTEMIC THERAPY:
Chronic psoriasis which is resistant to topical treatment can be handled by
administering systemic drugs only.
1) Systemic corticosteroids
2) Retinoids.
3) PUVA
4) Anti Metabolites: like
a) Methotrexate
b) Hydroxy urea
c) Razoxane
d) Cyclosporin
e) Colchicine
5) Hypnosis and Behavior therapy: It can produce remission in some patients.
Photo chemotherapy
Phototherapy uses natural and artificial light to treat psoriasis.
Sunlight - brief, daily exposure to small amounts of sunlight can improve symptoms,
but too much sun can cause a worsening of your condition and cause skin damage.
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Psoralean plus ultraviolet A (PUVA) - for this treatment, you will first be given a
tablet called psoralean. This makes your skin more sensitive to light.
• Alternative therapy
Climatotherapy involves the notion that some diseases can be successfully
treated by living in particular climate. Several psoriasis clinics are located throughout
the world based on this idea. The Dead Sea is one of the most popular locations for
this type of treatment.
In Turkey & in Croatia (Altermedica), doctor fish which live in the outdoor
pools of spas, are encouraged to feed on the psoriatic skin of people with psoriasis.
A number of patients have reported significant improvements from sun and
sea water herbology as a holistic approach that aims
to treat the underlying causes of psoriasis. Some alternative therapies consider Oil of
Oregano to be a powerful herbal method of treatment.
It is claimed that Epsom salt may have a positive effect in reducing the effects
of psoriasis. There are claims that Neem oil has been in documented use in India for
6000 years.
Sulphur has been used for many years as a safe treatment in the alleviation of
Psoriasis.
Dietary Supplements Omega-3 fatty acids, such as those found in flaxseed oil
and fish oil supplements, are said to decrease inflammation and itching. However,
studies evaluating the utility of omega-3s in the treatment of psoriasis have proved
inconclusive.
Capsaicin Extracted from cayenne peppers, capsaicin acts to block pain and
itch sensations from reaching the brain. It is often used by sufferers of psoriasis and
psoriatic arthritis. It is sold over the counter in lotions, creams and patches.
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DRUG REVIEW
DINAMALLIKA
Cestrum diurnum L92
Cestrum diurnum (Din Ka Raja) is a species of Cestrum, native to the West
Indies. Common names include Day-blooming Cestrum, Day-blooming Jessamine,
and Day-blooming Jasmine. Also known as Din ka Raja (King of the day), in Urdu
and Hindi. The scent of this quick-growing and evergreen woody shrub, often used
for screens and borders, is released by day. Cestrum diurnum is easily propagated
from the seed, which it produces in abundance.
Description
It is an erect evergreen woody shrub numerous leafy branches. The branches,
which are green and with well-marked white lenticels when young, fawn with age.
The younger parts are covered with a very sparse glandular scurf.
The leaves are simple, glabrous, entire, alternate, ex-stipulate, ovate-lanceolate
in shape with obtuse apex and obtusely wedge-shaped below. They are dark green
above and pale below and are generally 5 inches long by 1.5 inches wide. The leaves
are petiolate with petioles of 0.5-inch length.
The Inflorescence consists of a long axillary peduncle which bears short
clusters of sweet white-smelling flowers, each cluster supported by a leaf-like bract.
The individual flowers are sessile and may be with or without bracteoles. Calyx is
gamo-sepalous, about 0.15 inches long, somewhat puberulent, obtusely 5-ribbed and
5-lobed with obtuse, ciliate lobes.
Corolla tube is narrowly infundibuliform, white, sweet-scented, about half-
inch lobed with five lobes. The lobes are very obtuse and completely recurved when
the flower is fully open. Stamens oblong, five in number, alternate with the corolla
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lobes, brown in colour, included. Filaments adnate to the tube, free for a very short
distance.
Ovary seated on a nectar-secreting disk. The style is filiform and glabrous.
The stigmas are truncate-capitate. Cestrum diurnum has a black, nearly globular
berry.
Distribution
A native of the West Indies, it is widely cultivated in gardens throughout India
Medicinal Uses93
Leaves of Cestrum diurnum are reported as a sources of vitamin D3.
Aerial parts are also reported to have cytotoxic and thrombolytic activities.
Day jasmine also known as day cestrum, wild jasmine, ink-bush, Chinese
inkberry in English, ama de día, rufiana, galán de día, and saúcotintóreo (Spanish). In
Hindi, it is known as “cameli” in Bihar, “din-ka-raja” in Uttarpradesh and botanically
Cestrum diurnum L. (syn. Cestrum fastigiatum Jacq., Cestrum diurnum L. var.
fastigiatum (Jacq.) Stehlé in Fournet, Cestrum diurnumportoricense O.E. Schulz in
Urban).
The plant is considered as an invasive species occurring as a Weed of
roadside and wasteland in Nepal. Day jasmine is native to the Bahamas, Cuba,
Jamaica, Hispaniola, and the Cayman Islands. It has been introduced as an ornamental
into most of tropical and subtropical America, India. It has long been planted as an
ornamental for its pleasing appearance, moderate size, ease of establishment, and
fragrant flowers.
Habit: The erect plant grows up to the height of 1-3 m, and it is a much-
branched shrubs having lenticellate branches; leaves alternate, elliptic-oblong or
ellipticlenceolate; inflorescence in 1.5 - 6 cm long, axillary panicles; flower ivory
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white, sweet scented; Berries deep-purple or nearly black. Ethno-Botanical
Importance of the Plant: The fruits of day jasmine are one of the three foods that make
up the bulk of the diet of the endangered plain pigeon (Columba inornata) in Puerto
Rico. Avdabhai R. Modhvadia has reported that, it is Cultivated as a ornamental plant
in gardens in India and its Seeds have anti-fungal and inflammatory activity.
Chemical Constituents, efficacy, safety of Cestrum dirunum L. The leaves contain
nicotine, nor nicotine, ursolic acid, tigonin and 1,25 dihydroxy vitamin D3-glucoside
now known as calcitriol. Cestrum diurnam L leaves are considered best, reliable,
natural source for calictrol. Further, the process patent for extracting the same from
Cestrum dirunum L. leaves has been granted to Mitra Puccalapalli by World
Intellectual Property Organization. The oil was found to be an effective fungi
toxicant against both plant and human pathogens.
Toxicity: The leaves, seeds of the plant on ingestion can cause acute and
long-term poisoning. The plant is suspected of poisoning humans and domestic pets
causing hallucinations and muscular and nervous irritability. The Acute poisoning is
due to the constitutens Solanine and tropane alkaloids. Whereas the chronic toxicity in
the form of hypercalcinosis is due to a calcinogenic glycoside called 1, 25-
dihydroxycholecalciferol.
A. Acute poisoning: Unripe berries of Cestrum diurnum L. contain Solanine,
whereas tropane alkaloids are prevalent in the ripe berry. Apart from these, Saponins,
alkaloids, traces of nicotine, and 1,25-dihydroxyvitamin D3glucoside are found in this
plant.
Symptoms and signs: In general, the symptoms of poisoning mimic atropine
poisoning (mydriasis, tachycardia, xerostoma, dyspnea, ileus, urinary retention, CNS
stimulation followed by depression, paralysis, seizures). If solanine predominates,
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mild to severe gastrointestinal signs may predominate. Normal to increased
borborygmi may indicate predominance of solanine, whereas lack of bowel sounds
may hint at an atropine-like toxin.
Treatment: Rarely, fluid therapy to replace losses. In cases where atropine-
like signs are life threatening, physostigmine may be carefully administered
(CAUTION: physostigmine may cause asystole). Begin with 0.02 mg/kg administered
TV over 5 minutes. If delerium or coma is abolished, use repeated doses as needed. If
no effect is noted or gastrointestinal signs predominate, consider cautious
administration of atropine and observe for signs of improvement.
Tachydysarhythmias that do not respond to physostigmine may respond to
administration of propranolol. if Cestrum diurnum is the plant involved, monitor for
evidence of hypercalcemia and to be treated accordingly94
.
B. Chronic poisoning: The plant is poisonous to livestock. The leaves contain
a calcinogenic glycoside called 1, 25- dihydroxycholecalciferol that leads to a vitamin
D toxicity that results in elevated serum calcium and deposition of calcium in soft
tissues. Fifteen to 30 percent of day jasmine leaves in an animal‟s diet are sufficient to
cause symptoms. The symptoms, signs of Hypercalcemia: Progressive weight loss and
lameness of increasing severity.
Anatomical changes include dystrophic calcinosis of elastic tissues, viz. major
arteries, tendons and ligaments in Horses grazing on Cestrum diurnum L. leaves.
Chronic wasting and progressive lameness were observed in Cattle too along with
other anatomical, biochemical changes observed in Horses.
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DRAVYA GUNA95
Rasa – Tikta
Guna – Sheeta, slakshna
Veerya – Sheeta
Vipāka – Katu
Prabhava – Kustahara on external application
Karma – Vataprakopa, Asthikshaya, Sushirya, Asthibhagna on Internal
Consumption
Cestrum diurnum L.- Calcitriol and Utility in the treatment of Psoriasis and
other skin ailments:
The leaves of Cestrum diurnum are known to contain Calcitriol a naturally
occurring active form of vitamin D3 and has been used for topical psoriasis therapy in
Europe and other parts of the world. Further, Calcitriol 3 microg/g ointment has been
extensively evaluated for the treatment of chronic plaque-type psoriasis and has been
shown to be effective, safe and well- tolerated in a number of short-term and long-
term clinical trials. Pharmacokinetic studies in patients with psoriasis and healthy
control subjects have demonstrated that topical calcitriol ointment produces little
systemic absorption of calcitriol and does not alter systemic calcium homeostasis
significantly even when applied to approximately one third of the body surface area.
Calcitriol ointment is associated with a low rate of cutaneous irritation and does not
increase the sensitivity of treated skin to phototoxicity following treatment with
ultraviolet treatment.
Further, the efficacy of utilizing naturally occurring calcitriol from Cestrum
diurnum L in the treatment of psoriasis has been ascertained clinically in India by G.
Raghurama Rao.
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Ayurvedic Adoption of Cestrum diurnum L. It is interesting to note that in
recent times Ayurvedic practitioners have started to show interest to employ the
leaves of this plant in the treatment of different skin ailments, of which it is found to
be effective in the treatment of Psoriasis on external application. Though the specific
mechanism is unknown on the external application of extract of the leaves reduce
itching, roughness and scaling in psoriatic patches. Keeping in view of the day
blooming nature and the popular English name “Day Jasmine” the plant can be named
as “Dinamallika”96
.
Analysis and attribution of Rasapancaka (Rasa - Taste, Guna - Quality, Virya -
Potency, Vipaka - Post assimilatory taste, Prabhava - Exclusive therapeutic property)
& Vishaktata (toxicity)
A. Determination of Rasa, Guna, Virya, Vipaka: Based on the observations
made after ingesting the plant leaves (for a short period of two days in succession)
and also based on the acute toxicity profile of this plant it is inferred that, the Cestrum
diurnum L plant leaves, stem bark have Tiktarasa (bitter taste), Shitaguna (cold),
Shlakshnaguna (smoothness), Shitavirya (cold potency), Katuvipaka (pungent
postassimilatory taste/change).
During the study all the attributes pertaining to Tikta-bitter taste viz., Chedana
(cutting apart the vitiated Doshas such as Kapha), Rocana (appetizing), Dipana
(stimulates), Shodhana (cleanses), therapeutic properties viz., alleys Kandu (itching),
Kotha (tissue rotting), Trishna (thirst), Murcha (swooning) and Jvara (fever),
Stanyashodhana (cleanses breast milk), promoting the movement of Vit (faces), Mutra
(urine), Kleda (wetness), Medas (fat), Vasa (facia) and Puya (pus) etc., as described in
the classical texts of Ayurveda have been thoroughly observed and inferences were
drawn97
.
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B. Determination of Karma, Pabhava: Based on the published literature
pertaining to the efficacy of the plant as fungicide and effective agent in the
management of psoriasis it can be inferred that the plant leaves have
Kusthaharaprabhava (exclusive ability to treat skin ailments such as Kitibha) on
external application98
.
C. Vishaktata (Toxicity): As per the acute toxicity profile of the plant it can
be inferred that, the ingestion of plant leaves/ berries causes mydriasis, Hrudrava
(tachycardia), Asyashosha (xerostoma), Shvasa (dyspnea), Adhmana/Vibandha
(ileus), Mutraghata (urinary retention), Arati (CNS stimulation) followed by Avasada
(depression), Pakshaghata (paralysis) and Apatanaka (seizures) which happens due
the atropinelike toxin in the plant berries. On the contrary, if solanine predominates,
mild to severe gastrointestinal signs such as Atopa (increased borborygmi) may result
Further, as per the earlier studies it is known to be toxic to animals on chronic
ingestion, it is observed that, on long term ingestion the Cestrum diurnum L. leaves
cause poisonous symptoms due to “Asthikshaya” and lead to Panguta (lameness),
Kshaya (weight loss, debility) in animals. Keeping view of the same it can be deduced
that, on oral ingestion Cestrum diurnum L. leaves for a long period cause severe
Vataprakopa and lead to Asthikṣaya (bone resorption) leading to the development of
“Pangu (lameness)”, Balakṣaya (weight loss, debility). The symptoms/signs enlisted
here are in conformity with the excess consumption of Tikta-bitter taste (the taste of
the plant leaves) as narrated in Ayurveda viz., Gatra, Manyastambha (stiffness or a
rigidity of the body and the neck), Akshepa (convulsion and a palpitation), Ardita
(facial paralysis), Shirahshula (headache), Bhrama (dizziness), Toda (pain as if a
needle is pricking) or Bheda/Cheda (the region is being split) and Asyavairasya
(insipidity in the mouth)99
.
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Cestrum diurnum L christened as dinamallika, has already found a place into
Ayurvedic clinical practice with its usage being employing leaf extracts in the
management of KitibhaKustha (psoriasis) and related conditions (psoriasis).
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STREE KUTAJA100
Latin name : Wrightia tinctoria
Sanskrit/Indian name : Streekutaja, Hyamaraka
General information:
Streekutaja is a small, deciduous tree, which is found in the Indian states of
Andhra Pradesh, Telangana, Rajasthan, Tamil Nadu and Madhya Pradesh.
A poultice made from the leaves, which has astringent, anti-inflammatory and
antibacterial properties, is effective in treating various skin disorders. It is also a
potent antidandruff agent, which is beneficial in treating scalp disorders.
Therapeutic constituents:
The leaves of Stree kutaja contain beta-amyrin and glucoside, which give the
plant its skin-healing properties.
Key therapeutic benefits:
Streekutaja is used to treat psoriasis, nonspecific dermatitis and herpes.
Its astringent and antibacterial properties are beneficial in treating scalp disorders
like dandruff.
Use of wrightia tinctoria for psoriasis is promoted by the Siddha system of
medicine- a traditional medical system originated in ancient South India.
The wrightia tinctoria leaf extracts in virgin coconut oil applied on affected body
parts twice a day to reduce scaling, lesions thickness, inflammation and skin redness.
Wrightia tinctoria is a flowering plant with potent medicinal properties. Various
parts of this plant- leaves, bark, seeds and root- are used for various health benefits. It
is named after a Scottish biologist and physician, William Wright.
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It is a small plant that grows up to 8 to 10 meters in height. The flowers are white
in color.
It is deciduous in nature- the leaves fall after maturity.
Being native to India and Myanmar, other countries where it is mainly found
are Nepal, Vietnam, Australia and Southeast Asian countries.
Other names of wrightia tinctoria- Streekutaja, Pala Indigo plant, Shwetha
Kutaja, Dudhi, Kala Kuta.
The Ayurveda (Sanskrit) name of wrightia tinctoria is Streekutaja.
Leaves and seeds of this plant yield a natural dye- pale indigo in color. That‟s
why it is also called as dyer‟s oleander.
The juice of wrightia tinctoria leaves is used as a folk remedy to treat jaundice.
That‟s why it is also known as jaundice curative tree.
Medicinal benefits of Wrightia Tinctoria101
According to the various Siddha and Ayurveda text manuals, wrightia tinctoria
extracts can be used to treat skin problems, liver disorders and broad spectrum viral
infections.
Some of the uses of Wrightia tinctoria as a folk remedy are:
The crushed leaves are used as a poultice to treat burns, boils, wounds, rashes,
mouth ulcers.
The juice of crushed leaves to treat jaundice.
The fresh leaves are crushed and filled in the tooth cavity to provide relief from
toothache.
The leaf extracts in coconut oil to treat inflammatory skin problems such as
psoriasis and non-specific dermatitis.
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The leaf and bark extracts are administered orally to kill intestinal worms.
The bark is used to treat diarrhea, gas, bloating, abdominal pain, piles and kidney
stone.
The seeds are used to boost the libido (sex drive) and improves skin firmness and
tightness.
Anti-inflammatory properties
Another animal study published in the International Journal of Pharmtech
Research, Oct-Dec 2010 evaluated the chloroform extract of wrightia tinctoria with
diclofenac sodium (a conventional anti-inflammatory drug formulation) and found at
par results.
Another animal study reported in the Journal of Biologically Active Products
from Nature, Vol 1, 2011 suggested that leaf extracts of wrightia tinctoria possess
anti-inflammatory and analgesic properties.
Antifungal properties– A research study reported in the Journal of
Ethnopharmacology, Oct 2010 concluded that leaf extracts of wrightia tinctoria
possess antifungal properties and it can be used to treat ringworm.
Antiviral activity– A research study published in the International Journal of
Chemical Sciences, Vol 7, 2009 confirmed the antiviral properties of methanol
extracts of wrightia tinctoria leaves against Hepatitis-C virus.
Wound healing properties– As published in the Journal of Natural Remedies,
Vol 4, 2004- the ethanol extract of wrightia tinctoria bark has potent wound
healing properties.
Antibacterial properties– A research study conducted at the Entomology
Research Institute, Chennai, India suggested that leaf extracts of wrightia
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tinctoria may possess antibacterial properties. Though, more studies are required
to draw any concrete conclusion.
Chemical composition
Wrightia tinctoria plant extracts contain a variety of phytochemicals (naturally
occurring biologically active chemicals) which are responsible for almost all the
health benefits.
Flavonoids- anti-inflammatory, anti-oxidant, anti-viral in nature. Aids in
digestion and weight loss.
Beta-Sitosterol- It is used as a salicylic acid replacement due to its anti-
inflammatory and anti-bacterial properties. It is used in creams and ointments to
soothe and treat muscle ache, swelling, wounds and burns. There are animal
studies to claim its possible use against atopic dermatitis.
Saponin- regulates the immune system, anti-oxidant in nature.
Wrightia Tinctoria for Psoriasis
Psoriasis is an auto-immune disorder where the faulty immune system results
in rapid growth of skin cells to cause thick psoriasis patches on various parts of the
body. The situation is worsened by skin inflammation and itching.
Various possible reasons for a faulty immune system are:
Genetic problems
Accumulation of body toxins due to chronic indigestion and constipation
Inefficient digestive system (including liver)
Food intolerance
Chronic stress
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Long term use of steroids and antibiotics
Any skin injury of infection
Over consumption of tobacco (smoking) and alcohol
Unhealthy and sedentary lifestyle
Psoriasis is not just a skin problem- it is mainly a problem related to the sluggish
body metabolism (precisely the inefficient digestive system). Hence, just taking care
of the external skin patches is not enough.
The long-term relief from this stubborn skin disorder can be attained by adopting
an inside-out holistic healing approach focusing the inner body matters.
We have already in detail about the five pillars of holistic healing of psoriasis. Let us
revise them again:
Restricted diet
Positive, healthy lifestyle
Stress management
Use of dietary supplements and herbs
Use of natural/ herbal topical oils, shampoos and creams
So, how can wrightia tinctoria help here?
Yes, it can help as a natural topical oil- the leaf extract in virgin coconut oil
shows promising results in various case studies. Traditional Siddha and Ayurveda
doctors also approve it.
Wrightia Tinctoria for Psoriasis- Research studies
An animal (rat) study published in the Indian Journal of Dermatology, Vol 2,
1998 suggested that wrightia tinctoria extracts possess superior antipsoriatic
activity than betamethasone and retinyl acetate. Retinyl acetate is a vitamin A
based topical formulation.
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Another case study conducted by the Siddha doctors at the Praveena Hospitals,
Chennai, India evaluated the effect of wrightia tinctoria leaf extracts in coconut
oil against dithranol to treat plaque psoriasis. Dithranol is a pharma based topical
solution used to treat plaque psoriasis. A total of 30 patients in the age group 22-
64 were divided into two separate groups. The first group applied wrightia
tinctoria extracts on the psoriasis lesions twice a day and the second group
followed the same procedure with dithranol. After 8 weeks of daily application,
the reduction in scaling and skin redness was observed in both the groups. But,
wrightia tinctoria performed better to reduce skin inflammation (measured in
terms of dermal vessel tortuosity) than dithranol.
Mode of action
The exact mode of action of wrightia tinctoria for psoriasis is yet to be
established. Various possible reasons for the effectiveness of wrightia tinctoria for
psoriasis are:
The phytochemicals in Wrightia tinctoria extracts contain stimulates the
production of collagen in human skin to relieve psoriasis symptoms.
Collagen is the most abundant protein in human body which is continuously
produced by body cells. It plays a vital role in providing strength, structure and
durability to the skin. It maintains the skin elasticity and tightness- helps in restoration
and replacement of dead skin cells also.
The phytochemicals (flavonoids, saponins and beta-sitosterol) illustrate potent
anti-inflammatory properties. Along with that, flavonoids slow down the
production of helper T-cells (Th 17 cells) which in turn slows down the release of
inflammation inducing chemicals (cytokines) to relieve skin inflammation
Review of literature
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 68
Side effects
Wrightia tinctoria is a folk medicinal plant. It has been used for a long time by
traditional health experts without any documented side effects. Hence, external
application is completely safe for daily application. Sometimes, due to prolonged use
of steroidal creams and ointments, you may experience a mild skin irritation during
the initial days of application. But, these symptoms would fade away soon.
Review of literature
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 69
COCONUT
Scientific Name: Cocos nucifera
Common Names: Cocos nucifera
The Coconut tree ;(Cocos nucifera), is a member of the family Arecaceae (palm
family).
The Coconut tree is of the genus Cocos. The Coconut tree or Coconut palm
can be found in rainforests and countries with tropical climate such as in Africa, Asia,
Latin America and the Pacific. In the United States, Coconut tree can be found in
Hawaii, the Southern tip of Florida, and the Virgin Islands.
Traditional Health Benefits of Coconut: Coconut has long been used in traditional
medicine for almost any kind of illness and almost all parts have their uses. Among
these health benefits are as follows.
Antifungal and antimicrobial treatment for skin and mouth problems such as
ring worms, candidiasis, psoriasis, sores, skin burns, sunburns, toothache, sore throat
and ulcers.
From an Ayurvedic perspective, coconut has the following qualities...
Rasa : Sweet
Virya : Cooling
Vipaka : Sweet
Guna : Guru
Coconut oil is massaged over the skin as anti-ageing regimen to keep skin soft
and youthful looking. Used as oil massage to remove heel cracks and darkening of
armpits.
Coconut oil is used to treat scalp and hair problems. From greying hair,
dandruff to baldness.
Review of literature
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 70
Coconut oil is an antidote for pesticide poisoning
Coconut water is used to treat colitis, kidney stones, and stomach acidity.
Coconut water is also used as diuretic to improve removal of excess water.
Coconut water is used for the treatment of urinary tract, gall bladder and
kidney problems.
Used for the treatment of catarrhal inflammation associated with common
colds and coughs.
Consume the flesh of Coconut with Coconut Milk and Honey. It increases
libido in both men and women.
Coconut water is used to treat measles.
Coconut has many claims of health benefits in traditional medicine. Only
recently that laboratory studies and researches has been made to verify its
effectiveness and science has upheld some its claims as cure for many health
problems.
Coconut oil is good for the immune system.
Coconut water is now considered as a potent nutritional source that can boost
energy and endurance, enhancing physical and athletic performance.
Coconut has been found to improve digestion and hasten the absorption of
nutrients including vitamins, minerals, and amino acids. Coconut is also
effective in expelling parasites such as tapeworms and lice.
The coconut oil contains antimicrobial lipids, capric acid, caprylic acid and
lauric acid that are known to possess antifungal, antibacterial and antiviral properties.
Coconut helps strengthen the immune system by converting lauric acid into
monolaurin which limits the activities of viruses that cause diseases such as influenza,
herpes, measles, hepatitis C, SARS, and even AIDS.
Review of literature
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 71
Coconut also fights bacteria such as listeria monocytogenes and heliobacter
pylori that are causes of diseases such as throat infections, gum disease, ulcers,
urinary tract infections, pneumonia, and gonorrhea.
Coconut is also used in the treatment of fungi and yeast infections such as
ringworm, athlete's foot, thrush, diaper rash and candidiasis.
Coconut oil is widely used to promote healthy growth of hair.
Coconut is traditionally used to treat baldness, dandruff and head lice,
Coconut oil is used as hair conditioner to nourish damaged hair.
Coconut oil is also used as topical applicant for wounds and burns to lubricate
skin and to protect from infections.
Reduces symptoms associated to psoriasis, eczema, and dermatitis. It also
helps to soften the skin and relieve dryness and flaking.
Prevents wrinkles, sagging skin, and age spots.
Coconut is also used as a protection against the damaging effects of ultraviolet
radiation from the sun.
The antioxidants in coconut helps protect the body from free radicals that are
the primary cause of premature aging, degenerative disease and even cancer.
Coconut oil is traditionally used to protect the body against colon, breast and
other cancers.
The antioxidative property of coconut oil also protects other essential fatty
acids in the body from oxidation.
Coconut oil helps relieve symptoms and reduce health risks associated with
diabetes by improving insulin secretion and utilization of blood glucose. Helps relieve
symptoms associated with chronic fatigue syndrome.
Review of literature
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 72
Relieves symptoms associated with benign prostatic hyperplasia (prostate
enlargement).
Reduces epileptic seizures.
Coconut water is good for urinary, kidney and bladder problems.
Helps prevent liver disease.
Coconut improves the absorption of calcium and magnesium that supports
bone development that is beneficial for osteoporosis prevention.
Relieves pain and irritation caused by hemorrhoids.
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 73
MATERIAL AND METHODS
Every scientific investigation in the field of medical science on drug
evaluation must pass the stage of clinical study, before being declared therapeutically
valuable. Neither the in-vitro nor the in-vivo experimental studies can establish their
effectiveness unless and until they can cure the diseased man for which they have
been tested. Because, the goal of the medicine is to give relief to the suffering human
being. This is only possible by scientific clinical study.
Source of data:
Literary source:
All Ayurveda, Modern literatures and contemporary texts including the
journals, websites etc. were reviewed pertaining to the drug and diseases in the
intended study.
The present study “A CLINICAL EVALUATION OF DINAMALLIKA–
CESTRUM DIURNUM OIL IN KITIBHA KUSTHA WITH SPECIAL
REFERENCE TO PSORIASIS”, is conducted on 40 patients from OPD and IPD of
Muniyal Institute of Ayurveda Medical Sciences and Hospital, Manipal and from
referral sources and special camps.
The data collected and compiled from this clinical trial were sorted out and
processed further by subjection to varied statistical methods and presented with
tabular form in the following sequence. General observations viz. age, gender,
religion, etc. Results of therapy evaluated based on improvement in signs and
symptoms.
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 74
Objectives of Study were:
1. To study Etiopathogenesis of psoriasis / Kitibha Kustha.
2. To evaluate the efficacy of DINAMALLIKA patra taila in the management of
clinical Psoriasis.
3. To evaluate the efficacy of STREEKUTAJA taila in the management of
Psoriasis.
4. To statistically analyze the efficacy of Dinamallika patra taila by comparing
the efficacy of Streekutaja taila in the management of Psoriasis.
Hypothesis:
H0 – Dinamallika patra taila is not effective in the management of Kitibha
Kustha.
H1– Dinamallika patra taila is effective in the management of Kitibha Kustha.
H2 – Dinamallika patra taila is significantly effective in the management of
Kitibha Kustha than Streekutaja taila.
H3 – Dinamallika patra taila is less effective than Streekutaja taila in the
management of Kitibha Kustha.
Composition of the trial drug:
Preparation of medicine
1. Dinamallika taila:
Ingredients:
Cestrum diurnum leaves 1kg
Coconut oil Q.s
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 75
Method of preparation:
Dinamallika patra are taken from healthy plants, cleaned and added into
coconut oil till fully immersed and left in hot sun from sunrise to sunset for
7days. Then squeezed, filtered, standardized, bottled and labeled.
2. Streekutaja taila:
Ingredients:
Wrightia tinctoria leaves 1kg
Coconut oil Q.s
Method of preparation:
Streekutaja patra are taken from healthy plants, cleaned and added into
coconut oil till fully immersed and left in hot sun from sunrise to sunset for
7days. Then squeezed, filtered, standardized, bottled and labeled.
Pharmaceutical source:
The formulations selected for research work is oil from leaves of Cestrum
Diurnum from reliable sources, standardised in R&D and prepared in the M.I.A.M.S
pharmacy as per the Standard Operative procedures.
Clinical Source:
Patients who fulfil the inclusion criteria were randomly selected from OPD
and IPD of Muniyal Institute of Ayurveda Medical Sciences and Hospital, Manipal
and from referral sources and special camps conducted for the purpose.
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 76
Methods of collection of data:
(Including sampling procedures if any)
Sample size:
A minimum of 40 patients fulfilling the diagnostic and inclusion criteria
irrespective of their gender, caste, religion, education status and socio-economic
status were taken for the study. Registered patients were allotted randomly by lottery
method into two equal groups of minimum 20 patients each as A and B.
Study design
Single blind randomized comparative clinical study.
A total of 40 patients with Kitbha Kustha - Psoriasis were selected for the
present study and were divided in two equal groups i.e. Group A and Group B.
Group A : The subjects were treated with Dinamallika taila
Group B : The subjects were treated with Streekutaja taila
Group A:
Patients of the Group A were treated with Dinamallika patra taila external
application twice daily for a period of 60 days. Observations were made and recorded
before treatment. The changes with the treatment shall be observed and recorded on
15th
, 30th
and 45th
day in the proforma of Case Sheet prepared for the study.
Group B:
Patients of the Group B were treated with Streekutaja taila external application
twice daily for a period of 60 days. Observations were made and recorded before
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 77
treatment. The changes with the treatment shall be observed and recorded on 15th
, 30th
and 45th
day in the proforma of Case Sheet prepared for the study.
A period of 30 days after the course of treatment was fixed for observation
regarding the recurrences in cases where total relief was observed.
The observations regarding recurrences if any, were recorded in the proforma of Case
Sheet.
Treatment period and Observation period:
Patients were assessed clinically before treatment and on 15th
, 30th
and 45th
day
during treatment and 61st day (next day after stopping the treatment) and 90
th day. The
response of patient’s disease condition to the drug was observed and recorded before,
during and after the treatment in the specially designed case proforma which includes
detailed history, physical examination, laboratory investigations and assessment based
on objective and subjective parameters for which appropriate scoring pattern is
adopted.
Diagnostic criteria:
The main criterion of diagnosis of patients is based on cardinal and associated
signs and symptoms of the disease based on the Ayurveda and modern texts.
Ruksha Dryness of the skin
Kinakharasparsa Hard and torturous skin
Kandu Itching
Parushya Roughness
Asita hyperpigmentation
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 78
Inclusion criteria:
Male and female patients aged 15 years or above.
Psoriasis involving arms / trunk / legs / scalp.
Patients were enrolled after informed consent.
Subjects who could be available for all study related visits.
Exclusion criteria:
Patients with generalized pustular or erythrodermic exfoliative psoriasis,
atopic dermatitis, seborrheic dermatitis or other inflammatory skin diseases.
Systemic anti psoriatic treatment or phototherapy within the last 6 weeks
Patients who used any topical antipsoriatic treatment on the body within the
previous 2 weeks, except emollients.
Usage of corticosteroids for any reason within the last 6 weeks of the start of
the Study.
Patients with planned changes in the concomitant medications (e.g. beta
blockers, lithium etc.) that affect their psoriasis during the study period.
Subjects with uncontrolled metabolic diseases such as diabetes/hypertension,
hyper or hypothyroidism.
Method:
• At baseline, informed consent is obtained after checking the inclusion and
exclusion criteria and relevant medical history
• All prior medications are stopped 2 weeks before the start of the study
• Total lesion severity scores (TLSS) and global assessment scoring system are
administered throughout the study
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 79
• Patients are enquired about adverse events and compliance with the study
medication on all follow ups
• The patients are asked to apply the oil twice daily
• No concomitant drugs are allowed during the study
• Statistical methods were employed to study the significance level from
baseline to follow up
Intervention:
40 patients of psoriasis were selected randomly and divided into two groups,
as Group-A and Group-B.
Group-A were given Dinamallika taila for external application twice daily.
Group-B were given Streekutaja taila for external application twice daily.
Clinical assessment was done on the 15th
, 30th
and 45th
day of treatment.
Follow Up-on 61st day and 90
th day of treatment.
Assessment criteria:
The following subjective and objective parameters were assessed using
different grading and scoring methods before and after treatment.
The following subjective and objective parameters will be assessed using
different grading and scoring methods before and after treatment.
Subjective parameters
1. Itching
2. Redness and burning
3. Size of lesion
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 80
4. Desquamation
5. Dryness
6. Epidermal Thickening
Objective parameters
1. Auspitz Sign
2. Candle Grease Sign
3. P.A.S.I Scoring
4. K A S I Scoring
Treatment schedule:
Group-A were given Dinamallika taila for external application twice daily for
60 days.
Group-B were given Streekutaja taila for external application twice daily for
60 days.
Statistical methods :-
The findings of before and after treatment were reloaded and evaluated by
using T test. Paired T test and unpaired T test.
Diet and Regimen:
The patients are strictly advised to follow the Pathyapathya of kustha Roga.
Drop-out Criteria:
During treatment if any serious condition or serious adverse effects occur, or
subject himself/herself wanted to withdraw from the study, such subjects were
withdrawn from the study.
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 81
The Ethical clearance has been obtained from the institutional ethical
committee formulated in the college. However, consent was also taken from the
patients before the treatment.
SCORING PATTERN:
The improvement provided by the therapy was assessed based on relief in
signs and symptoms of the disease and Dushti Lakshana of Dosha, Dushya etc.
Routine hematological, urine, stool and biochemical investigations were repeated. All
the signs and symptoms were assigned score depending upon their severity to assess
the effect of the drugs objectively, the details of which are as follows:
1.ITCHING / KANDU
No itching- 0
Mild itching-only aware of itching as times, when relaxing- 1
Intermediate itching-( 1 to 3)- 2
Moderate itching-sometimes disturbed the sleep and day time activity 3
Intermediate-between 3 to 5- 4
Severe-constant itching, frequent sleep disturbed- 5
2.ERYTHEMA
Normal colour 0
Near to normal, this looks like normal colour- 1
Light reddish colour- 2
Moderate red colour- 3
Bright red colour- 4
Dusky to deep red colour- 5
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 82
3.DESQUAMATION
No scaling- 0
Minimal -(occasional fine scale over < 5% of lesion)- 1
Mild-(fine scale predominant)- 2
Moderate – (coarse scale predominant)- 3
Marked -(thick non tenacious scale predominant)- 4
Severe-(very thick tenacious scale predominant- 5
4.DRYNESS
No line on scrubbing with nail- 0
Faint line on scrubbing with nail - 1
Lines and even words can be written on scrubbing with nail- 2
Excessive rukshata leading to kandu- 3
Rukshata leading to crack formation- 4
5. EPIDERMAL THICKENING
No thickening 0
Mild thickening 1
Moderate thickening 2
Very thick 3
Very thick with induration 4
6.BURNING SENSATION
No burning sensation 0
Mild burning sensation 1
Moderate burning sensation 2
Severe burning sensation 3
Severe burning sensation affecting sleep 4
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 83
7. Srava: (Discharge)
No Srava 0
Mild Srava 1
Moderate Srava 2
8. Unnati:
No elevation 0
Slight elevation that cannot be felt 1
Elevation can be felt but depressed in middle 2
Elevation in all lesions but soft 3
Elevation in all lesions and hard 4
9.Joint involvement:
No arthritis 0
Slight pain 1
Pain present but do not hinder activity 2
Pain with deformity 3
Pain with deformity affecting activity & sleep 4
10.Jvara:
No fever 0
Occasional fever subsides by itself 1
Occasional fever subsides by drug 2
Remittent fever 3
Continuous fever 4
11.Pitting:
No Pitting 0
Pitting in 1 finger only 1
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 84
Pitting in few fingers 2
Uncountable pitting 3
Uncountable Pitting with nail pathology 4
CANDLE GREASE SIGN
Candle grease sign: When a psoriatic lesion is scratched with the point of a dissecting
forceps, candle grease like scale can be repeatedly produced even from the non-
scaling lesions. This is called the candle grease sign (Tache de bougie).
Scale Score
Absent 0
Improvement 1
Present 2
AUSPITZ’S SIGN:
Auspitz sign: This sign occurs only in psoriasis. Psoriasis can be diagnosed when
there is a classical silvery white scaling and the Auspitz sign. When hyperkeratosis
scale is mechanically removed from a psoriatic plaque by scratching, within few
minutes, small blood droplets appear on erythamatous surface. This phenomenon is
called Auspitz sign.
Scale Score
No Bleeding 0
Mild Bleeding 1
Moderate Bleeding 2
Severe Bleeding 3
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 85
PASI SCORING REFERENCE
Calculation:
The body is divided into 4 sections (head (H) (10% of a person’s skin), arms
(A) (20%), trunk (30%), legs (40%)). Each of these areas is scored by itself, and then
the four scores are combined for the final PASI. For each section, the percent of area
of skin involved, is estimated and then transformed into a grade from 0 to 6.
0 – 0% of involved area.
1 - <10% of involved area.
2 – 10-29% of involved area
3 – 30-49% of involved area
4 – 50-69% of involved area
5 – 70-89% of involved area
6 – 90-100% of involved area.
Within each area, the severity is estimated by three clinical signs, erythema
(redness), induration (thickness) and desquamation (scaling). Severity parameters are
measured on a scale of 0 to 4, from none to maximum.
The sum of all three severity parameters is then calculated for each section of
skin, multiplied by the area score for that area and multiplied by weight of respective
section. (0.1 for head, 0.2 for arms, 0.3 for body and 0.4 for legs).
Presentation of Data
The data collected and compiled from this clinical trial were sorted out and
processed further by subjection to varied statistical methods and presented with
tabular form in the following sequence.
Methodology
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 86
General observations viz. age, sex, religion, etc. Results of therapy evaluated
based on improvement in signs and symptoms.
Statistical Analysis
All the BT score of all symptoms of a patient were added. All the AT score of
every symptom of that patient were added. The information gathered based on
observation made about various parameters was subjected to statistical analysis in
terms of Mean, Standard Deviation.
For all symptoms in both group name of test applied is Kruskalwallis test with
Dunns multiple comparison test. It is non-parametric, one-way ANOVA test.
For comparisons between two groups, for all subjective and objective
parameters, name of test applied is Unpaired T test.
The obtained results were interpreted as:
Indications-
ns-not significant- p>0.05
*-significant-p<0.01
**-more significant-p<0.001
***-highly significant-p<0.0001
Sample size of Estimation
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 87
SAMPLE SIZE OF ESTIMATION
A total of 40 patients fulfilling the diagnostic and inclusion criteria
irrespective of their gender, caste, religion, education status and socio-economic
status were taken for the study. Registered patients were allotted randomly by lottery
method into two equal groups of minimum 20 patients in each as group A and B.
Sample size: 40 patients
Number of groups: 2 groups (Group A & Group B)
Level of study: OPD and IPD
Type of study: Single blind randomized comparative clinical study.
Source of data: Patients who fulfill the inclusion criteria were randomly selected
from OPD and IPD of Muniyal Institute of Ayurveda Medical Sciences and
Hospital, Manipal and from referral sources and special camps conducted for the
purpose.
Group-A
Drug – Dinamallika taila (external application)
Dosage – Twice a day
Time of administration – Oil is applied at affected region.
Group-B
Drug – Streekutaja taila (external application)
Dosage – Twice a day
Time of administration – Oil is applied at affected region
Duration of treatment – 60 days
Follow up – 61st and 90
th day of treatment.
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 88
OBSERVATION AND RESULTS
The present study “A CLINICAL EVALUATION OF DINAMALLIKA–
CESTRUM DIURNUM OIL IN KITIBHA KUSTHA WITH SPECIAL
REFERENCE TO PSORIASIS”, is conducted on 40 patients from OPD and IPD of
Muniyal Institute of Ayurveda Medical Sciences and Hospital, Manipal and from
referral sources and special camps.
The data collected and compiled from this clinical trial was sorted out and
processed further by subjection to varied statistical methods and presented in tabular
form in the following sequence. General observations viz. age, gender, religion, etc.,
results of therapy evaluated based on improvement in signs and symptoms.
All the 40 subjects who were suffering from psoriasis, their demographic
details and other observations were recorded and the data obtained is presented below:
The 40 subjects with KITIBHA KUSTHA - PSORIASIS were selected for the
present study and were divided in two equal groups i.e. Group A and Group B.
Group A : The subjects were treated with Dinamallika taila
Group B : The subjects were treated with Streekutaja taila
The taila was applied locally two times a day, in the morning and evening;
every day for 60 days.
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 89
OBSERVATIONS
TABLE – 8
STATUS OF 40 SUBJECTS OF PSORIASIS- AGE WISE DISTRIBUTION
S.NO. AGE IN YEARS GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 18-30 05 25% 04 20%
2 30-50 11 55% 09 45%
3 50-70 04 20% 07 35%
Total
subjects
20 20
Table no.8 shows age wise distribution of study. In Group A, 5(25%) subjects
and in Group B 4(20%) were in age group of 10-30yrs. In Group A, 11 (55%)subjects
and in Group B 9(45 %) belonged to age group of 30-50 yrs. In Group A, 4 (20%)
and in Group B, 7(35 %) subjects belonged to age groups of 50-70 yrs.
FIGURE : 2
0%
10%
20%
30%
40%
50%
60%
10-30 YRS 30 -50YRS 50 -70
AGE GR A
AGE GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 90
TABLE NO-9
STATUS OF 40 SUBJECTS OF PSORIASIS - GENDER DISTRIBUTION
SR.NO GENDER GROUP A GROUP B
NO. OF
SUBJECTS
PERCENT NO. OF
SUBJECTS
PERCENT
1 MALE 12 60% 14 70%
2 FEMALE 08 40% 06 30%
Table no.9 shows GENDER wise distribution of subjects. In group A 12(60%) and
in group B 14(70%) subjects were MALE. Where as in group A 8(40%) and in group
B 6(30%) subjects were FEMALE.
FIGURE: 3
0%
10%
20%
30%
40%
50%
60%
70%
80%
M F
SEX GR A
SEX GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 91
TABLE NO-10
STATUS OF 40 SUBJECTS OF PSORIASIS- OCCUPATION WISE
DISTRIBUTION
SR.NO OCCUPATION GROUP A GROUP B
NO. OF
SUBJECTS
PERCENT NO. OF
SUBJECTS
PERCENT
1 STUDENT 03 15% 02 10%
2 EMPLOYEE/
GOVT EMP
03 15% 02 10%
3 HOME MAKER 04 20% 02 10%
4 BUSINESS 03 15% 06 30%
5 WORKER 07 35% 08 40%
TOTAL
SUBJECTS
20 20
Table no.10 shows Occupation wise distribution of subjects. In Group A
03(15%) and in Group B 02(10%) subjects were students. In Group A 03(15%) and in
Group B 02(10%) were Employees. In Group A 04(20%) and in Group B 02(10%)
subjects were Home maker. From Business class, in Group A 03(15%) and in Group
B 06(30%). Finally, in Group A 07(35%) and in Group B 08(40%) subjects were
Workers.
FIGURE: 4
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
STUDENT EMPLOYEE/GOVTEMP
HOUSE WIFE BUSSINESS WORKER
occupation GR A
occupation GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 92
TABLE NO-11
STATUS OF 40 SUBJECTS OF PSORIASIS - MARITAL STATUS WISE
DISTRIBUTION
S.NO MARITA
L
STATUS
GROUP A GROUP B
NO. OF
SUBJECTS
PERCENT NO. OF
SUBJECTS
PERCENT
1 Married 15 75% 17 85 %
2 Unmarried 05 25% 03 15%
Table no. 11 shows distribution of subjects according to marital status of
subjects. In Group A 15(75%) were Married and 5(25%) subjects were Unmarried.
Where as in Group B 17(85%)were Married and 03(15%) subjects were Unmarried.
FIGURE: 5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
M UM
marriatal status GR A
marriatal status GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 93
TABLE NO-12
STATUS OF 40 SUBJECTS OF PSORIASIS - RELIGION WISE
DISTRIBUTION
S. NO. RELIGION GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 Hindu 18 90% 19 95 %
2 Muslim 00 00% 00 00 %
3 Christian 02 10% 01 05%
TOTAL
SUBJECTS
20 20
Table no.12 shows religion wise distribution of study subjects. In Gr A 18
(90%) were Hindu, 02(10%) were Christian. In Gr B 19(95 %) were Hindu and 01
(05%) was Christian.
FIGURE: 6
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HINDU MUSLIM CHRISTIAN
RELIGION GR A
RELIGION GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 94
TABLE NO- 13
STATUS OF 40 SUBJECTS OF PSORIASIS SOCIO-ECONOMIC STATUS
S.NO. SOCIO
ECONOMIC
STATUS
GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 Poor 00 00 % 00 00 %
2 Lower Middle 05 25 % 04 20 %
3 Middle 12 60 % 14 70 %
4 Upper Middle 03 15% 02 10%
5 Rich 00 00% 00 00%
Maximum subjects i.e 60 % in Group A and 70 % in Group B belongs to
Middle socio-economical status followed by Lower middle class i.e 25 % and 20 %
in groups A and B respectively. 15 % in Group A and 10 % in Group B belong to
Upper middle socio-economicalstatus.
FIGURE: 7
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
P LM M UM R
social status GR A
social status GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 95
TABLE NO-14
STATUS OF 40 SUBJECTS OF PSORIASIS- EDUCATION WISE
DISTRIBUTION
S. NO. EDUCATION GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 UE 01 05 % 02 10 %
2 HS 06 30 % 06 30%
3 JC 00 00% 00 00%
4 PRIMARY 07 35% 04 20%
5 UG 03 15% 06 30%
6 PG 03 15% 02 10%
In present study maximum subjects 35 % and 30% were educated upto higher
secondary and primary respectively in Group A. In Group B 30% and 30% were
educated upto higher secondary and under graduate respectively.
FIGURE: 8
0%
5%
10%
15%
20%
25%
30%
35%
40%
UE HS JC PRIMARY UG PG
EDUCATION GR A
EDUCATION GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 96
TABLE NO- 15
STATUS OF 40 SUBJECTS OF PSORIASIS - APPETITE
S. NO. APPETITE GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 GOOD 07 35 % 08 40 %
2 MODERATE 13 65 % 12 60%
3 POOR 00 00 % 00 00 %
Maximum subjects i.e 65% in Group A and 60% in Group B are having
Moderate appetite followed by Good appetite i.e 35% and 40% in groups A and B
respectively.
FIGURE: 9
0%
10%
20%
30%
40%
50%
60%
70%
good moderate poor
appetite GR A
appetite GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 97
TABLE NO- 16
STATUS OF 40 SUBJECTS OF PSORIASIS - DIET
S NO. DIET GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 VEG 01 5 % 04 20 %
2 NONVEG 01 5 % 00 00%
3 MIXED 18 90 % 16 80 %
Maximum subjects i.e 90% in Group A and 80% in Group B were having
Mixed diet. 5% were having veg and 5% nonveg in group A, 20% veg in group B.
FIGURE: 10
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
VEG NON VEG MIXED
diet GR A
diet GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 98
TABLE NO- 17
STATUS OF 40 SUBJECTS OF PSORIASIS - QUANTITYOF FOOD
SR
NO.
QUANTITY GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 PRAMITA 00 00% 00 00 %
2 ALPA 03 15% 04 20 %
3 SAMA 17 85% 16 80%
4 ATI 00 00% 00 00%
TOTAL
SUBJECTS
20 20
Maximum subjects i.e 85% in Group A and 80% in Group B are having
SAMA quantity followed by PRAMITHA i.e 15% and 20% in groups A and B
respectively.
FIGURE: 11
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
ALPA PRAMITHA SAMA ATHI
quantity GR A
quantity GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 99
TABLE NO- 18
STATUS OF 40 SUBJECTS OF PSORIASIS - AGNI
S. NO. AGNI GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 MANDAGNI 06 30% 02 10 %
2 TEEKSHNAGNI 00 00% 00 00 %
3 SAMAGNI 14 70% 18 90%
4 VISHAMAGNI 00 00% 00 00%
TOTAL
SUBJECTS
20 20
Maximum subjects i.e 70% in Group A and 90% in Group B are having
SAMAGNI followed by MANDAGNI i.e 30% and 10% in groups A and B
respectively.
FIGURE: 12
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
VISHAMA THEEKSHNA MANDA SAMA
agni GR A
agni GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 100
TABLE NO- 19
STATUS OF 40 SUBJECTS OF PSORIASIS- KOSTHA
S.NO. KOSTHA GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 MRUDU 08 40 % 08 25 %
2 MADHYAMA 12 60 % 12 75%
3 KRURA 00 00 % 00 00 %
Maximum subjects i.e 60% in Group A and 75% in Group B are having
MADHYAMA kostha followed by MRUDU kostha i.e 40% and 25% in groups A
and B respectively.
FIGURE: 13
0%
10%
20%
30%
40%
50%
60%
70%
80%
MRUDU MADHYAMA KRURA
kosta GR A
kosta GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 101
TABLE NO- 20
STATUS OF 40 SUBJECTS OF PSORIASIS - PRAKRITI
SR NO PRAKRITI GROUP A GROUP B
NO OF
SUB
PERCENT NO OF
SUB
PERCENT
1 VATAJA 05 25% 07 35%
2 PITTAJA 04 20% 02 10%
3 KAPHAJA 03 15% 02 10%
4 VATA-
PITTAJA
04 20% 05 25%
5 VATA-
KAPHAJA
02 10% 02 10%
6 PITTA-
KAPHA
02 10% 02 10%
7 TRIDOSHAJA 00 00% 00 00%
TOTAL 20 20
Maximum subjects i.e 25 % in Group A and 35 % in Group B are having
VATAJA PRAKRITI. Followed by VATA-PITTAJA PRAKRITI i.e 13.33 % and
16.66 % in groups A and B respectively.
FIGURE: 14
0%
5%
10%
15%
20%
25%
30%
35%
40%
vata pitta kapha vata-piia pitta-kapha kapha-Vata mixed
prakriti GR A
prakriti GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 102
TABLE NO- 21
STATUS OF 40 SUBJECTS OF PSORIASIS - SATVA
S.
NO.
SATVA GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 PRAVARA 02 10 % 02 10 %
2 MADHYAMA 17 85 % 16 80%
3 AVARA 01 05 % 02 10 %
Maximum subjects in i.e 85% in Group A and 80% in Group B are having
MADHYAMA SATVA followed by PRAVARA and AVARA 10% and 10% in
groups A and B respectively.
FIGURE: 15
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
pravara madhyama avara
satva GR A
satva GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 103
TABLE NO- 22
STATUS OF 40 SUBJECTS OF PSORIASIS - SARA
S. NO. SARA GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 PRAVARA 01 05 % 02 10 %
2 MADHYAMA 13 65 % 12 605%
3 AVARA 06 30 % 06 30 %
Maximum subjects in i.e 85% in Group A and 85% in Group B are having
MADHYAMA SARA followed by PRAVARA and AVARA 10% and 10% in
groups A and B respectively.
FIGURE: 16
0%
10%
20%
30%
40%
50%
60%
70%
pravara madhyama avara
sara GR A
sara GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 104
TABLE NO- 23
STATUS OF 40 SUBJECTS OF PSORIASIS - ONSET OF DISEASE
S. NO. ONSET GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 SUDDEN 08 40 % 09 45 %
2 GRADUAL 12 60 % 11 55%
3 INSIDIOUS 00 00 % 00 00 %
Maximum subjects i.e 60% in Group A and 55% in Group B are having
GRADUAL ONSET of disease, followed by SUDDEN 40% and 45% in groups A
and B respectively.
FIGURE: 17
0%
10%
20%
30%
40%
50%
60%
70%
sudden gradual insidious
onset GR A
onset GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 105
TABLE NO- 24
STATUS OF 40 SUBJECTS OF PSORIASIS - DURATION OF DISEASE
S.NO. DURATION GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 ACUTE 11 55 % 12 60 %
2 SUBACUTE 07 35 % 06 30%
3 CHRONIC 02 10 % 02 10 %
Maximum subjects i.e 55% in Group A and 60% in Group B are having
ACUTE onset of disease followed by SUBACUTE 35% and 30% in groups A
and B respectively.
FIGURE: 18
0%
10%
20%
30%
40%
50%
60%
70%
acute subacute chronic
duration GR A
duration GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 106
TABLE NO- 25
STATUS OF 40 SUBJECTS OF PSORIASIS- SITE OF ONSET OF DISEASE
SITE OF ONSET Group A Group B
HEAD 7 11
NECK 1 0
FACE 4 10
ARMS 3 5
HAND 8 13
WRIST 4 9
PALM 9 6
TRUNK 10 9
LEGS 6 10
FEET 6 4
SOLE 10 8
Maximum subjects i.e 10 each in Group A are having SITE OF ONSET as
TRUNK and SOLE. 10-13 subjects are having SITE OF ONSET as
HAND,HEAD,TRUNK and FACE.
FIGURE: 19
0
2
4
6
8
10
12
14
site of onset GR A
site of onset GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 107
TABLE NO- 26
STATUS OF 40 SUBJECTS OF PSORIASIS- COURSE OF DISEASE
S. NO. COURSE OF
DISEASE
GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 CONTINUOUS 07 35 % 08 40 %
2 INTERMITTENT 03 15 % 04 20%
3 PROGRESSIVE 10 50 % 08 40 %
4 WAXING AND
WANING
00 00% 00 00%
Maximum subjects i.e 50% in Group A and 40% in Group B are having
PROGRESSIVE nature of disease followed by CONTINUOUS 35% and 40% in
groups A and B respectively.
FIGURE: 20
0%
10%
20%
30%
40%
50%
60%
continuous intermittent progressive waxing andwaning
course GR A
course GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 108
TABLE NO- 27
STATUS OF 40 SUBJECTS OF PSORIASIS- AGGRAVATING FACTORS
S.
NO.
AGGRAVATING
FACTORS
GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBECTS
PERCENT
1 CHEMICALS 02 10 % 02 10 %
2 DYES 00 00 % 00 00%
3 ORNAMENT 00 00 % 00 00 %
4 SEASONAL 05 25% 07 35%
5 FOOD 01 05% 00 00
6 DUST 01 05% 01 05%
7 POLLEN 00 00% 00 00%
8 NONE 11 55% 11 55%
Maximum subjects i.e 55% in Group A and Group B are having no
AGGRAVATING factors. 25% in Group A and 35% in Group B are SEASONAL in
origin. 10% in both groups have CHEMICAL as aggrevating factor.
FIGURE: 21
0%
10%
20%
30%
40%
50%
60%
CHEMICALS DYES ORNAMENTS SEASONALS FOOD DUST POLLEN NONE
aggrevating factors GR A
aggrevating factors GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 109
TABLE NO- 28
STATUS OF 40 SUBJECTS OF PSORIASIS - RELIEVING FACTORS
S.
NO.
RELIEVING
FACTORS
GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 PRESENT 01 05 % 00 00 %
2 ABSENT 19 95 % 20 100 %
Maximum subjects i.e 95% in Group A and 100% in Group B are having NO
RELIEVING factors. Only 5% RELIEVING factors present in Group A.
FIGURE: 22
0%
20%
40%
60%
80%
100%
120%
PRESENT ABSENT
relieving factors GR A
relieving factors GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 110
TABLE NO- 29
STATUS OF 40 SUBJECTS OF PSORIASIS- FAMILY HISTORY
S.
NO.
FAMILY
HISTORY
GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 PRESENT 02 10 % 01 05 %
2 ABSENT 18 90 % 19 95%
Maximum subjects i.e 90% in Group A and 95% in Group B are having NO
FAMILY HISTORY. Only 10% in Group A and 5% in Group B have FAMILY
HISTORY.
FIGURE: 23
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PRESENT ABSENT
family history GR A
family history GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 111
TABLE NO- 30
STATUS OF 40 SUBJECTS OF PSORIASIS - RASA OF FOOD TAKEN
RASA OF FOOD TAKEN Group A Group B
MADHURA 6 5
AMLA 7 5
LAVANA 6 9
KATU 5 7
TIKTHA 0 0
KASHAYA 0 7
SAMA 6 3
Maximum subjects in Group A and in Group B are taking food having
MADHURA, AMLA, LAVANA, KATU, KASHAYA SAMA RASA.
FIGURE: 24
0
1
2
3
4
5
6
7
8
9
10
rasa of food taken GR A
rasa of food taken GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 112
TABLE NO- 31
STATUS OF 40 SUBJECTS OF PSORIASIS - GUNA OF FOOD TAKEN
S.NO. GUNA OF
FOOD
TAKEN
GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 RUKSHA 01 05% 01 05 %
2 SNIGDHA 13 65 % 11 55%
3 USHNA 05 25 % 07 35 %
4 SITA 00 00% 00 00%
5 GURU 01 05% 00 00
6 LAGHU 00 00% 01 05%
Maximum subjects 65% in Group A and 55% in Group B are taking food of
SNIGDHA GUNA. 25% in Group A and 35% in Group B are taking food of
RUKSHA GUNA.
FIGURE: 25
0%
10%
20%
30%
40%
50%
60%
70%
RUKSHA SNIGDHA USHNA SITA GURU LAGHU
guna of food taken GR A
guna of food taken GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 113
TABLE NO- 32
STATUS OF 40 SUBJECTS OF PSORIASIS - ADDICTION
S.
NO.
ADDICTION GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 SMOKING 02 10% 02 10 %
2 ALCOHOL 00 00 % 02 10%
3 TOBACCO 01 05 % 00 00%
4 SNUFF 00 00% 00 00%
5 OTHER 00 00% 00 00
6 NO 17 85% 16 80%
Maximum subjects 85% in Group A and 80% in Group B are having no
addiction. 10% SMOKING in both the groups.
FIGURE: 26
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
smoking alcohol tobacco snuff other no
addiction GR A
addiction GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 114
TABLE NO- 33
STATUS OF 40 SUBJECTS OF PSORIASIS - SROTAS
S.
NO.
SROTAS GROUP A GROUP B
NO OF
SUBJECTS
PERCENT NO OF
SUBJECTS
PERCENT
1 RAKTAVAHA+
RASAVAHA
01 05 % 01 05 %
2 RAKTAVAHA+
ANNAVAHA
01 05 % 00 00%
3 RAKTAVAHA 18 90 % 19 95 %
Maximum subject’s symptoms i.e 90% in Group A and 95% in Group B are
those with predominantly due to RAKTAVAHA SROTAS.There is an involvment of
UDAKAVAHA STROTAS in 5% subjects in both the groups.
FIGURE: 27
0
2
4
6
8
10
12
14
16
18
20
SROTAS GR A
SROTAS GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 115
RESULTS AND INTERPRETATION
Following indication have been used in the below tables:
Indications- ns-not significant- p>0.05
*-significant-p<0.01
**-more significant-p<0.001
***-highly significant-p<0.0001
TABLE NO- 34
EFFECT ON SYMPTOMS OF PSORIASIS - ITCHING
GROUP BT 15th day 30th day 45th day AT
Mean A 3.2 2 1.7 1.25 0.6
B 2.95 2.5 2.05 1.7 1.3
Median A 3 2 2 1 1
B 3 2.5 2 2 1
Std.
Deviation A 0.7678 0.7255 0.5712 0.4443 0.5026
B 0.7592 0.513 0.394 0.4702 0.5712
Std. Error A 0.1717 0.1622 0.1277 0.09934 0.1124
B 0.1698 0.1147 0.08811 0.1051 0.1277
Sum A 64 40 34 25 12
B 59 50 41 34 26
P value
summary A
* ** *** ***
B
NS ** *** ***
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 116
In Gr A, before treatment, Mean was 3.2 and after treatment, Mean was
found 0.6, whose ‘p’ value summary is highly significant. (means p <0.0001).
In Gr B, before treatment, Mean was 2.95 and after treatment, Mean was
found 1.3, whose p value summary is highly significant. (means p <0.0001).
FIGURE: 28
0
0.5
1
1.5
2
2.5
3
3.5
BT 15th day 30th day 45th day AT
ITCHING
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 117
TABLE NO - 35
ITCHING (COMPARISON)
GROUP A GROUP B
Mean 2.6 1.65
Median 3 2
Std. Deviation 0.7539 0.7452
Std. Error 0.1686 0.1666
Sum 52 33
P value summary
***
In symptom ITCHING, when both the Groups were compared, in Group A
Mean was 2.6 and in Group B Mean was 1.65, whose p value summary is highly
significant. (means p <0.0001).
FIGURE: 29
0
0.5
1
1.5
2
2.5
3
GR A GR B
ITCHING
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 118
TABLE NO- 36
EFFECT ON SYMPTOMS OF PSORIASIS - REDNESS
GROUP BT 15th day 30th day 45th day AT
Mean A 3.3 1.85 1.65 1.15 0.6
B 2.75 2.25 1.85 1.7 1.55
Median A 4 2 2 1 1
B 3 2 2 2 2
Std.
Deviation A 0.9787 0.4894 0.5871 0.4894 0.5026
B 0.7864 0.6387 0.3663 0.4702 0.5104
Std. Error A 0.2188 0.1094 0.1313 0.1094 0.1124
B 0.1758 0.1428 0.08192 0.1051 0.1141
Sum A 66 37 33 23 12
B 55 45 37 34 31
P value
summary A
* ** *** ***
B
NS ** *** ***
In Group A, before treatment, Mean was 3.3 and after treatment, Mean was
found 0.6, whose p value summary is highly significant. (means p <0.0001).
In Group B, before treatment, Mean was 2.75 and after treatment, Mean was
found 1.56, whose p value summary is highly significant. (means p <0.0001).
FIGURE: 30
0
0.5
1
1.5
2
2.5
3
3.5
BT 15th day 30th day 45th day AT
REDNESS
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 119
TABLE NO - 37
REDNESS (COMPARISON)
GROUP A GROUP B
Mean 2.7 1.2
Median 3 1
Std. Deviation 1.031 0.7678
Std. Error 0.2306 0.1717
Sum 54 24
P value summary
***
In symptom REDNESS, when both the Groups were compared, in Group A
Mean was 2.7 and in Group B Mean was 1.2, whose p value summary is highly
significant. (means p <0.0001)
FIGURE: 31
2.7
1.2
0
0.5
1
1.5
2
2.5
3
GR B
REDNESS GR A
REDNESS
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 120
TABLE NO- 38
EFFECT ON SYMPTOMS OF PSORIASIS - BURNING
GROUP BT 15th day 30th day 45th day AT
Mean A 1.95 1.05 0.9 0.75 0.45
B 2 1.9 1.75 1.45 1.3
Median A 2 1 1 1 0
B 2 2 2 1 1
Std.
Deviation A 0.9445 0.2236 0.3078 0.4443 0.5104
B 1.026 0.8522 0.7164 0.5104 0.4702
Std. Error A 0.2112 0.05 0.06882 0.09934 0.1141
B 0.2294 0.1906 0.1602 0.1141 0.1051
Sum A 39 21 18 15 9
B 40 38 35 29 26
P value
summary A
* ** *** ***
B
NS NS NS NS
In Group A, before treatment, Mean was 1.95 and after treatment, Mean was
found 0.45, whose p value summary is highly significant. (means p <0.0001).
In Group B, before treatment, Mean was 2.0 and after treatment, Mean was
found 1.30, whose p value summary is not significant. (means p > 0.05).
FIGURE: 32
0
0.5
1
1.5
2
2.5
BT 15th day 30th day 45th day AT
BURNING
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 121
TABLE NO - 39
BURNING (COMPARISON)
GROUP A GROUP B
Mean 1.5 0.7
Median 1 0
Std. Deviation 0.8885 0.9234
Std. Error 0.1987 0.2065
Sum 30 14
P value summary
**
In symptom BURNING, when both the Groups were compared, in Group A
Mean was 1.5 and in Group B Mean was 0.7, whose p value summary is more
significant. (means p <0.001).
FIGURE: 33
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
GR A GR B
BURNING
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 122
TABLE NO- 40
EFFECT ON SYMPTOMS OF PSORIASIS - DESQUAMATION
GROUP BT 15th day 30th day 45th day AT
Mean A 3.35 2.05 1.85 1.3 0.55
B 2.9 2.55 2.15 1.9 1.55
Median A 3 2 2 1 1
B 3 3 2 2 2
Std.
Deviation A 0.6708 0.5104 0.3663 0.4702 0.5104
B 0.6407 0.5104 0.3663 0.4472 0.5104
Std. Error A 0.15 0.1141 0.08192 0.1051 0.1141
B 0.1433 0.1141 0.08192 0.1 0.1141
Sum A 67 41 37 26 11
B 58 51 43 38 31
P value
summary A
* ** *** ***
B
NS ** *** ***
In Group A, before treatment, Mean was 3.3 and after treatment, Mean was
found 0.55, whose p value summary is highly significant. (means p <0.0001).
In Group B, before treatment, Mean was 2.9 and after treatment, Mean was
found 1.55, whose p value summary is highly significant. (means p <0.0001).
FIGURE: 34
00.5
11.5
22.5
33.5
4
BT 15th day 30th day 45th day AT
DESQUAMATION
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 123
TABLE NO - 41
DESQUAMATION (COMPARISON)
GROUP A GROUP B
Mean 2.8 1.35
Median 3 1
Std. Deviation 0.8335 0.8751
Std. Error 0.1864 0.1957
Sum 56 27
P value summary
***
In symptom DESQUAMATION, when both the Groups were compared, in
Gr A Mean was 2.8 and in Gr B Mean was 1.3, whose p value summary is highly
significant. (means p <0.0001).
FIGURE: 35
0
0.5
1
1.5
2
2.5
3
GR A GR B
DESQUAMATION
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 124
TABLE NO - 42
EFFECT ON SYMPTOMS OF PSORIASIS - DRYNESS
GROUP BT 15th day 30th day 45th day AT
Mean A 2.5 1.35 1.2 0.9 0.45
B 2.5 2.2 2 1.75 1.4
Median A 3 1 1 1 0
B 3 2 2 2 1
Std. Deviation A 0.8885 0.4894 0.4104 0.3078 0.5104
B 0.607 0.5231 0.562 0.5501 0.5026
Std. Error A 0.1987 0.1094 0.09177 0.06882 0.1141
B 0.1357 0.117 0.1257 0.123 0.1124
Sum A 50 27 24 18 9
B 50 44 40 35 28
P value
summary A
* ** *** ***
B
NS NS ** ***
In Group A, before treatment, Mean was 2.5 and after treatment, Mean was
found 0.45, whose p value summary is highly significant. (means p <0.0001).
In Group B, before treatment, Mean was 2.5 and after treatment, Mean was
found 1.4, whose p value summary is highly significant (means p <0.0001).
FIGURE: 36
0
0.5
1
1.5
2
2.5
3
BT 15th day 30th day 45th day AT
DRYNESS
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 125
TABLE NO - 43
DRYNESS (COMPARISON)
GROUP A GOUPR B
Mean 2.05 1.1
Median 2 1
Std. Deviation 0.887 0.9119
Std. Error 0.1983 0.2039
Sum 41 22
P value summary
**
In symptom DRYNESS, when both the Groups were compared , in Group A
Mean was 2.05 and in Group B Mean was 1.1, whose p value summary is more
significant(means p <0.001).
FIGURE: 37
0
0.5
1
1.5
2
2.5
GR A GR B
DRYNESS
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 126
TABLE NO- 44
EFFECT ON SYMPTOMS OF PSORIASIS – EPIDERMAL THICKENING
GROUP BT 15th day 30th day 45th day AT
Mean A 2.25 1.3 1.15 0.8 0.4
B 2 1.75 1.5 1.35 1.25
Median A 2 1 1 1 0
B 2 2 1.5 1 1
Std. Deviation A 0.7864 0.4702 0.3663 0.4104 0.5026
B 0.6489 0.5501 0.513 0.4894 0.4443
Std. Error A 0.1758 0.1051 0.08192 0.09177 0.1124
B 0.1451 0.123 0.1147 0.1094 0.09934
Sum A 45 26 23 16 8
B 40 35 30 27 25
P value
summary A
* ** *** ***
B
NS NS * **
In Group A, before treatment, Mean was 2.25 and after treatment, Mean was
found 0.4, whose p value summary is highly significant. (means p <0.0001).
In Group B, before treatment, Mean was 2.0 and after treatment, Mean was
found 1.25, whose p value summary is more significant. (means p <0.001).
FIGURE: 38
0
0.5
1
1.5
2
2.5
BT 15th day 30th day 45th day AT
EPIDERMAL THICKENING
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 127
TABLE NO - 45
EPIDERMAL THICKENING (COMPARISON)
GROUP A GROUP B
Mean 1.85 0.75
Median 2 1
Std. Deviation 0.4894 0.7864
Std. Error 0.1094 0.1758
Sum 37 15
P value summary
***
In symptom EPIDERMAL THICKENING, when both the Groups were
compared, in Gr A Mean was 1.85 and in Gr B Mean was 0.75, whose p value
summary is highly significant. (means p <0.0001).
FIGURE: 39
0
0.5
1
1.5
2
GR A GR B
EPIDERMAL THICKENING
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 128
TABLE NO- 46
EFFECT ON SYMPTOMS OF PSORIASIS – AUSPITZ SIGN
GROUP BT 15th day 30th day 45th day AT
Mean A 1.35 1 0.85 0.7 0.4
B 1.25 1.15 1.05 0.9 0.8
Median A 1 1 1 1 0
B 1 1 1 1 1
Std. Deviation A 0.4894 0 0.3663 0.4702 0.5026
B 0.4443 0.3663 0.2236 0.3078 0.4104
Std. Error A 0.1094 0 0.08192 0.1051 0.1124
B 0.09934 0.08192 0.05 0.06882 0.09177
Sum A 27 20 17 14 8
B 25 23 21 18 16
P value
summary A
NS * ** ***
B
NS NS * **
In Gr A, before treatment, Mean was 1.35 and after treatment, Mean was
found 0.4, whose p value summary is highly significant. (means p <0.0001).
In Gr B, before treatment, Mean was 1.25 and after treatment, Mean was
found 0.8, whose p value summary is highly significant. (means p <0.001).
FIGURE: 40
00.20.40.60.8
11.21.41.6
BT 15th day 30th day 45th day AT
AUSPITZ SIGN
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 129
TABLE NO - 47
AUSPITZ SIGN (COMPARISON)
GROUP A GROUP B
Mean 0.95 0.45
Median 1 0
Std. Deviation 0.2236 0.5104
Std. Error 0.05 0.1141
Sum 19 9
P value summary
***
In symptom AUSPITZ SIGN, when both the Groups were compared, in Gr A
Mean was 0.95 and in Gr B Mean was 0.45, whose p value summary is highly
significant .(means p <0.0001).
FIGURE: 41
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
GR A GR B
AUSPITZ SIGN
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 130
TABLE NO- 48
EFFECT ON SYMPTOMS OF PSORIASIS – CANDLE GREASE SIGN
GROUP BT 15th day 30th day 45th day AT
Mean A 1.9 1.45 1.15 1 0.4
B 2 1.85 1.7 1.5 1.3
Median A 2 1 1 1 0
B 2 2 2 1.5 1
Std. Deviation A 0.8522 0.5104 0.3663 0 0.5026
B 0.6489 0.4894 0.4702 0.513 0.4702
Std. Error A 0.1906 0.1141 0.08192 0 0.1124
B 0.1451 0.1094 0.1051 0.1147 0.1051
Sum A 38 29 23 20 8
B 40 37 34 30 26
P value
summary A
NS * ** ***
B
NS NS NS *
In Group A, before treatment, Mean was 1.9 and after treatment, Mean was
found 0.4, whose p value summary is highly significant. (means p <0.0001)
In Group B, before treatment, Mean was 2.0 and after treatment, Mean was
found 1.3, whose p value summary is highly significant. (means p <0.01)
FIGURE: 42
0
0.5
1
1.5
2
2.5
BT 15th day 30th day 45th day AT
CANDLE GREASE SIGN
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 131
TABLE NO - 49
CANDLE GREASE SIGN (COMPARISON)
GROUP A GROUP B
Mean 1.5 0.7
Median 1 1
Std. Deviation 0.7609 0.6569
Std. Error 0.1701 0.1469
Sum 30 14
P value summary
**
In symptom CANDLE GREASE SIGN, when both the Groups were
compared, in Group A Mean was 1.5 and in Group B Mean was 0.7, whose p value
summary is more significant (means p <0.0001).
FIGURE: 43
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
GR A GR B
CANDLE GREASE SIGN
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 132
TABLE NO- 50
EFFECT ON SYMPTOMS OF PSORIASIS – PASI SCORE
GROUP BT AT
Mean A 17.9 2.42
B 8.79 6.135
Median A 12 2.3
B 4.95 3.5
Std. Deviation A 17.15 1.964
B 8.454 6.754
Std. Error A 3.835 0.4391
B 1.89 1.51
Sum A 358 48.4
B 175.8 122.7
P value summary A
***
B
NS
In Group A, before treatment, Mean was 17.9 and after treatment, Mean was
found 2.42, whose p value summary is highly significant. (means p <0.0001)
In Group B, before treatment, Mean was 8.79 and after treatment, Mean was
found 1.56, whose p value summary is not significant. (means p >0.05)
FIGURE: 44
0
2
4
6
8
10
12
14
16
18
20
BT AT
PASI SCORE
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 133
TABLE NO - 51
PASI SCORE (COMPARISON)
GROUP A GROUP B
Mean 15.48 2.655
Median 9.2 1.35
Std. Deviation 15.47 2.849
Std. Error 3.46 0.6372
Sum 309.6 53.1
P value summary
***
In PASI SCORE, when both the Groups were compared, in Group A Mean
was 15.48 and in Group B Mean was 2.65, whose p value summary is highly
significant (means p <0.0001).
FIGURE: 45
0
2
4
6
8
10
12
14
16
18
GR A GR B
PASI SCORE
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 134
TABLE NO- 52
EFFECT ON SYMPTOMS OF PSORIASIS – KASI SCORE
GROUP BT AT
Mean A 31.11 4.465
B 15.32 11.64
Median A 18 4
B 8.75 7.6
Std. Deviation A 32.59 3.076
B 13.21 10.22
Std. Error A 7.288 0.6878
B 2.954 2.285
Sum A 622.2 89.3
B 306.4 232.7
P value summary A
***
B
NS
In Group A, before treatment, Mean was 31.11 and after treatment, Mean
was found 0.6, whose p value summary is highly significant (means p <0.0001).
In Group B, before treatment, Mean was 15.32 and after treatment, Mean was
found 11.64, whose p value summary is not significant (means p>0.05).
FIGURE: 46
0
5
10
15
20
25
30
35
BT AT
KASI SCORE
Mean GR A
Mean GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 135
TABLE NO - 53
KASI SCORE (COMPARISON)
GROUP A GROUP B
Mean 26.65 3.685
Median 13.5 2.75
Std. Deviation 29.89 3.282
Std. Error 6.684 0.7339
Sum 532.9 73.7
P value summary
**
In KASI SCORE, when both the Groups were compared, in Group A Mean
was 26.65 and in Group B Mean was 3.68, whose p value summary is highly
significant(means p <0.001).
FIGURE: 47
0
5
10
15
20
25
30
GR A GR B
KASI SCORE
Mean
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 136
TABLE NO- 54
RELIEF FROM SYMPTOMS IN SUBJECTS (IN PERCENTAGE)
RELIEF IN SUBJECTS GROUP A GROUP B
80%-100% 14 0
60%-80% 6 0
40%-60% 0 7
20%-40% 0 13
In TOTAL PERCENTAGE RELIEF, it is observed that, in Group A 14
subjects got relief in between 80% - 100%, while 6 subjects got 60%-80% relief from
the symptoms.
In Group B it is observed that, 13 subjects got relief in between 20%-40%,
while 7 subjects got 40% - 60% relief from the symptoms.
FIGURE: 48
0
2
4
6
8
10
12
14
16
80%-100% 60%-80% 40%-60% 20%-40%
GR A
GR B
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 137
TOTAL EFFECT OF THERAPY
In GROUP A 14 SUBJECTS get 80-100% relief from symptoms and 6
subjects gets 60-80% relief.While in GROUP B 7 SUBJECTS get 40-60% and 13
subjects got 20-40% relief in symptoms.
TABLE NO - 55
Total Effect of therapy at a glance
ITCHI
NG
REDN
ESS
BURN
ING
DESQUA
MATION
DRYN
ESS
EPI
THICK
NESS
AUSPI
TZ
SIGN
CANDL
E
GROUP
EASE
SIGN
PASI
SCORE
KASI
SCORE
B
T
A
T
B
T
A
T
B
T
A
T
BT AT B
T
A
T
B
T
A
T
B
T
A
T
B
T
A
T
B
T
A
T
B
T
A
T
MEA
N
GR
OU
P A
3.
2
0
.
6
3.
3
0.
6
1.
9
5
0.
4
5
3.3
5
0.5
5
2
.
5
0.
4
5
2.
25
0.
4
1.
3
5
0
.
4
1.
9
0.
4
1
7.
9
2.
42
31
.1
1
4.
46
5
GR
OU
P B
2.
9
5
1
.
3
2.
7
5
1.
5
5
2 1.
3
2.9 1.5
5
2
.
5
1.
4
2 1.
25
1.
2
5
0
.
8
2 1.
3
8.
7
9
6.
13
5
15
.3
2
11
.6
4
P
VAL
U
SUM
MAR
Y
GR
OU
P A
*
*
*
*
*
*
*
*
*
*** *
*
*
**
*
*
*
*
**
*
**
*
**
*
GR
OU
P B
*
*
*
*
*
*
N
S
*** *
*
*
** *
*
* N
S
N
S
Observation and results
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 138
The signs and symptoms in Group-A Dinamallika (Cestrum diurnum) treated
patients showed better result than Group-B Shrishwetakutaja (Wrightia tinctoria). The
symptom of Kitibha kustha showed significant changes when compared between the
Before treatment and after treatment scores.
FIGURE: 49
TOTAL EFFECT OF THERAPY AT A GLANCE
The signs and symptoms in Group-A Dinamallika (Cestrum diurnum) treated
patients showed better result than Group-B Shrishwetakutaja (Wrightia tinctoria). The
symptom of Kitibha kustha showed significant changes when compared between the
Before treatment and after treatment scores.
0
5
10
15
20
25
30
35
BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT
ITCHING REDNESS BURNING DESQUAMATION DRYNESS EPIDERMALTHICKENING
AUSPITZ SIGN CANDLE GREASESIGN
PASI SCORE KASI SCORE
Mean GR A
Mean GR B
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 139
DISCUSSION
Discussion is the main substratum of any type of research work. It is nothing
but theological reasoning of observations and comprises the analysis of results
obtained from Applied Study. The disease Psoriasis is known to Indian vaidyas since
olden times.
DISCUSSION ON DISEASE:
Kushtha is a broad term for all skin diseases. Separate chapter under the
heading of “Kushtha" has been described. Kithibha kustha is one among the 11
Kshudra Kushtha with the dominance of Kapha & Vata Dosha in particular and Rakta
vitiation in general in its pathogenesis. Psoriasis can be correlated with different
varieties of Kushtha.
At the outset, though it appears that some of the symptoms of Psoriasis are
found in various Kshudrakustha, a careful review suggested that Kithibha kustha is
more similar to the symptoms of psoriasis. Though Kithibha kustha is considered as
Kshudra Kushtha, in the present scenario psoriasis is one of the severe skin disease
which is Krichhra Saadhya in the treatment.
Psoriasis is a non-infectious, chronic inflammatory disease of skin,
characterized by well-defined erythematous plaques with silvery white scale with a
predilection, for the extensor surface and scalp, and a chronic fluctuating course. Its
incidence is 1-2% of world population.
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 140
Comparison between Kithibha kustha and Psoriasis are as follow:
TABLE NO: 56
COMPARISON BETWEEN KITIBHA KUSTHA AND PSORIASIS
No Lakshanas of Kitibha Kushta Signs and symptoms of psoriasis
1 Aruna varnaKS, Rakta Krishna varna Erythema
2 Shyavata Hyperpigmentation
3 Kinakhara sparsha Hyperkeratinisation
4 Rookshata Dryness
5 Prashantani cha punahpunarutpadyante Reccurance
6 Kandu Mild to moderate itching
7 Vritta Circumscribed lesions
8 Ghana ( vistara ) More involvement of body parts
Among the Dosha wise symptoms of Kushtha, due to Vata- Raukshya,
Parushya, Toda, due to Pitta- Raga & due to Kapha- Kandu,Shvaitya,Sthairya were
found in Kithibha kustha, so it is clear that Kithibha kustha is VataKapha dominant
skin disease. The Doshic dominancy in the chief symptoms of Kithibha kustha may be
taken asAswedanam, Matsyashakalopamam due to VataKapha, Rukshata due to Vata,
Krishna Arunavarna due to VataPitta, and Mahavastu, Mandala due to Kapha
Asvedanam indicate the Svedavaha Sroto Dushti or Svedakshaya Lakshana.
Treatment for Psoriasis in Allopathy is more palliative than curative. The
topical applications form the first line of treatment in spite of its impractibility
especially in diffuse lesions. There is a constant need to develop safe, more effective,
economic, user friendly modalities of treatment like topical applications. Even so,
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 141
applications which may be easily applied to suit diffuse areas and not harming the
unaffected areas is the need. Hence, medicated oils is a better choice.
Many efforts have been done to treat Psoriasis / Kitibha in Ayurveda line of
treatment using different modalities, like Siravyada and Jaloaka which are not so
friendly or easily acceptable by patient, which needs direct supervision by a
Physician. Lepa one among the Bahya pradana upakrama which could be easily
employed with effective results. As it is the first line of treatment for Kushtha,
according to Susrutha many Lepas like Aragvadha Patra lepa, Aragvadha Kshara
Lepa, have been tried in Kitibha. Results have shown moderate to good response as
high as 40% and 60%, but no total cure was observed in any of the studies.
External application of Dinamallika leaves in different forms has been
traditionally used by members of many families since their ancestral period and also
very much in vogue in some parts of Andhra Pradesh. In this regard, a study was
planned with Dinamallika taila in one group of Kitibha Kustha patients. A
comparative group with Streekutaja taila prepared by Bhanupaka vidhi was taken up
as control, the result of which has already been established in a previous study with a
success rate of 60%.
It is not a new phenomenon to include new drugs into Ayurvedic pharmacopea
under the category of “anukta dravya” i.e., unlisted/ non-narrated drugs (extra-
pharmacopoeia medicine). However, before any such medicine already in use
elsewhere or found to have merit is used by a Vaidya, it should be subjected to
examination based on Rasa panchaka which qualify any substance before it is put to
medicinal or edible use.
Ayurveda ka Vaijnanika Itihasa provides details of 121 new therapeutic
entities, which were introduced to Ayurveda in different phases. Among the reported
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 142
54-plant drugs, 7-flowers, 26-fruits, 12-vegetables, 14-food groupains, 8-animal
origin ingroupedients. (PV Sharma, 1975: 338-372)
In similar lines a non-native ornamental plant “Cestrum diurnum” know as Din-
ka-raja has been in use with some of the traditional Ayurvedic vaidyas who by trial
and error found out that the leaves of the plant are useful in the treatment of Kitibha
kushta. Further review of literature based on the methodology of Anuktadravya the
drug has been found suitable for therapeutic use in Skin ailments such as Kitibha
kushta (psoriasis) and there is a need to conduct appropriate clinical trials to establish
the same. Further, as the plant is very easy to cultivate and the useful part being the
leaves it is an ideal choice to prevent adulteration and employ it for therapeutic usage.
The present study “A CLINICAL EVALUATION OF DINAMALLIKA–
CESTRUM DIURNUM OIL IN KITIBHA KUSTHA WITH SPECIAL
REFERENCE TO PSORIASIS” is conducted on 40 patients from OPD and IPD of
Muniyal Institute of Ayurveda Medical Sciences and Hospital, Manipal and also from
referral sources and special camps.
The data collected and compiled from this clinical trial were sorted out and
processed further by subjection to varied statistical methods and presented in tabular
form in the following sequence. General observations viz. age, gender, religion, etc.
Overall results of therapy were evaluated on the basis of improvement in signs and
symptoms.
A total of 40 patients with Kitibha Kustha-psoriasis were selected for the
present study and were divided in two equal groups i.e. Group A and Group B.
Group A : The subjects were treated with Dinamallika taila
Group B : The subjects were treated with Streekutaja taila
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 143
The patients were subjected to the treatment of Dinamallika taila, and
Streekutaja taila, external application, twice daily, for 60 days.
Nidanatmaka aspect of all 40 patients of Kitbha Kustha-psoriasis were studied,
the detail of which are as follows.
AGE
5 patients in GROUP A (25%) and 4 in GROUP B (20%) were in age Group
of 10-30yrs. In Group A 11 (55%) and in GROUP B 09(45 %) belonged to age
group of 30-50 yrs. In Group A 04 (20%) and in GROUP B 07(35 %) belonged to age
group of 50-70 yrs. Psoriasis can develop at any age and any time. Statistically, there
are two age peaks when psoriasis is more likely to start, 13-25 years and 50-60 years.
It may be due to hormonal changes in puberty & less immunity during old age and
stressful life style.
GENDER
Maximum subjects in, GROUP A, i.e 12(60%) and in Group B 14(70%) pts
were MALE. Where as in Group A 08(40%) and 06(30%) pts were FEMALE.
Psoriasis equally affect male and female. But in some Indian studies male ratio is
greater than female. Also in some articles Psoriasis is more common in men than in
women which support the present data.
OCCUPATION
In GROUP A, 03(15%) and in Group B, 02(10%) pts were students. In Group
A, 03(15%) and in GROUP B, 02(10%) were Employees. In GROUP A, 04(20%) and
in GROUP B, 02(10%) pts were House wives. From Bussiness class, in GROUP A,
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 144
03(15%) and in GROUP B, 06(30%). And in GROUP A,07(35%) and in GROUP B,
08(40%) pts were Workers. It can be said that stressful condition aggravates the
disease in house wives, students, Workers & businessmen.
MARITAL STATUS
Maximum subjects in group, i.e GROUP A, 15(75%) were Married and
05(25%) pts were Unmarried. Where as in Group B, 17(85%) were Married and
03(15%) pts were Unmarried. It may happen that after marriage, mental stress may
increase due to familial & social responsibilities, economic status etc. which is the
cause of psoriasis. Psoriasis is more stress sensitive than many other skin diseases.
Up to 85 % of patients described stress as a trigger for their disease.
RELIGION
Maximum subjects in GROUP A, 18( 90%) were Hindu, 02(10%) were
Christian .In GROUP B, 19(95 %) were Hindu, and 01 (05%) was Christian.
Because of majority of the Hindus in this region, there was no specific relation found.
SOCIO-ECONOMIC STATUS
Maximum subjects in i.e 60 % in Group A and 70 % in Group B belonged to
Middle socioeconomical status followed by Lower middle class i.e 25 % and 20 %
in the Groups A and B respectively. 15 % in Group A and 10 % in Group B belongs
to Upper middle socioeconomical status. It indicates that Midde socioeconomical
people may have more struggled life and economic problems, which may lead to more
stressful condition. It has no direct relation with the disease
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 145
EDUCATION WISE DISTRIBUTION
Maximum subjects 35 % and 30% were educated upto higher secondary and
primary respectively in Group A .In Group B, 30% were educated upto higher
secondary and under grauduates. It indicates that less educated people may have more
struggled life and economic problems, which may lead to more stressful condition. It
has no direct relation with the disease.
AGNI
Maximum subjects in i.e 70% in Group A and 90% in Group B were having
SAMAGNI followed by MANDAGNI in 30% and 10% in Groups A and B
respectively. In patients who had poor & average Agni (appetite), a minor Apathya
can lead the vitiation of Doshas and take part in the Samprapti of disease.
KOSTHA
Maximum subjects in i.e 60% in Group A and 75% in Group B were having
MADHYAMA kostha followed by MRUDU kostha in 40% and 25% in Groups A
and B respectively.In present study it is found that Kithibha kusta (Psoriasis) is more
in patients of madhyama kostha.
PRAKRITI
Maximum subjects in i.e 25 % in Group A and 35 % in Group B were having
VATAJA PRAKRITI, followed by VATA-PITTAJA PRAKRITI i.e 13.33 % and
16.66 % in the Groups A and B respectively. In present study it is found that Kitibha
kustha (Psoriasis) is more in patients of VATAJA PRAKRITI and VATA-PITTAJA
PRAKRITI. Due to Ruksha guna of vata dryness and scales are repeated.
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 146
SATVA
Maximum subjects i.e 85% in Group A and 80% in Group B were having
MADHYAMASATVA followed by PRAVARA and AVARA, i.e 10% and 10% in
both the Groups A and B respectively. Patients describe psychological stress as being
a key exacerbation or trigger of psoriasis. Which support the present data of disturbed
psychological status (Manas Bhava) History of the patients indicates that tension,
anxiety & depression are causative and also aggravating factor of this disease, which
indicates the more psychosomatic nature of the disease.
SARA
Maximum subjects i.e 85% in Group A and 85% in Group B are having
MADHYAMA SARA followed by PRAVARA and AVARA 10% and 10% in
both the Groups A and B respectively.
ONSET OF DISEASE
Maximum subjects i.e 60% in Group A and 55% in Group B are having
GRADUAL ONSET of disease followed by SUDDEN 40% and 45% in both the
Groups A and B respectively.
DURATION OF DISEASE
Maximum subjects i.e 55% in Group A and 60% in Group B are having
ACUTE onset of disease followed by SUBACUTE35% and 30% in both the
Groups A and B respectively.
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 147
SITE OF ONSET OF DISEASE
Maximum subjects i.e 10 in Group A were having the onset on TRUNK,
SOLE and10-13 subjects are having SITE of onset on HAND,HEAD,TRUNK and
FACE.
COURSE OF DISEASE
Maximum subjects i.e 50% in Group A and 40% in Group B are having
PROGRESSIVE nature of disease followed by CONTINUOUS 35% and 40% in
both the Groups A and B respectively.
AGGRAVATING FACTORS
Maximum subjects i.e 55% in Group A and Group B are having no
AGGREVATING factor.25% in GROUP A and 35% in GROUP B are SEASONAL
in origin.10% in both Groups have CHEMICAL as aggravating factors.
RELIEVING FACTORS
Maximum patients i.e 95% in Group A and 100% in Group B are having NO
RELIEVING factor .Only 5% had RELIEVING factor in GROUP A.
FAMILY HISTORY
Maximum subjects i.e 90% in Group A and 95% in Group B were having NO
FAMILY HISTORY .Only 10% in GROUP A and 5% in GROUP B FAMILY
HISTORY present.
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 148
DIET HABIT-
APPETITE, VEG, NON-VEG, QUANTITY
Maximum subjects i.e 65% in Group A and 60% in Group B were having
Moderate appetite followed by Good appetite i.e 35% and 40% in both the Groups
A and B respectively. Maximum subjects i.e 90% in Group A and 80% in Group B
were having Mixed diet.
Maximum subjects i.e 85% in Group A and 80% in Group B were having
SAMA quantity followed by PRAMITHA i.e 15% and 20% in both the Groups A
and B respectively. Mamsa Sevana is mentioned in the Nidana of Kustha, which
Vitiates Kapha & Rakta. Meat contains arachadonic acid, a natural inflammatory
substance that is believed to make psoriasis. Which make psoriasis stores red and
swollen. All animal fats, eggs, processed canned foods are not to be taken as they can
irritate the intestinal tract and perpetuate psoriasis outbreaks.
RASA OF FOOD TAKEN
Maximum subjects in Group A and in Group B were taking food having
MADHURA, AMLA, LAVANA, KATU, KASHAYA, SAMA RASA. Madhura &
Lavana increases the Kapha Dosha & Kleda in the body. Specifically, excessive use
of Lavana Rasa is a cause for Kushtha. Study on Salivary electrolytes in psoriasis
concluded that there was elevation of salivary sodium levels in patients of psoriasis
and potassium levels correlated with severity of the disease. Hence Lavana (Salt)
should be restricted along with Madhura,
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 149
GUNA OF FOOD TAKEN
Maximum subjects 65% in Group A and 55% in Group B were taking food
of SNIGDHA GUNA.25% in GROUP A and 35% in GROUP B were taking food of
RUKSHA GUNA. As Atisnigdha Ahara have deprivating effect on agni, causes
Amlotpatti, Kledotpatti in dhatu and AtiRukshata is known to increase Vata and
subsequently psoriasis symptoms.
ADDICTION
Maximum subjects 85% in Group A and 85% in Group B were having no
addiction.10% had SMOKING in both the Groups. Tobacoo chewers constituted 5%
in both groups. Tobacco, smoking and alcohol indicated as aggravating factors which
supports the present data. "Specifically, patients who smoked more than a pack of
cigarettes (more than 20 cigarettes) daily had twice the risk of more severe psoriasis
compared with those who smoked ten cigarettes or less per day," the authors report
concluded, "Smoking is associated with the clinical severity of psoriasis and
highlights the importance of smoking cessation in patients with psoriasis." Specialists
consider that the toxins, which are ingredients in cigarettes, can negatively influence
the immune system, which may trigger the psoriasis mechanisms. The most striking
link between cigarette smoking and psoriasis has been established is Palmo-plantar
pustulosis.
SROTAS
Maximum subjects in i.e 90% in Group A and 95% in Group B are those with
predominant DUSHTHI of RAKTAVAHA SROTAS.There is an involvment of
UDAKAVAHA SROTAS in 5% subjects in both the Groups. Raktavaha Strotas Dusti
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 150
is the prime factor in the samprapti of Kustha and the same gets reflected in the
current study.
EFFECT OF THERAPIES
EFFECT ON SYMPTOMATOLOGY
In Group A, relief in ITCHING was 81.25%, REDNESS 81.81%, BURNING
76.92%, DESQUAMATION 83.58%, DRYNESS 82%, EPIDERMAL
THICKENING 82.22%. With relief in score of signs of AUSPITZ 70.37%, CANDLE
GREASE SIGN 78.94%, PASI SCORE 86.48% and KASI SCORE 85.64% was
observed.
Dinamallika (Cestrum diurnum) has utility in the treatment of Psoriasis and
other skin ailments. The leaves of Cestrum diurnum are known to contain Calcitriol a
naturally occurring active form of vitamin D3 and has been used for topical psoriasis
therapy in Europe and other parts of the world. Further, Calcitriol 3 microg/g
ointment has been extensively evaluated for the treatment of chronic plaque-type
psoriasis and has been shown to be effective, safe and well- tolerated in a number of
short-term and long-term clinical trials. Pharmacokinetic studies in patients with
psoriasis and healthy control subjects have demonstrated that topical calcitriol
ointment produces little systemic absorption of calcitriol and does not alter systemic
calcium homeostasis significantly even when applied to approximately one third of
the body surface area. Calcitriol ointment is associated with a low rate of cutaneous
irritation and does not increase the sensitivity of treated skin to phototoxicity
following treatment with ultraviolet treatment.
Further, the efficacy of utilizing naturally occurring calcitriol from Cestrum
diurnum L in the treatment of psoriasis has been ascertained clinically.
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 151
It is interesting to note that in recent times Ayurvedic practitioners have
started to show interest to employ the leaves of this plant in the treatment of different
skin ailments, of which it is found to be effective in the treatment of Psoriasis on
external application. Though the specific mechanism is unknown on the external
application of extract of the leaves reduce itching, roughness and scaling in psoriatic
patches. Keeping in view, the „day blooming nature‟ and the popular English name
“Day Jasmine” the plant can be named as “Dinamallika”.
Cestrum diurnum L plant leaves, stem bark has Tiktarasa (bitter taste),
Shitaguna (cold), Shlakshnaguna (smoothness), Shitavirya (cold potency), Katuvipaka
(pungent post assimilatory taste/change).
During the study all the attributes pertaining to Tikta-bitter taste viz., Chedana
(cutting apart the vitiated Doshas such as Kapha), Rocana (appetizing), Dipana
(stimulates), Shodhana (cleanses), therapeutic properties, alleviating Kandu (itching),
Kotha (tissue rotting), Trishna (thirst), Murcha (swooning) and Jvara (fever),
Stanyashodhana (cleanses breast milk), promoting the movement of Vit (faces), Mutra
(urine), Kleda (wetness), Medas (fat), Vasa (facia) and Puya (pus) etc., as described in
the classical texts of Ayurveda have been thoroughly observed and inferences were
drawn.
Based on the published literature pertaining to the efficacy of the plant as
fungicide and effective agent in the management of psoriasis it can be inferred that the
plant leaves have Kushtaharaprabhava (exclusive ability to treat skin ailments such as
Kitibha) on external application.
In Group B, relief in ITCHING 55.93%, REDNESS 43.63%, BURNING
35%, DESQUAMATION 46.55%, DRYNESS 44%, EPIDERMAL THICKENING
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 152
37.5%, With relief in score of signs of AUSPITZ 36%, CANDLE GROUPEASE
SIGN 35% , PASI SCORE 30.20% and KASI SCORE 24.05% was observed.
Streekutaja is used to treat psoriasis, nonspecific dermatitis and herpes. Its
astringent and antibacterial properties are beneficial in treating scalp disorders like
dandruff. Use of wrightia tinctoria for psoriasis is promoted by the Siddha system of
medicine- a traditional medical system originated in ancient South India. The wrightia
tinctoria leaf extracts in virgin coconut oil applied on affected body parts twice a day
to reduce scaling, lesions thickness, inflammation and skin redness.
Probable mode of action of Dinamallika (Cestrum diurnum) in psoriasis
The leaves of Cestrum diurnum are known to contain Calcitriol a naturally
occurring active form of vitamin D3 and has been used for topical psoriasis therapy in
Europe and other parts of the world. Further, Calcitriol 3 microg/g ointment has been
extensively evaluated for the treatment of chronic plaque-type psoriasis and has been
shown to be effective, safe and well- tolerated in several short-term and long-term
clinical trials. Based on the published literature pertaining to the efficacy of the plant
as effective agent in the management of psoriasis it can be inferred that the plant
leaves have Kushthahara prabhava (exclusive ability to treat skin ailments such as
Kitibha) on external application.
Total Effect of therapy
In GROUP A 14 SUBJECTS got 80-100% relief from symptoms and 6
subjects obtained 60-80% relief, while in GROUP B, 7 SUBJECTS got 40-60% and
13 subjects got 20-40% relief in symptoms
Discussion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 153
The signs and symptoms in Group-A Dinamallika (Cestrum diurnum) treated
patients showed better result than Group-B Streekutaja (Wrightia tinctoria). The
symptom of Kitibha Kushtha showed significant changes when compared between the
Before treatment and after treatment scores.
Results of the present study are encouraging and looking to the importance of
emerging problem of Psoriasis particularly in Indian society, there is need to conduct
long duration study on Psoriasis with large sample size and wide range of assessment
parameters.
Conclusion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 154
CONCLUSION
1. Kithibha kustha was similar to the psoriasis due to its maximum similarity in
chief symptoms. Though Kithibha kustha is considered as Kshudra Kushtha,
in the present scenario psoriasis is one of the severe skin disease which is
Krichhra Saadhya.
2. Psoriasis is a psychosomatic disease & one most triggering factor of this
disease is Stress. There is a strong correlation between etiopathogenesis of
psoriasis & stress.
3 Kithibha kustha (psoriasis) may be successfully managed by Dinamallika
(Cestrum diurnum) oil and Shrishwetakutaja (Wrightia tinctoria) oil.
4 The signs and symptoms in Group-A Dinamallika (Cestrum diurnum) treated
patients showed better result than Group-B Shrishwetakutaja (Wrightia
tinctoria). The symptom of Kitibha kustha were significantly relieved by the
two applications which is evident by comparing the before treatment and after
treatment scores.
5 In Group A, relief in ITCHING was 81.25%, REDNESS was relieved by
81.81%, BURNING by 76.92%, DESQUAMATION by 83.58%, DRYNESS
by 82%, EPIDERMAL THICKENING by 82.22%. Relief in score of signs of
AUSPITZ was 70.37%, CANDLE EASE SIGN - 78.94%, PASI SCORE -
86.48% and KASI SCORE - 85.64% was observed.
6 In Group B, relief in ITCHING was 55.93%, REDNESS was relieved by
43.63%, BURNING by 35%, DESQUAMATION by 46.55%, DRYNESS by
44%, EPIDERMAL THICKENING by 37.5%, The relief in score of
Conclusion
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with
special reference to Psoriasis” 155
AUSPITZ SIGN was 36%, CANDLE EASE SIGN - 35%, PASI SCORE -
30.20% and KASI SCORE - 24.05% was observed.
7 In GROUP A, 14 SUBJECTS got 80-100% relief from symptoms and 6
subjects got 60-80% relief. While in GROUP B, 7 SUBJECTS got 40-60%
and 13 subjects got 20-40% relief in symptoms. None of the patients
remained unchanged.
8 Results of the present study are encouraging and looking to the importance of
emerging problem of Psoriasis particularly in Indian society, there is a need
to conduct long duration study on Psoriasis with large sample size and wide
range of assessment parameters.
9 In both the groups after the treatment, it was observed that new lesions had
developed, in entirely new areas which again indicates that the continuous
aggravation spate of Doshas still exists and it gets directed to relatively newer
areas. Hence, to eliminate the Tvakgata Doshas and to prevent further
onslaught of Doshas, Shodhana therapy is absolutely necessary.
10 Though the present study was planned only with Bahya Shamana, the
advocation of concomitant diet definitely has helped controlling the Prakupita
Dosha and also preventing the perpetuation of samprapti. Thereby the
‘Nidana Parivarjana’ was accomplished.
References
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 159
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101. Formulary of Siddha Mwdicine, IMPCOPS, 4th
ed, Indian Medical
practitioners cooperative and pharmacy and stores limited 1993 Madras. Pp
546, Page no.13
Consent Form
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 170
MUNIYAL INSTITUTE OF AYURVEDA MEDICAL SCIENCES, MANIPAL.
DEPARTMENT OF P.G. STUDIES IN KAYA CHIKITSA
gÉÆÃVAiÀÄ ¸ÀªÀÄäw ¥ÀvÀæ/ Patient Consent Form
__________________ JA§ £Á£ÀÄ ¸ÉÆÃjAiÀiÁ¹¸ï gÉÆÃUÀzÀ ªÉÄïÉ
¢£ÀªÀÄ°èPÀ vÉÊ® ¥ÀæAiÉÆÃUÀzÀ ¥ÀjuÁªÀÄUÀ¼À CzsÀåAiÀÄ£À AiÉÆÃd£ÉAiÀÄ ¸ÁgÁA±ÀzÀ
«ªÀgÀuÉ ¥ÀqÉ¢zÀÄÝ ¸Àé EZÉѬÄAzÀ F AiÉÆÃd£ÉAiÀÄ°è M¼À¥ÀqÀ®Ä M¦àzÉÝãÉ. F
CzsÀåAiÀÄ£ÀzÀ°è £À£Àß ¨sÁUÀªÀ»¸ÀÄ«PÉ £À£ÀUÉ ¯Á¨sÀzÁAiÀÄPÀªÁUÀzÉ EgÀ§ºÀÄzÀÄ JAzÀÄ
£Á£ÀÄ w½¢zÉÝãÉ. EzÀgÀ GzÉÝñÀ ¸ÁzsÀPÀ ¨sÁzÀPÀUÀ¼À£ÀÄß £À£Àß vÀȦÛUÉ vÀPÀÌAvÉ £À£ÀUÉ
«ªÀj¸À®ànÖzÉ. F ªÀÄÆ®PÀ F AiÉÆÃd£ÉAiÀÄ°è M¼À¥ÀqÀ®Ä £Á£ÀÄ ¸ÀªÀÄäw
¸ÀÆa¸ÀÄwÛzÉÝãÉ. £Á£ÀÄ AiÀiÁªÀÅzÉà PÁgÀtªÀ£ÀÄß PÉÆqÀzÉ F AiÉÆÃd£É¬ÄAzÀ
AiÀiÁªÀÅzÉà ¸ÀAzÀ s̈ÀðzÀ°è »AzÉ §gÀĪÀ C¢üPÁgÀªÀ£ÀÄß ºÉÆA¢gÀĪÀ §UÉÎ w½¢zÉÝãÉ.
I …………………..…………………….. aged……………….……….. years
R/O………………………….. is exercising my free power of choice, hereby
give my consent to be included as a trial subject in the clinical research subject
“THE CLINICAL EVALUATION OF DINAMALLIKA- CESTRUM
DIURINUM OIL IN KITIBHA KUSHTA W.S.R. TO PSORIASIS’’. I
understand that I may be treated with drug for the disease with which I am
suffering. I have been informed to my satisfaction the aim, objective of the
clinical trial, ingredients of the trial drug treatment and follow up including
laboratory investigations to monitor and safeguard my body functions as and
when required. I am also aware of the right to opt out of the trial at any time
during the course of my treatment. I will not make any compensatory claim
for any hazardous effects on me during the treatment.
Date…………… Patient’s signature
Patient has signed the declaration and has given consent.
Signature of the research scholar
Ethical committee Clearance Letter
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 171
Ethical committee Clearance Letter
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 172
Ethical committee Clearance Letter
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 173
Ethical committee Clearance Letter
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 174
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 175
MUNIYAL INSTITUTE OF AYURVEDA MEDICAL SCIENCES, MANIPAL.
DEPARTMENT OF P.G. STUDIES IN KAYA CHIKITSA
Patient Inclusion/Exclusion Form Case Number : Name: Age: yrs Sex: M/F
Address:
Sl Patient details Criteria Eligible
Not
Eligible
01 Signed informed consent Required
02 Itching Present
03 Redness and Burning Present
04 Desquamation Yes
05 Dryness Yes
06 Epidermal thickening Yes
07 Auspitz sign Yes
08 Candle grease sign Yes
09 PASI scoring >
10
Affected Body Surface Area_______
< 50%
11 Age >15 years
12
Exfoliating dermatitis / psoriatic arthritis / atopic
dermatitis / seborrhoeic dermatitis No
13 No oral anti psoriatic Rx / Steroids last 6 weeks Yes
14 No topical application last 2 weeks Yes
15 Uncontrolled DM / HTN / Others* No
16 Inflammatory skin disorders No
The subject is accepted / rejected for the study
Randomized allocation : Cestrum group / Wrightia group
Serial number of the subject
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 176
MUNIYAL INSTITUTE OF AYURVEDA MEDICAL SCIENCES, MANIPAL.
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA
RESEARCH PROFORMA FOR THE STUDY ON KITIBHA
“THE CLINICAL EVALUATION OF „DINAMALLIKA – CESTRUM DIURINUM‟ OIL IN
KITIBA KUSHTA WITH SPECIAL REFERENCE TO PSORIASIS.”
SCHOLAR – DR. LAKSHMI PRASANNA
GUIDE: DR. SHRIPATHI ACHARYA CO-GUIDE: DR. VEERAJ HEGDE
I. PATIENT PROFORMA
GROUP – A(CESTRUM DIURINUM), B(WRIGHTIA TINCTORIA)
S. NO: DATE: DOA: DOD:
OPD NO: IP NO: BED NO:
NAME: AGE: years GENDER: M/F
Religion: H / M / C / J / Others Education: UE / P / HS / JC / UG / PG
Marital Status: M / UM / D / W Social Status : P / LM / M / UM / R
Place / Desha: U / R - JN / AN / SD Occupation:
Contact No: Email ID:
Address:
Treatment commenced: Treatment completed:
II. CHIEF COMPLAINTS (PRADHANA VEDHANA)
SYMPTOMS DURATION SITE
Matsya shakha lopam
Ruksha
Kina khara sparsa
Kandu
Parushya
Asita
III. ASSOCIATED COMPLAINTS
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 177
IV. HISTORY OF PRESENT ILLNESS
Onset Sudden / Gradual / Insidious
Duration Acute / Sub acute / Chronic
Site of onset Head / Neck / Face / Arms / Hands / Wrist / Palm / Trunk /
Legs/ Feet / Soles
Character
Course Continuous / Intermittent / Progressive / Waxing and Waning
Extent Head / Neck / Face / Arms / Hands / Wrist / Palm / Trunk /
Legs/ Feet / Soles
Colour
No. Of lesions At onset: At present:
Aggravating factors Chemicals / Dyes / Ornaments / Seasonal / Food / Dust /
Pollen / None
Relieving factors Present / Absent. Details :
V. HISTORY OF PAST ILLNESS
DISEASE PRESENT /
ABSENT
DURATION TREATMENT
DM
HTN
Bronchial
Asthma
Skin diseases
Others
VI. TREATMENT TAKEN SO FAR
TYPE MODE DURATION RESULTS
Ayurveda Shodhana / Shamana
Allopathy Oral / Parental / Ext.
App
Others
VII. FAMILY HISTORY
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 178
VIII. PERSONAL HISTORY
Appetite Good / Moderate / Poor
Diet Veg / Non Veg / Mixed / Fish / Masha / Madhu / Curds
Quantity Alpa / Pramitha / Sama / Athi
Habit Sama / Vishama / Adhyasana / Anasana
Agni Vishama / Theekshana / Manda / Sama
kosta Mrudhu/ Madhayama/ Krura
Rasa of food taken M / A / L / K / T / KS / Sama
Guna of food taken Ruksha / Snigdha / Ushna / Sita / Guru / Laghu
Allegy to specific food
Mictirition Scanty / Free / Burning / Dysuria / Retention
Frequency: Day____times, Night_____ times
Bowels Regular / Constipated / ______________
Water intake
Nature of work Manual labour / Sedentary / Travelling / Walking /
Standing / Sitting / Stressful / Day / Night
Rest Hours Adequate / Inadequate / Excessive
Exercise No / Less / Adequate / Excessive / Irregular / Routine
work
Sleep Sound / Disturbed / Delayed / Awake at nights / ____
hours
OTHERS
IX. ADDICTIONS
HABIT DURATION REGULAR /
OCCASIONAL
REMARKS
Smoking
Alcohol
Tobacco
Snuff
Others
X. GYNAEC-OBS HISTORY
GYNAECOLOGICAL HISTORY
Menarche
Menopause
Menstrual cycle Regular / Irregular / Painful / _________ days
OBSTETRIC HISTORY P ____ G ____ L ____ D ____ A ____
H / O contraception Present / Absent
Temporary Mechanical / Chemical / Oral / Local / IUCD
Permanent Tubectomy / Hysterectomy
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 179
XI. VITAL SIGNS
Pulse
Blood Pressure
Temperature
Heart rate
Resp. Rate
XII. GENERAL EXAMINATION
Built Slender / Muscular / Obese Ht: _____ cms, Wt: ______ kgs
Nourishment Good / Fair / Poor
Nails Pink / Pallor / Bluish
Conjunctiva Pink / Pallor / Bluish
Cyanosis Present / Absent , Remarks -
Oedema Present / Absent , Pitting / Non pitting, Remarks:
JVP
Lymph nodes Present / Absent , Remarks -
XIII. SYSTEMIC EXAMINATION
SYSTEM FINDINGS
Respiratory
Cardio vascular
GIT
Urino genital
Musculo skeletal
XIV. DASHAVIDHA PAREEKSHA
Prakrithi V / P / K / VP / PK / KV / KP / VK / S
Vikrithi V / P / K
Satva P / M / A
Sara P / M / A
Samhanana P / M / A
Pramana P / M / A
Satmya P / M / A
Ahara sakthi Jarana Sakthi : P / M / A
Abhya varna sakthi : P / M / A
Vyayama sakthi P / M / A
Vaya Bala / Madhyama / Vridha
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 180
XV. SROTO PAREEKSHA PRANAVAHA
UDAKAVAHA
ANNAVAHA
RASAVAHA
RAKTHAVAHA
MAMSAVAHA
MEDHOVAHA
ASTHIVAHA
MAJJAVAHA
SUKRAVAHA
MOOTHRAVAHA
PUREESHAVAHA
XVI. SKIN
A Colour
1 Normal Black / Grey / Greyish white / White
2 Abnormal Erythematous / Pinkish / Bluish (Raktha / Aruna / Shyava)
B Appearance Rooksha / Parusha / Khara / Sthira / Utseda / Snigdha
C Lesion
1 Character Macule / Papule / Plaque / Nodule / Lichen /
Other____________
2 Scales Yes / No, Colour : ___________, Powder / Flake / Dry /
Moist
3 Itching Yes / No, Day / Night / Both
4 Discharge Yes / No, Colour: White / Red / Watery, Pus / Blood / Clear
5 Area affected Scalp / Face / Neck / Trunk / Hands / Wrists / Ankles / Feet /
Fingers / Toes / Soles / Palms
6 Distribution Symmetrical / Asymmetrical / Flexor / Extensor / Exposed
body part / Unexposed body part
7 Superficial
sensation
Normal / Anesthesia / Parasthesia
8 Associated with Pain / Swelling / Inflammation / Ulcers / Others __________
D Others
1 Confirmatory
signs
Candle grease sign / Auspitz‟s sign / Koebner phenomenon
2 Nails Normal / Clubbing / Koilonychia / Pitting / Onycholysis
3 Hairs Colour : _____________, Distribution :
_________________
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 181
XVII. INVESTIGATIONS
PARAMETERS BEFORE TREATMENT AFTER TREATMENT
HB
TC
DC
ESR
RBS
B. Urea
S.Creatinine
Urine Analysis
Albumin
Sugar
Microscopic Examination
Epithilial cells
Pus cells
RBC
Casts, crystals, etc.
XVIII. SCORING
SCORE 1ST
DAY 15TH
DAY
30TH
DAY
45TH
DAY
61ST
DAY
90TH
DAY
PASI
KASI
XIX. TREATMENT Group A
Sample size 20 patients
Intervention drug Dinamallika taila
Dose External application bid
Treatment duration 60 days Group B
Sample size 20 patients
Intervention drug Streekutaja taila
Dose External application bid
Treatment duration 60 days
Group A: Patients of the Group A shall be treated with Dinamallika patra taila external application twice daily for a period of 60 days. Observations shall be
made and recorded before treatment. The changes with the treatment shall be
observed and recorded on 15th, 30th and 45th day in the proforma of Case
Sheet prepared for the study
Group B: Patients of the Group B shall be treated with Streekutaja taila external application twice daily for a period of 60 days. Observations shall be
made and recorded before treatment. The changes with the treatment shall be
observed and recorded on 15th, 30th and 45th day in the proforma of Case
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 182
Sheet prepared for the study. A period of 30 days after the course of treatment
shall be fixed for observation regarding the recurrences in cases where total
relief was observed.
The observations regarding recurrences if any shall also be recorded in the proforma of Case Sheet.
Duration: 60 days
XX. ADVERSE REACTIONS DURING TREATMENT
YES/ NO
If Yes Details
Signature of scholar Signature of co-guide
Signature of guide
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 183
I. PASI SCORING
Head Arms
Area
0% <10% 10-29%
30-49% 50-69% 70-
89% 90-100%
0% <10% 10-29%
30-49% 50-69% 70-
89% 90-100%
Erythema
(redness) 0 1 2 3
4
0 1 2
3 4
Induration
(thickness)
0 1 2
3 4
0 1 2
3 4
Desquamation
(scaling)
0 1 2
3 4
0 1 2
3 4
Trunk Legs
Area
0% <10% 10-29%
30-49% 50-69% 70-
89% 90-100%
0% <10% 10-29%
30-49% 50-69% 70-
89% 90-100%
Erythema
(redness)
0 1 2
3 4
0 1 2
3 4
Induration
(thickness)
0 1 2
3 4
0 1 2
3 4
Desquamation
(scaling)
0 1 2
3 4
0 1 2
3 4
Proforma Prototype
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 184
II. KASI SCORING
Head Arms
Area
0% <10% 10-29%
30-49% 50-69% 70-89%
90-100%
0% <10% 10-29%
30-49% 50-69% 70-89%
90-100%
Shoola 0 1 2 3 4
0 1 2 3 4
Daha 0 1 2 3 4 0 1 2 3 4
Kandu 0 1 2 3 4 0 1 2 3 4
Shyava 0 1 2 3 4 0 1 2 3 4
Raga 0 1 2 3 4 0 1 2 3 4
Shwaithya 0 1 2 3 4 0 1 2 3 4
Raukshya 0 1 2 3 4 0 1 2 3 4
Srava 0 1 2 3 4 0 1 2 3 4
Utseda 0 1 2 3 4 0 1 2 3 4
Trunk Legs
Area
0% <10% 10-29%
30-49% 50-69% 70-89%
90-100%
0% <10% 10-29%
30-49% 50-69% 70-89%
90-100%
Shoola 0 1 2 3 4
0 1 2 3 4
Daha 0 1 2 3 4 0 1 2 3 4
Kandu 0 1 2 3 4 0 1 2 3 4
Shyava 0 1 2 3 4 0 1 2 3 4
Raga 0 1 2 3 4 0 1 2 3 4
Shwaithya 0 1 2 3 4 0 1 2 3 4
Raukshya 0 1 2 3 4 0 1 2 3 4
Srava 0 1 2 3 4 0 1 2 3 4
Utseda 0 1 2 3 4 0 1 2 3 4
Annexures
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 203
DINAMALLIKA
STREEKUTAJA
Annexures
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 204
Patients before and after treatment – Group A
Before treatment After treatment
Annexures
“Clinical evaluation of “Dinamallika- Cestrum Diurnum” oil in Kitibha Kustha with special reference to Psoriasis” 205
Patients before and after treatment – Group B
Before treatment After treatment
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