INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE Bi-Monthly Peer Reviewed International Journal

- 2348-0173 Vol-2 / Issue - 6 / Nov - Dec - 2014 Free Full Text @ www.ijaam.org I J A A M www.ijaam.org INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE Bi-Monthly Peer Reviewed International Journal

RESEARCH ARTICLE 2348-0173 CLINICAL STUDY OF VAMAN KARMA & STREE KUTAJ OIL IN THE MANAGEMENT OF EKA-KUSTHA VIS-A-VIS PSORIASIS Pravin Kumar Rai 1*, Shikha Sharma 2, Ajay Saxena 3, Gyanendra Dutt Shukla 4, Priyanka Pandey 5, Dr. Sanjay Kumar 6 1. Lecturer, Dept. of Panchakarma, J.D. Ayurved Medical College & Hospital, Bhankari, Aligarh (U.P.), Contact no.- +917042167237, E-mail: drpravinrai16@gmail.com 2. Lecturer, Dept. of Prasooti Tantra & Stree Rog, J. D. Ayurved Medical College & Hospital, Bhankari, Aligarh (U.P.), Contact no.- +918743976379, E-mail: drshikhasharma1982@gmail.com 3. Consultant, Department of AYUSH, New Delhi, Contact no.- +918010517819, E-mail: drajaysaxena1127@gmail.com 4. Medical Officer, Rishikul PG Ayurvedic Medical College & Hospital, Haridwar, Uttarakahand, Contact no.- +918791265576, E-mail: dr.gdshukla@gmail.com 5. Medical officer, CGHS wellness centre, Devnagar, New Delhi, Contact no.-+918010547182, E-mail: drajaysaxena1127@gmail.com 6. Medical Officer, U. P. Government, Akbarpur, Contact no.-+919760790471, E-mail: shipra_elma@rediffmail.com Article Received on - 22 nd Nov 2014 Article Revised on - 26 th Nov 2014 Article Revised on - 1 st Dec 2014 Article Accepted on - 3 rd Dec 2014 All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non commercial purpose (see copyright notice below). (Full Text Available @ www.ijaam.org) Page33 2013 IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_us), which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

RESEARCH ARTICLE 2348-0173 CLINICAL STUDY OF VAMAN KARMA & STREE KUTAJ OIL IN THE MANAGEMENT OF EKA-KUSTHA VIS-A-VIS PSORIASIS *Corresponding Author Pravin Kumar Rai Lecturer, Dept. of Panchakarma, J.D. Ayurved Medical College & Hospital, Bhankari, Aligarh (U.P.), Contact No.- +917042167237, E-mail: drpravinrai16@gmail.com QR Code IJAAM ABSTRACT: Skin is an organ of the integumentary system made up of multiple layers of ectodermic tissue, and guards the underlying muscles, bones, ligaments and internal organs. It is the first organ of the body interacting with the environmental agents like physical, chemical and biological agents. Variations in the environmental stimuli and natural ability of body to deal with these factors result in spontaneous remissions and relapses. Eka-kustha can be correlated with Psoriasis in Ayurvedic perspective. Eka-kushtha (Psoriasis) is an important disease not because it kills or cripples, since it does not, but because skin damaging is common and the lesions it causes seriously produce feeling of unsightliness, lowered self esteem and feeling of socially out cost. It has got its own social stigma in society also. Eka-kushtha (Psoriasis) is one of the common dermatological problems in India. Psoriasis is a common chronic genetically determined, inflammatory and proliferative disease of skin. Total 15 patients were randomly selected from O.P.D. and I.P.D. of Panchkarma P.G. Department, Rishikul Govt. Ayurvedic P.G. College & Hospital, Hardwar, Uttarakhand, for the purpose of clinical trials of present study. After full observation of therapies, it was found that no. of patient unchanged was 0, whereas, observed mild improvement was found in 2 patients (13.3 %), moderate improvement in 4 patients (26.67 %) and marked improvement was observed in 9 patients (40 %). Key Words: Psoriasis, Ek-kustha, Vaman Karma, Stree Kutaj INTRODUCTION Psoriasis is a common, chronic, relapsing / remitting, immune mediated skin disease characterized by red, scaly patches, papules, and plaques, which usually itch [1]. The skin lesions seen in psoriasis may vary in severity from minor localized patches to complete body coverage. The disease affects 2 4% of the general population [2]. In one research positive family history of psoriasis was reported in 14% of their patients [3] while another study reported family history in only 2% of their patients [4]. the study. The patients of infectious diseases like Syphilis, Gonorrhoea were also excluded. Inclusion Criteria For diagnosis characteristic history, presentations of the patients and through clinical examination were taken into consideration. The patients of localized and generalized Psoriasis both were included in the study. The patients of age group from 7 year to 75 years were taken in the study amongst them male and female both were included. Eka-kushtha (Psoriasis) is a skin ailment and is described in Ayurvedic text under Kushtha. Ekakushtha is stated to be Tridoshaja with the dominance of Kapha- Vata Dosha [5]. Bruhat Trayi have mentioned the Shodhana Chikitsa followed by Samshaman therapy for Kustha. Among Shodhanas, Vaman and Virechana are the best for Kustha. MATERIAL & METHODS: Exclusion Criteria The patients having complicated symptoms and controversial diagnosis were discarded. The patients having active hepatic and renal disorders, endocrinal disorders like Thyrotoxicosis, Diabetes mellitus, exfoliative dermatitis were not taken in Criteria for selection of therapies along with their constituents: In Ayurvedic classics, the various drugs have been indicated for different skin diseases. The authentic background is the basic criteria for selection of the drug. The Kutaja is one of them. In Sushruta Sutrasthana chapter 38/6 in Aragvadhadigana has claimed the Kutaja as-kushthaghna, Vranashodhaka and Kandughna. In Charaka samhita Chikitsa sthana 7/43 Kutaja beej (Indrayava) used in the Vamana Karma and Sutrasthana 3/14 Kutaja is used for skin diseases. Also in Charaka Sutrasthana 3/15-16 the bark of Kutaja is used along with some other ingredients for the Kushtha (skin disease). In addition to above Page34

mentioned reference the Kutaja is one of the ingredients of the various formulations which are used in the skin diseases. The information received from experience of physicians doing practice of traditional herbal medicine is also a basis for selection of drug. The Kutaja is also used as Folklore remedy for skin disease in South India and some parts of Northern India. The Siddha system of medicine in Madras has also claimed that the Stree Kutaja (Kutaja Bheda-Wrightia tinctoria) is effective in the management of Psoriasis, and they are using this with encouraging results [6]. Selection of the patients: Total 15 patients were randomly selected from O.P.D. and I.P.D. of Panchkarma P.G. Department, Rishikul Govt. Ayurvedic P.G. College & Hospital, Hardwar, Uttarakhand, for the purpose of clinical trials of present study. The patients were randomly selected regardless their age, sex, socioeconomic status, marital status etc. but they were fully gratifying the criteria of diagnosis of Psoriasis in modern medicine as well as clinical features of Eka-kustha as in Ayurvedic literatures. Details of therapy Patients of the group were treated with Vamana Karma and trial oil (Stree Kutaj). The Vamana Karma has been selected on the basis of classical references. Vamana-Karma is well known for its Kapha-Shodhan therapy and also for skin diseases. The Vamana Karma has been done as mentioned in Ayurvedic classic for Vamana Karma on followup followed by Shamana therapy with Stree-Kutaj oil. Patients of the group were admitted and treated at indoor level for initial 15 days of Vamana Karma. The admitted patients were subjected to Snehana Karma with Panchatikta Ghrit for 7 days followed by Vamana Karma on 9th day. 2. Yastimadhu Churna = 5-10 gm 3. Kutaja Beej Churna = 3-5 gm 4. Madhu as required 5. Saindhava = 5 gm Contents of other requirements 1. Milk = 3 litres 2. Chhoti Ela = 5 gm 3. Nimba Twaka Kwath = 1 liter 4. Saline water = 5 liters. All the contents of Vamana Karma mixed well in a Khalva Yantra and Kalka was made. Then patient has been advised to take milk (half liter) and after Mangala Mantra Uccharana, Kalka has been given to the patient. Patient is advised to take rest till observing nausea and sweating on forehead. Vegas of Vamana Karma have been observed till Samyaka Vamana Lakshanas/ Pittannta Vamana. Duration of Treatment: The duration of treatment was fixed for 3 months. The patients were instructed to stop all the medications except the trial drug. The Pathya and Apathya were also directed to the patients. The patients were advised: To avoid the use of soap. To use the Gram flour for bathing purpose. To avoid the use of synthetic apparel. Not to use the common allergens in their diet like-fish, brinjal, tomato and curd. To use less salt in their diet and also the diet should be low fat and protein rich. To avoid the stressful conditions. Clinical assessment of diseases: It has been employed in numerous clinical trials to assess difference before and after treatment in a fairy rigorous and consistent manner that is reproducible between investigators and centers. The four main anatomic sites are assessed: Purvakarma of Vamana Karma: The Vamana Karma has been indicated in all the patients of Psoriasis after observing Samyaka Snehana symptoms. After completion of Snehana Karma on 7th day on 8th day patient was advised for Snehana and Swedana at morning and taking Kapha-Vardhaka Ahaara and mild laxative at night. At morning of 9 th days, Vamana Karma was done after passing urine and stool. Contents of Vamana Karma: Vamana Karma was induced with the help of following drugs: 1. Madana Phala Pippali Churna = 10-15 gm The head (h), upper extremities (u), trunk (t) and lower extremities (l) roughly corresponding to 10, 20, 30 and 40 of body surface area (BSA), respectively. PASI [7] (Psoriasis area and severity index) was introduced for studies of synthetic retinoid in 1978. The PASI score is calculated from- PASI = 0.1 (E h + I h + S h) A h + 0.2 (E u + I u + S u) A u + 0.3 (E t + I t + S t) A t + 0.4 (E l + L l+ S I)A I. Where E = Erythema, I = Induration, S = Scaling or Desquamation and A = Area. E, I and D are assessed according to a 4 point scale where Page35

0 = No Symptoms. 1 = Slight 2 = Moderate 3 = Marked 4 = Very marked A is assigned a numerical value based on the extent of lesion in a given anatomic site 1 (< 10%) 2 (10-29%) 3 (30-49%) 4 (50-69%) 5 (70-89%) 6. (90-100%) The PASI score varies in steps of 0.1 units from 0.0 to 72.0, the highest score represents completed erythroderma of the severest possible degree. Scoring criteria for itching: 0 = No Itching 1 = Mild Itching 2 = Moderate Itching 3 = Severe Itching. Scoring criteria for burning sensation: 0 = No Burning Sensation 1 = Mild Burning Sensation 2 = Moderate burning sensation 3 = Severe Burning Sensation Criteria for result assessment Percentage of improvement of initial PASI score of each individual: Significant improvement 60-80% Moderate improvement 30-60% Mild improvement Up to 30% No improvement 0% DISCUSSION According to Ayurveda all the skin disease come under broad Kushtha. It is difficult to say what psoriasis is; in terms of Ayurveda. There is no any Tvaka Roga in Ayurveda, which can exactly be corelated with psoriasis. All research workers included psoriasis under Kshudrakushtha. But specific type correlation was done with Sidhma, Mandala, Kitibha and Eka-kustha. The symptoms of Sidhma found in Urdhvakaya but in psoriasis the lesion are distributed all over the body. Scaling which is Raja Sama but in psoriasis silvery scaling is seen so Sidhma is not correlated with psoriasis. In Kitibha the lesions are Sukshma (small) and Sravi (exudation). But to contrary that in psoriasis the lesions are larger (plaque) and dry. So, Kitibha may not be co-related with Psoriasis. Psoriasis is considered as one of the type of Kushtha i.e. Kshudra Kushtha under the heading of Eka- Kushtha. Eka-kushtha is accepted as Psoriasis because the description and characteristic features of it are co-inciding with description of psoriasis than any other type of Kushtha. In present study management of psoriasis was done with Vamana and Shaman with Stree Kutaj oil. Relief observed in PASI score, burning sensation and itching were 63.5, 71.44 and 73.29% respectively. Final result observed were significant improvement in 09 patients (60%), moderate improvement in 04 patients (26.67%) and mild improvement in 02 patients (13.33%).Shodhana has superior hand in the treatment of psoriasis as explained by Vagbhat [8]. Observation & results: The clinical data shows that demographic distribution of maximum number of patients of Psoriasis belongs to the age group 21 to 40 years. It means that the chances of Psoriasis are more in middle age group. Religion and sex wise distribution of the group have no significance because of very small no. of patients. 33.33% patients have been given the history of hereditary relationship but studies show that there is definite relationship between disease and genetic influence. The results assessed on the basis of PASI score, burning sensation and itching were statistically significant (Table 1). Most of the patients show significant improvement (09 patients, 60%), moderate improvement in 04 patients (26.67%) and mild improvement in 02 patients (13.33%) (Table 2). CONCLUSION Eka-Kushtha is a clinical entity described in Ayurveda under Kshudra Kushtha. According to Charaka, it is Vata-Kapha dominant disorder while Sushruta described this under Kapha dominant disorder, with involvement of all the threebiodynamic factors. Eka-kushtha being a Kshudra Kustha has Vata-Kapha dominance and even involvement of Tridosha can be evident from its signs and symptoms. Eka-kushtha in modern parlance has similarity with Psoriasis. Most of the patients were reported in the chronic stage of Psoriasis. Negligence in early stage and recurrence of Psoriasis is common phenomenon. The disease used to aggravate during winter season and in dry weather. It can be concluded that Shodhana (Vamana) along with Shaman therapy (Stree Kutaj oil, external & internal application) proved to be an effective therapy and recurrence could also be prevented. Page36

Table:1 Assessment of results over criteria S. Assessment Mean score Mean diff. % relief S.D. S.E. t-value p-value No criteria B.T. A.T. 1. PASI score 14.8±3.29 5.4±3.35 9.4 63.51 2.784 0.718 11.559 <0.001 Burning 2.33 ± 0.67 ± 2. 1.67 71.44 0.58 0.33 5.003 < 0.02 Sensation 0.58 0.58 2.142 ± 0.5714 ± 3. Itching 1.5 73.29 0.7867 0.2974 3.362 <0.001 0.8997 0.5345 REFERENCES 1. Menter, A.,Gottlieb, A., Feldman, S.R., Van Voorhees, A.S., Leonardi, C.L., Gordon, K.B., Lebwohl, M., Koo, JY., Elmets, C.A., Korman, N.J., Beutner, K.R., Bhushan, R. (May 2008). "Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics". J Am Acad Dermatol 58 (5): 826 50. doi:10.1016/j.jaad.2008.02.039. PMID 18423260 2. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team (February 2013). "Global epidemiology of psoriasis: a systematic review of incidence and prevalence". J Invest Dermatol 133 (2): 377 85. 3. Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol 195;61:202-5.. CITE THIS ARTICLE AS Table:2 Final assessed result Results Group % Significant Improvement 9 60 Moderate Improvement 4 26.67 Mild Improvement 2 13.33 Unchanged 0 0 4. Kaur I, Handa S, Kumar B. Natural history of psoriasis: a study from the Indian subcontinent. J Dermatol 197; 24:230-4. 5. Agnivesha, Charaka Samhita, Elabourated Vidyotini Hindi commentary, Pt. Kashinath Shastri and Dr. Gorakhnath Chaturvedi, Chaukhambha Bharti Academy, Varanasi; Edition 2004; Part 2; page 253-55 (Ch. Chi. 7/31, 7/30, 7/39). 6. Kalavathy KR, Shetty BMV, Ramachandran, Krishnamurthy JR. Effect of 777 oil on non- specific dermatitis (777 oil- a siddha herbal coded preparation). Journal of Research in Ayurveda and Siddha 1989;10: 132-140. 7. Fredriksson, T., U. Pettersson. Severe psoriasis oral therapy with a new retinoid. Dermatologica, 1978, 157(4):238-44. PMID 357213 8. Paradkar H, editor. commentary by Arunadatta and Hemadri on Ashtang Hridaya, Chikitsa Sthana: Chapter 19; reprint ed. Varanasi: Krishnadas Academy, 1995; 718 Pravin Kumar Rai et. al., Clinical Study of Vaman Karma & Stree Kutaj Oil in the Management of Eka- Kustha vis-a-vis Psoriasis, Int. J. Ayu. Alt. Med., 2014; 2(6):33-37 Source of Support Nil Conflict of Interest None Declared Page37

#401/8-A, 4 th Floor, Shiv Shrishti Apt. Nardas Nagar, TP Rd., Bhandup (W), Mumbai 400078 E:mail-editorijaam@gmail.com, Web- www.ijaam.org