E-ISSN:2456-3110

Case Report

Plaque Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 5 MAY
Publisherwww.maharshicharaka.in

Effective management of Kitibha Kushta (Plaque Psoriasis) using Ojavyapat Chikitsa (Hypersensitivity Line of Treatment): A Case Report

Chavan DS1*, Karigar SB2
DOI:10.21760/jaims.10.5.32

1* Deepika S Chavan, Second Year Post Graduate Scholar, Department of PG Studies in Dravyaguna, Taranath Government Ayurvedic Medical College and Hospital, Bellary, Karnataka, India.

2 Shivananda B Karigar, Assistant Professor, Department of PG Studies in Dravyaguna, Taranath Government Ayurvedic Medical College and Hospital, Bellary, Karnataka, India.

Skin is the seat of complexion which depends on factors like nutrition, hygiene, circulation, age, immunity, genetic traits, psychological state. Psoriasis is a common long-lasting Auto-immune skin disease with prevalence of 0.44-2.8 percent in India. Psoriasis is typically present as erythematous plaque with silvery scales. Most common type of Psoriasis is Plaque Psoriasis in which each lesion is separated from other lesions with diameter of millimeters to centimeters. All the Twak Vikara in Ayurveda have been discussed under the broad heading of Kustha. Two types mainly Mahakushta and Kshudrakushta. This Kitibha Kushta which includes Shyava, Krishna Varna, Parushata, Khara sparsha, Kandu, Ghanatwa and Srava can be co-related to Plaque psoriasis. The Ayurvedic diagnosis was made as “Amavisha Janya Kitibha Kushta” and treatment was done on basis of this. The present article was prepared to assess the role of Amavisha Hara, Vishama Dhatu Chikitsa and Rasayana Chikitsa in such emerging autoimmune skin condition. Improvement in the skin lesion were observed after a period of 1 months of regular treatment and complete remission with no further attack after 2 months follow-up. The improvement was observable through the follow-up photograph.

Keywords: Kitibha Kushta, Ojovyapat Chikitsa, Psoriasis, Rasayana, Amavisha

Corresponding Author How to Cite this Article To Browse
Deepika S Chavan, Second Year Post Graduate Scholar, Department of PG Studies in Dravyaguna, Taranath Government Ayurvedic Medical College and Hospital, Bellary, Karnataka, India.
Email: 		Chavan DS, Karigar SB, Effective management of Kitibha Kushta (Plaque Psoriasis) using Ojavyapat Chikitsa (Hypersensitivity Line of Treatment): A Case Report. J Ayu Int Med Sci. 2025;10(5):214-220.
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https://jaims.in/jaims/article/view/4249/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-04-13 2025-04-28 2025-05-07 2025-05-17 2025-05-27
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© 2025 by Chavan DS, Karigar SB and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Deepika SC et al. Effective management of Kitibha Kushta (Plaque Psoriasis)

Introduction

Among all skin diseases, ‘Psoriasis’ is a very distressing disease both for the patients and physicians because of its pathogenic mechanism. All the skin diseases in Ayurveda have been discussed under the broad heading of “Kustha”.[1]

Which are further divided into Mahakustha and Ksudra Kustha. Kitibha Kustha is considered as one of the Kshudra Kustha[2] where the signs and symptoms of which simulates with that of Plaque psoriasis. Kitibha Kusta having symptoms like Shyava Varna (discoloration), Kinakhara Sparsha (rough in touch/scaly), Parushatva (hard), Ruksha (dry).[3] Every Kusta manifests due to derangement of seven factors like Vata, Pitta, Kapha, Twak (skin), Rakta (blood), Mamsa (Muscle and Lasika (lymphatic system).[4]

Here We report a case of Kitibha Kushta treated successfully with pure Ayurvedic treatment with complete remission. Ayurvedic Ojovyapat line of treatment, Visha Hara and long term Rasayan Chikitsa is found to be effective in treating emerging Autoimmune skin conditions and need to be accessed further through big clinical studies.

Case Report

Patient information

A female patient of 45 years visited Kayachiktsa OPD, TGAMC Ballari (3-11-2023) with complaints of red scaly patches all over the body more at bilateral hands, inner thighs and flank region since 6 years, increased symptoms since 2 months.

She also had severe itching, dryness and cracks near heel area of foot. Clinical signs and symptoms like Shyava Varna (discolouration), Kinakhara Sparsha (rough in touch), Ruksha (dry), and Parushatva (hard) were present. She had taken treatment from general physician but found no relief then she came here for further management.

Associated complaints

She had Agnimandya (low digestive fire), Ajirna (indigestion), Mala Vibhanda (constipation) and regular sleep pattern. She is having habit of taking tea, Virudhahaara (milk shakes) and increase use of tangy items like tamarind and tomato in food preparations.

Past history

K/C/O hypothyroidism in the last 2 years, not taking any medications.
No h/o DM/HTN or any other major medical or surgical history.

Family history

No history of same illness in any of family members.

Psychological evaluation

She was in stress due to cosmetic consideration.

General Examination

Built: Moderate
Nourishment: Moderate
BP: 120/80 mm of hg
Pulse: 78 b/min
Height: 152 cm
Weight: 77 kg
Tongue: coated

Palor/icterus/cyanosis/clubbing/edema/lymphadenopathy: absent

Systemic Examination

CVS: S1 S2 normal
CNS: well oriented, conscious.
RS: Normal Vesicular Breathing, No Added Sounds
P/A: Soft, Non-Tender, No Organomegaly.

Dasha Vidha Pariksha

1. Prakruti: Pitta-Kapha
2. Vikruti:

  • Dosha: Kapha- Vata
  • Dushya : Rasa, Rakta, Mamsa
  • Sroto Dusti: Sanga

3. Sara: Madhyama
4. Samhanana: Madhyama
5. Satmya: Madhyama
6. Satva: Madhyama
7. Pramana:

  • Dhairgya: 150 cm
  • Dehabhara: 77 kg

8. Ahara Shakti :

  • Abhyavarana Shakti : Avara
  • Jarana Shakti : Avara

9. Vyayama Shakti: Avara
10. Vaya: Madhyama


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Anga Pratyanga Pareeksha

Per Abdomen Examination

Inspection: Shape of abdomen - distended
Umbilicus: Normal, inverted
Hyperpigmentation scars over abdomen.
Palpation: Soft, no tenderness, no organomegaly
Percussion: Tympanic sounds heard except the area of liver dullness
Auscultation: Sound - absent

Central Nervous System

Patient is conscious, well oriented to time, place and person.

Respiratory System

Inspection: Shape of chest - bilaterally symmetrical
Palpation: Trachea - centrally placed
Tactile vocal fremitus: Normal
Percussion: Resonant sounds heard except the cardiac dullness
Auscultation: Normal Vesicular breath sounds heard

Cardiovascular System

Inspection: No scar, no swelling
Palpation: Non tender
Percussion: Defined area of cardiac dullness
Auscultation: S1 and S2 heard, no added sounds or murmurs heard

Integumentary System Examination

Inspection

Location - bilateral upper limb, flank region, neck, abdomen
Shape - circular lesion
Color - reddish black
Discharge - Absent

Palpation

Temperature - felt
Texture of lesion - rough and scaly

Tests

ANA (antinuclear antibodies) - ‘Positive’

  • Candle grease test - Positive
  • Auspitz sign - Negative
  • Koebner phenomenon - Positive
  • Distribution of lesion - Symmetrical

Ayurvedic intervention

A detailed therapeutic intervention undertaken is provided in Table 1.

Table 1: Therapeutic intervention.

DateTreatmentDoseDuration
03-11-20231.  Tab. Shaddharana - DS
2.  Amruttashadanga Kasayam
3.  Guduchi Paneeya		½ tab per day
5ml/every 2 hourlies
For drinking		first 15 days
20-11-20231.  Tab Punarnavadi Kasayam
2.  Amruttashadanga Kasayam
3.  Guduchi Paneeya		½ - ½ - ½ - ½ tab after food
5ml/every 2 hourlies
For drinking		Next 2 months
11-01-2024Mahatiktaka Ghrita as Shamana Snehapana5ml, 10, 15, 20, 25, 30, 35ml.For 7 days

Pathya and Apathya (do’s & don’t’s)

Patient was advised to follow strict Pathya-Apathya (Ayurvedic diet). light food like brown rice Khichadi, eating more of Moog Daal, Patola (Tikta Rasa), Guduchi Paneeya for drinking. Apathya-meat, milk, curd, Mamsa Ahara (non veg), Viruddhahara (incompatible food items), Adhyasana (over eating), Vidhaya food (which causes burning like pickles, chilly, spices), Abhishyandi Ahara, Avoid day sleep, Ati Amla Rasa (sour food items). Soaps and detergents were completely avoided.

Follow-up and Outcomes

The symptoms like Shyava Varna (discolouration), Parushata (dryness), Kandu (itching), and scaling were 60% reduced within 15 days, fresh lesion on neck was seen (20-11-2023). Examination was done after every 15th day picture was taken with consent. After 60-day treatment, 95% of the lesions were resolved and skin comes back to normal (11-01-2024) (Fig. 1-images 8,9,10).

Results

ParametersBefore TreatmentAfter Treatment
ANA TestPositiveNegative
Koebner PhenomenonPositiveNegative
Pasi Score37.500.0
IgE142 Iu/Ml93 Iu/Ml

jaims_4249_01.JPG
Image 1: ANA-IF Before Treatment


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Deepika SC et al. Effective management of Kitibha Kushta (Plaque Psoriasis)

jaims_4249_02.JPG
Image 2: ANA-IF After Treatment

jaims_4249_03.JPG
Image 3: IgE Before Treatment

jaims_4249_04.JPG
Image 4: IgE After Treatment

jaims_4249_05.JPG
Figure 1 - 5,6,7 images are of Before treatment

jaims_4249_06.JPG
Figure 1 - 8,9,10 images are of After treatment

Discussion

Predispose factor

Most cases are Autoimmune disorders. Causes of Auto Immune Disorder are unknown but some prominent triggers are enumerated as under Bacteria, Toxins, Virus, Germs and parasites, Fungi, Drugs, Chemical irritants, Environmental irritants, Hereditary. “Ayurveda perceives autoimmune diseases in a slightly different way. As per Ayurveda, the immune cells do not attack body cells accidentally, but to defend against harmful metabolites termed as Ama.”[4,6]

According to Ayurveda ‘Kitibha Kushta’ is one among Kshudra Kushta where the signs and symptoms of which simulates with that of Plaque Psoriasis. It is the Vyadhi of Raktavahasrotas, having Samprapti Ghataka of Vata and Kapha Dosha, Twak, Lasika, Rakta and Mamsa. Even if it is managed by Panchakarma procedures like Virechana or Vamana relapses are common.

Limitation of management

In contemporary science, topical and systemic corticosteroids are the mainstay of treatment but there are reports of cases that have been treated with botulinum toxin and calcineurin inhibitors.[7] Other immunosuppressants such as cyclosporine, azathioprine, and methrotrexate have occasionally be used for recalcitrant and severe cases unresponsive to the above measures, but with variable success, and typically not in children.[8]

Oral antihistamines can provide symptomatic relief because of their sedative properties. Unfortunately, most of these attempts do not lead to long-term improvement and the majority of cases of psoriasis relapse, persists for years, and still presents a therapeutic problem.

Role of Ojovyapat Chikitsa in ANA Positive Psoriasis

Amavisha Janya Kitibha Kushta was clinical condition diagnosed in the present case, which can be taken as toxic manifestation of skin due to Amavisha (metabolic toxins). The measures adopted for ‘ANA positive’ Kitibha Kushta is ‘Ojovyapat line of treatment’ as Visha (metabolic toxin) has the tendency to affect Rakta Dhatu (Visham Praak Dooshayati Shonitam).


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Ojovyapat develops due to altered central regulation of immune functions by Hridaya (hypothalamus - Ojovahasroto-Moolastana) caused by Ama-Visha. Autoimmune diseases come under this category of Ojo-Vyapat. Exposure to certain environmental factors and ingested toxins effect and disturb Jataragni primarily and consequently Bhoothagni and Dhatwagni. Agni Mandya leads to Ama which vitiates Rasa Dhatu and Rasavaha Srotas. For Dooshivisha - habitat, season, food and day sleep is said to be the aggravating factors.[9] Due to Dooshivisha, many skin diseases are said to appear like Mandal (vesicles/boils), Kotha (round patches and rashes on the skin), Kitibha Kushta[10] (various skin manifestation). When Dushivisha vitiates Rasa Dhatu[11], it will produce the Rasa Pradoshaja Vikara (diseases) like-disinclination towards food, anorexia, indigestion, fatigue, anemia, obstruction of the Srotas, etc. When Dushivisha located in Rakta Dhatu, it will produce Rakta Proshaja Vikara like-skin disorders, erysipelas, vesicles[12], etc.


which are very much evident in present case.

Ayurvedic diagnosis

The clinical signs like Shyava (discolouration), Krishna Varna (blackish colour), Parushata (hardness), Khara Sparsha (rough in touch), Kandu (itching), Ghanatwa (solidity) and Srava (discharge) suggested the features of Kapha Vata dominancy. On the basis of symptomatology, the present disease can be equated with Kapha-Vata Doshic Kushta. All variety of Kushta results from imbalance of Tridosha, hence at the time of treatment should be decided after determining the varying degree of each dosha by its specific features. The principle of management of Kushta in the different stages of the Kushta (skin diseases) and Dushivisha (anti poisonous therapy) includes Panchakarma (eliminative procedures-therapeutic emesis, purgation, etc.), vein puncture, local applications, and internal administration of drugs.

SNFormulationsIngredientsKamusta (Ayurvedic Pharmacology)DoshaharaRationale use
1.Tab Shaddharana DSChitraka, Indrayava, Patha, Katuka, Ativisha, DarviKushta,Vatavyadh, Ama, Udara, Amavata, GrahaniKapha-Pitta HaraIt corrects Agni Dushti, helpful in deep rooted skin diseases. Kledahara, Vishahara property and does Kaphapitta Shamana.
2.Tab Punarnavadi KasayamPunarnava, Nimba, Patola, Shunti, Bharangi, Amrutha, Darvi, Abhaya, Punarnava and BharangiKushta, Jwara, Kasa, Shwasa, Pandu, Visha VikaraKapha-Vata HaraDeepana, Pacana, antioxidant property. It has anti-inflammatory action, anti-allergic, immunomodulatory effect.
3.Amruttashadanga KasayamMusta, Chandana, Guduchi, Parpata, Ushira, Hrivera.Pitta Vikaras, Amavisha, KushtaKapha-Pitta HaraDeepana, Pacana. removes Amavisha (metabolic toxin), and is helpful in relieving Daha (burning sensation).
4.Guduchi ChoornaGuduchiJwara, Chardi, Daha, Trishna, Kandu and Kushta.Kapha-Pittahara, RasayanaDetoxifying, rejuvenating, immune-supporting, immunomodulatory and anti-ama properties, Best Rasayana as has antioxidant property
5.Mahatiktaka Ghrita[13]Saptaparna, Ativisha, Shampaka, Patha, Amalaki, Haridra, Daruharidra, Ushira, Shatavari, Amruta, Murva, Yashtimadhu, Vasa, Sariva, Visaka, Trayamana, Kiratatikta, Tiktarohini, Parpataka, Pippali, Gajapippali, Chandana, Dhanvayasa, PichumardaKushta, Pandu, Asrigdhara, Visha Vikara, Pacana, VranaropakaKapha-Pitta haraNeutralizes effect of Dushi Visha. Because of Rasayana property it helps in rejuvenating and repairing the damage cells. Helps in reducing the stress factor.

Role of Amavishahara Drugs

The drugs with Primarily Vishaharam, Kapha Vataghna (Doshahara), Ruksha Guna, Tikta Rasa properties, Kushtaghna, Krimihara, along with Amahara, Kandughna, Deepana, Pachana, Rakta Shodhaka (blood purifier), Shotha Hara (anti-inflammatory), Vrana Shodhana, Ropanam, Vata Anulomana and Pitta Rechaka were chosen and prescribed at different stages in the case. First course of medication was selected (Table 1). No adverse drug reaction was noticed during the course of treatment. After 15 days Tab. Shaddharana DS was stopped and Tab. Punarnavadi Kashayam was added with Guduchi Paneeya. Next, Shamana Snehapana as Rasayana Chikitsa given with Mahatiktaka Ghruta in increasing dose for 7 days, and later patient appetite was good and all the previous lesions of psoriasis were completely healed and patient was very happy and convinced.


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Role of Shamana Snehapana as Rasayana

Mahatiktaka Ghrita is Ghrita preparation and it contains ingredients like Amalaki, Ativisha, Aragwadha, Katuka, Patha, Usheera, Haritaki are predominantly Tikta Kashaya Rasa, Laghu Rooksha Guna, Ushna Virya, Katu Vipaka and Kapha-Vata Shamaka in action.[13]

According to ‘Acharya Sharangdhara’, Kushta Roga occurs due to Dosha Bahulyata. The accumulation of Kleda results in Srotorodha leading to Vatavriddhi, because of the combined effect of Vata Vriddhi and Srotavarodha, the Rasa Dhatu does not enter in the Srotas. Due to loss of this Dravamsha the Kleda that remains in Twacha will be transferred into Ghanibhuta Kleda. This results in Parushata and Khara Sparsha of Twacha in Kitibha. So, to pacify vitiated Vata Dosha, Ghruta especially Mahatiktaka Ghruta plays an important role. It’s been indicated for Kushta, Visha (poison) conditions and various mental disorders so it helps in reducing the mental tension in patient as stress is also one of the major factors for disease manifestation. Addition to that, Ghruta is mentioned as a Vishahara and good Deepana Dravya. It can promote the digestive power in all the Agni level. Ghrita is one of the best Rasayana and Vishaghna Dravya as it is having all the qualities exactly opposite to that of Visha. It is having Brimhana, Snehana, Yogavaahi, Dahaprashamana and Medhya property. Snehaguna property oleate the tissue, make proper arrangement of Dhatu and do Dridhikaranam of body. Thus, the body acquires Bala, Varna, luster, firmness, and ability to encounter disease. Due to its Manda Guna, its action lasts longer. Medicines of the Rasayana group are supposed to repair and rejuvenate damaged cells and having balancing and rejuvenating effects on the three constitutional elements that sustain human life (Table 2).

Conclusion

In Ayurveda, the treatment of Kushta (skin disorders) is commonly done by same clinical approach like Deepana, Pachana and then directly giving Virechana or Vamana for immediate remission of symptoms. But this kind of approach leads to relapses of symptoms and again Ojovyapat occurs. Hence after analyzing the pathogenesis of disease, Ojovyapat Chikitsa i.e., Hypersensitivity line of treatment,

Ama-Vishahara and Vishama Dhatu Chikitsa is followed for Rasa and Rakta Dhatu Shuddhi and restoring Ojas and Vishama Dhatu by repeated Sneha-Pana. Application of just Shamanoushadi followed by Shamana Snehapana with strict Pathya gives better and scientific results without any other complication. Ayurvedic treatment modality stands non-invasive, cost effective. Here a case was presented, the subject was suffering from Kitibha Kushta successfully treated by Scientific Ayurveda treatment Modality. Present case definitely boosts up the new research scholars to take these condition and do further studies.

Declaration of patient consent

The author certifies that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images, reports, and other clinical information to be reported in the journal.

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