“clinical evaluation of “dinamallika- cestrum

“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

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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


GENDER DISTRIBUTION

90


OCCUPATION WISE DISTRIBUTION

91


MARITAL STATUS WISE DISTRIBUTION

92


RELIGION WISE DISTRIBUTION

93

7. STATUS OF 40 SUBJECTS OF PSORIASIS – SOCIO-

ECONOMIC STATUS

94


EDUCATION WISE DISTRIBUTION

95


APPETITE

96

10. STATUS OF 40 SUBJECTS OF PSORIASIS – DIET 97


QUANTITY OF FOOD TAKEN

98

ix

12. STATUS OF 40 SUBJECTS OF PSORIASIS – AGNI 99


KOSTHA

100


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


DURATION OF DISEASE

105

19. STATUS OF 40 SUBJECTS OF PSORIASIS – SITE

OF ONSET OF DISEASE

106


COURSE OF DISEASE

107


AGGRAVATING FACTORS

108


RELIEVING FACTORS

109


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


ADDICTION

113


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


BURNING

120

33. BURNING (COMPARISON) 121


DESQUAMATION

122

35. DESQUAMATION (COMPARISON) 123


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



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



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



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



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



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



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



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).




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




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




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).




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.




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




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




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

.




• 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




(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




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.




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




• 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 - - - + -




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.




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 - + + - -




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




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.




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.




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 - - - + -




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 - - - + -




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




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.




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




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




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




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.




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.




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




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




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.




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.




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.




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.




• 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




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.




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.




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.




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.




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




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.




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




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




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.




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




(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.




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.




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




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




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,




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.




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.




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

.




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

.




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).




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.




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.




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




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




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.




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




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.




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.




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.




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.




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



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



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



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



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



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



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



• 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



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



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



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



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



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



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




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


processed further by subjection to varied statistical methods and presented with

tabular form in the following sequence.

Methodology



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



OBSERVATION AND RESULTS



REFERENCE TO PSORIASIS”, is conducted on 40 patients from OPD and IPD of

Muniyal Institute of Ayurveda Medical Sciences and Hospital, Manipal and from


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




The taila was applied locally two times a day, in the morning and evening;

every day for 60 days.




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




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




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




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




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




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




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




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




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




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


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




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


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




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 %


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




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




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




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


FIGURE: 16

0%

10%

20%

30%

40%

50%

60%

70%

pravara madhyama avara

sara GR A

sara GR B




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 %


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




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 %


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




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




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%


PROGRESSIVE nature of disease followed by CONTINUOUS 35% and 40% in


FIGURE: 20

0%

10%

20%

30%

40%

50%

60%

continuous intermittent progressive waxing andwaning

course GR A

course GR B




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




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




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




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




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




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




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




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 ** *** ***




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




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




TABLE NO- 36

EFFECT ON SYMPTOMS OF PSORIASIS - REDNESS


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


In Group B, before treatment, Mean was 2.75 and after treatment, Mean was


FIGURE: 30

0

0.5

1

1.5

2

2.5

3

3.5


REDNESS

Mean GR A

Mean GR B




TABLE NO - 37

REDNESS (COMPARISON)

GROUP A GROUP B

Mean 2.7 1.2

Median 3 1


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




TABLE NO- 38

EFFECT ON SYMPTOMS OF PSORIASIS - BURNING


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




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


BURNING

Mean GR A

Mean GR B




TABLE NO - 39

BURNING (COMPARISON)

GROUP A GROUP B

Mean 1.5 0.7

Median 1 0


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


FIGURE: 33

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

GR A GR B

BURNING

Mean




TABLE NO- 40

EFFECT ON SYMPTOMS OF PSORIASIS - DESQUAMATION


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 ** *** ***





FIGURE: 34

00.5

11.5

22.5

33.5

4


DESQUAMATION

Mean GR A

Mean GR B




TABLE NO - 41

DESQUAMATION (COMPARISON)

GROUP A GROUP B

Mean 2.8 1.35

Median 3 1


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


FIGURE: 35

0

0.5

1

1.5

2

2.5

3

GR A GR B

DESQUAMATION

Mean




TABLE NO - 42

EFFECT ON SYMPTOMS OF PSORIASIS - DRYNESS


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 ** ***




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


DRYNESS

Mean GR A

Mean GR B




TABLE NO - 43

DRYNESS (COMPARISON)

GROUP A GOUPR B

Mean 2.05 1.1

Median 2 1


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




TABLE NO- 44

EFFECT ON SYMPTOMS OF PSORIASIS – EPIDERMAL THICKENING


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 * **




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



Mean GR A

Mean GR B




TABLE NO - 45

EPIDERMAL THICKENING (COMPARISON)

GROUP A GROUP B

Mean 1.85 0.75

Median 2 1


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


Mean




TABLE NO- 46

EFFECT ON SYMPTOMS OF PSORIASIS – AUSPITZ SIGN


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


In Gr B, before treatment, Mean was 1.25 and after treatment, Mean was


FIGURE: 40

00.20.40.60.8

11.21.41.6


AUSPITZ SIGN

Mean GR A

Mean GR B




TABLE NO - 47

AUSPITZ SIGN (COMPARISON)

GROUP A GROUP B

Mean 0.95 0.45

Median 1 0


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




TABLE NO- 48

EFFECT ON SYMPTOMS OF PSORIASIS – CANDLE GREASE SIGN


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 *


found 0.4, whose p value summary is highly significant. (means p <0.0001)



FIGURE: 42

0

0.5

1

1.5

2

2.5


CANDLE GREASE SIGN

Mean GR A

Mean GR B




TABLE NO - 49

CANDLE GREASE SIGN (COMPARISON)

GROUP A GROUP B

Mean 1.5 0.7

Median 1 1


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




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




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




TABLE NO - 51

PASI SCORE (COMPARISON)

GROUP A GROUP B

Mean 15.48 2.655

Median 9.2 1.35


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




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).


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




TABLE NO - 53

KASI SCORE (COMPARISON)

GROUP A GROUP B

Mean 26.65 3.685

Median 13.5 2.75


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




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




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




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


patients showed better result than Group-B Shrishwetakutaja (Wrightia tinctoria). The

symptom of Kitibha kustha showed significant changes when compared between the


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



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



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



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



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.



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



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




Discussion



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



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



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



SATVA


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


MADHYAMA SARA followed by PRAVARA and AVARA 10% and 10% in

both the Groups A and B respectively.

ONSET OF DISEASE


GRADUAL ONSET of disease followed by SUDDEN 40% and 45% in both the

Groups A and B respectively.

DURATION OF DISEASE


ACUTE onset of disease followed by SUBACUTE35% and 30% in both the

Groups A and B respectively.

Discussion



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


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



DIET HABIT-

APPETITE, VEG, NON-VEG, QUANTITY


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.


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



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



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



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



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




patients showed better result than Group-B Streekutaja (Wrightia tinctoria). The

symptom of Kitibha Kushtha showed significant changes when compared between the


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



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



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.

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1990; 29:401-10.

90. http://www.ncbi.nlm.nih.gov/pubmed/15153885 (accessed on 26/3/2016)

91. Colledge Nieki R, Walker Brian R, Ralson Stuart H, eds. Davidson’s Principles


1267.

http://www.ncbi.nlm.nih.gov/pubmed/15153885

References


92. Francis, John K. ed. 2004. Wildland shrubs of the United States and its

Territories: thamnic descriptions: volume 1. Gen. Tech. Rep. IITF-GTR-26.

San Juan, PR: U.S. Department of Agriculture, Forest Service, International

Institute of Tropical Forestry, and Fort Collins, CO: U.S. Department of

Agriculture, Forest Service, Rocky Mountain Research Station. 830 p. 184


Cestrum diurnum L, International Journal of Ayurved and Pharma Research,

Vol 4, Issue II, Saketh Ram T, Ramakrishna V, Ayurvedic Pharmaco-

therapeutic adoption of Cestrum diurnum L. , International Journal of

Ayurveda and Pharma Research, Vol 4, Issue II, February 2016





work





Vol 4, Issue II, February 2016

98. Modhvadia, Avdabhai R., 2009, “A Contribution to Ethnobotany of Mehsana

District, North Gujarat”, thesis PhD, Saurashtra University pp.111

[http://etheses.saurashtrauniversity.edu/id/eprint/607]

References



Cestrum diurnum L., International Journal of Ayurved and Pharma Research,





101. Formulary of Siddha Mwdicine, IMPCOPS, 4th

ed, Indian Medical

practitioners cooperative and pharmacy and stores limited 1993 Madras. Pp

546, Page no.13

References


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issue6; spage595; epage601; aulast=Dogra (accessed on 26/3/2016)

3. http:// www. ehealthmd.com/library/psoriasis/pso_treatment, 14-4-2010. p. 1

4. http://www.psoriasisguide.com (26.03.2016) www.ayujournal.org, july2o11,

vol.32, p333

5. Srikanthamurthy K.R.Ashtanga sangraha of Vagbhata vol.1. 3rd

ed.Varanasi;Chaukhambha orientalia; 2000.p.402

6. Sushrutha. Yadavji Trikamji Acharya, editor. Sushrutha Samhita. Sushrutha

with the Nibandha Sangraha commentary by Dalhana. Varanasi: Chaukambha

Krishnadas Academy; 2002. Pp- 824. p- 443








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Research, Vol 4, Issue II, February 2016


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Sanskrit sansthan publishers 2001 Varanasi. Pp 738, Page no 227


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18. Agni purana, Maharshi Vedavyasa 1st ed. Acharya Baladev Upadhyaya,

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34. Anjana Nidana, Sri Brahmashankar Mishra. Jayakrishnadas Haridas gupta

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35. Gada Nigraha of Sri Vaidya Shodhala Part II, Sri Indradev Tripathi 3rd

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Choukambha Sanskrit sansthana publishers, 1999 Varanasi Pp: 891Page No:

768-769

36. Bhaishajya Ratnavali, Sri Ambikadatta shastri, Choukambha Sanskrit

sansthana publishers, Varanasi Pp: 891 Page No: 618-619

37. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana ,

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40. Bhattoji Dikshta, Siddanta kaumudi, translated and commented by

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42. Joshi Jayashankara, Halayudha kosha, lucknow: uttarpradesh hindi

samsthan,3rd edition, 1993, Pp. 746 p. 237

43. Sushruta, Sushruta Samhita, Acharya Jadavji Trikamji, 7th ed. Choukambha


44. Vagbhata, Ashtangahrdayam, Sarvanga Sundari commentary of Arunadatta

and Ayurveda Rasayana commentary of Hemadri, Edited by Bhishagacharya

Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha

Orientalia; 2005, Pp.956; p. 524

45. Harita, Harita Samhita, with Nirmala Hindi commentary, Edited and translated

by Vaidya Jaymini Pandey, Varanasi:Chaukambha Vishvabharati, 2010;

Pp.544; p.430

46. Bhela, Bhela Samhita, Edited by Prof. P.V Sharma, Varanasi: Choukhambha

Vishvabharati, Reprint 2000; Pp.660; p.327.



in 2000; Pp.364, p116.










References





52. Sushruta, Sushruta Samhita, with Nibhandha Sangraha commentary by

Dalhana, foreword by Acharya Yadavji Trikamji. 8th edition. Varanasi;

Choukhamba Sanskrit Sansthan; 2005. Pp.824; p.288-289.

53. Shabdakalpadhruma, Raja Radhakant Dev, Bahyadarena, Dwitiya khanda,

Nag publishers 1988 Pp: 937 Page No: 126

54. Amarakosha, Ramasrami commentary of Bhanuji dikshit, 3rd

ed. Pt,

Haragovinda shastri, Choukambha Sanskrit sansthan publishers 1997

Varanasi. Pp 738, Page no: 239.






ed. Choukambha



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no. 524



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64. vangasena


ed. Choukambha



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9th


no. 525



in 2000; Pp.364, p331.



No: 526


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no. 525





in 2000; Pp.364, p332.


9th


no. 524


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ed. Choukambha



ed. Choukambha



ed. Choukambha

Sanskrit sansthan publishers 2001 Varanasi. Pp 738, Page no: 452 - 458


ed. Choukambha

orientalia publishers 2002 Varanasi. Pp: 824, Page no:442 - 448

81. Sharangadhara. Translated by Himasagara Chandra Murthy. Sharangadhara

Samhita. Varanasi: Chaukambha Sanskrit Series Office; 2010. Pp- 454. P 343.

References



9th


no. 711





ed. Choukambha


85. Text book of Dermatology, R.H.Champion 6 th ed. 1992 Pp: 3683. Blackwell

sciences publishers

86. Practice of Dermatology, P.N.Bhel, Director, skin institute and school of

dermatology, New delhi, 5th

ed. B.K.Sarkar publishers, allied book agency

1982, cculcutta.

87. ColledgeNieki R, Walker Brian R,Ralson Stuart H, eds. Davidson’s Principles


1267.

88. Lita Lee, Ph.D. Psoriasis, causes and nutritional support,

http://www.litalee.com/favicon.ico

89. Boyd AS, Neldna KH. The isomorphic response of koebner. Int J Dermatol

1990; 29:401-10.

90. http://www.ncbi.nlm.nih.gov/pubmed/15153885 (accessed on 26/3/2016)

91. Colledge Nieki R, Walker Brian R, Ralson Stuart H, eds. Davidson’s Principles


1267.

http://www.ncbi.nlm.nih.gov/pubmed/15153885

References


92. Francis, John K. ed. 2004. Wildland shrubs of the United States and its

Territories: thamnic descriptions: volume 1. Gen. Tech. Rep. IITF-GTR-26.

San Juan, PR: U.S. Department of Agriculture, Forest Service, International

Institute of Tropical Forestry, and Fort Collins, CO: U.S. Department of

Agriculture, Forest Service, Rocky Mountain Research Station. 830 p. 184



Vol 4, Issue II, Saketh Ram T, Ramakrishna V, Ayurvedic Pharmaco-

therapeutic adoption of Cestrum diurnum L. , International Journal of

Ayurveda and Pharma Research, Vol 4, Issue II, February 2016





work






98. Modhvadia, Avdabhai R., 2009, “A Contribution to Ethnobotany of Mehsana

District, North Gujarat”, thesis PhD, Saurashtra University pp.111

[http://etheses.saurashtrauniversity.edu/id/eprint/607]

References



Cestrum diurnum L., International Journal of Ayurved and Pharma Research,





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


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 ªÉÄÃ¯É

¢£ÀªÀÄ°èPÀ vÉÊ® ¥ÀæAiÉÆÃUÀzÀ ¥ÀjuÁªÀÄUÀ¼À CzsÀåAiÀÄ£À AiÉÆÃd£ÉAiÀÄ ¸ÁgÁA±ÀzÀ

«ªÀgÀuÉ ¥ÀqÉ¢zÀÄÝ ¸Àé EZÉÑ¬ÄAzÀ F AiÉÆÃd£ÉAiÀÄ°è M¼À¥ÀqÀ®Ä M¦àzÉÝÃ£É. F

CzsÀåAiÀÄ£ÀzÀ°è £À£Àß ¨sÁUÀªÀ»¸ÀÄ«PÉ £À£ÀUÉ ¯Á¨sÀzÁAiÀÄPÀªÁUÀzÉ EgÀ§ºÀÄzÀÄ JAzÀÄ

£Á£ÀÄ w½¢zÉÝÃ£É. EzÀgÀ GzÉÝÃ±À ¸ÁzsÀPÀ ¨sÁzÀPÀUÀ¼À£ÀÄß £À£Àß vÀÈ¦ÛUÉ vÀPÀÌAvÉ £À£ÀUÉ

«ªÀj¸À®ànÖzÉ. F ªÀÄÆ®PÀ F AiÉÆÃd£ÉAiÀÄ°è M¼À¥ÀqÀ®Ä £Á£ÀÄ ¸ÀªÀÄäw

¸ÀÆa¸ÀÄwÛzÉÝÃ£É. £Á£ÀÄ AiÀiÁªÀÅzÉÃ PÁgÀtªÀ£ÀÄß PÉÆqÀzÉ F AiÉÆÃd£É¬ÄAzÀ

AiÀiÁªÀÅzÉÃ ¸ÀAzÀ s̈ÀðzÀ°è »AzÉ §gÀÄªÀ C¢üPÁgÀªÀ£ÀÄß ºÉÆA¢gÀÄªÀ §UÉÎ w½¢zÉÝÃ£É.

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


Proforma Prototype



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



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


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


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


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


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


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


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


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


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


DINAMALLIKA

STREEKUTAJA

Annexures


Patients before and after treatment – Group A

Before treatment After treatment

Annexures


Patients before and after treatment – Group B

Before treatment After treatment

“clinical evaluation of “dinamallika- cestrum

Documents