E-ISSN:2456-3110

Case Report

Kitibha Kushtha

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 2 FEBRUARY
Publisherwww.maharshicharaka.in

Impact of Sadyovamana and Virechana in the management of Kitibha Kushtha in co-relation to Psoriasis - A Case Report

Udikeri M1*, Keshava DV2
DOI:10.21760/jaims.10.2.57

1* Manjunath Udikeri, Third Year Post Graduate Scholar, Department of Kayachikitsa, ALN Rao Memorial Ayurvedic Medical College Koppa, Karnataka, India.

2 Keshava DV, Professor, Department of Kayachikitsa, ALN Rao Memorial Ayurvedic Medical College Koppa, Karnataka, India.

Introduction: The skin, which forms the outermost layer of the body, is its largest organ. It acts as an anatomical barrier against biological, chemical, and physical external agents. Due to environmental and lifestyle changes - such as altered work schedules that elevate stress levels and directly affect health - numerous interconnected factors contributing to skin diseases are often categorized under the term 'Kushta. Kushta is a Kleda Pradhana Vyadhi involving all Sapta Dravyas and is considered one of the Ashta Mahagadas. If left untreated, it leads to Kutsita - characterized by vitiation and discoloration of the skin. Kitibha Kushta is classified under Kshudra Kushta and closely resembles the signs and symptoms of psoriasis.

Aim of study: To evaluate the effectiveness of Sadhyo vamana and Virechana karma in Kitibha Kushta (psoriasis), along with Shamana Aushadhi in terms of alleviating the symptoms and improving the quality of life of patient.

Methodology: A detailed study of Kitibha Kushta was conducted through a comprehensive review of Ayurvedic treatises, research journals, and electronic databases. A patient diagnosed with Kitibha Kushta was selected for the study and administered both internal and external Ayurvedic medications. The patient's response to the treatment was closely observed and documented.

Result: The integrated Panchakarma approach resulted in significant clinical improvement. The patient reported substantial relief in itching, scaling, and discoloration. Post-treatment signs showed restored skin texture, improved sleep, appetite, and bowel regularity.

Discussion: The combined use of Sadyovamana and Virechana offers an effective alternative in managing chronic skin diseases like psoriasis. The therapies helped regulate the aggravated Doshas and enhanced Agni, facilitating better absorption and metabolism.

Keywords: Kitibha Kushta, Ayurveda, Shodhananga Snehana, Virechana

Corresponding Author How to Cite this Article To Browse
Manjunath Udikeri, Third Year Post Graduate Scholar, Department of Kayachikitsa, ALN Rao Memorial Ayurvedic Medical College Koppa, Karnataka, , India.
Email: 		Udikeri M, Keshava DV, Impact of Sadyovamana and Virechana in the management of Kitibha Kushtha in co-relation to Psoriasis - A Case Report. J Ayu Int Med Sci. 2025;10(2):386-393.
Available From
https://jaims.in/jaims/article/view/4400/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-01-12 2025-01-22 2025-02-05 2025-02-15 2025-02-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nill Not required 11.63

© 2025by Udikeri M, Keshava DV 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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Manjunath U et al. Sadyovamana and Virechana in the management of Kitibha Kushtha

Introduction

In Ayurveda, all skin conditions are broadly classified under the term Kushta, which is further divided into Mahakushta (major skin diseases) and Kshudra Kushta (minor skin diseases). Among the Kshudra Kushta, Kitibha Kushta presents symptoms that closely resemble those of plaque psoriasis. These symptoms include Ruksha (dryness), Parushatva (hardness), Kinakara Sparsha (scaly or rough texture), and Shyava Varna (discoloration).[1] Psoriasis is a chronic inflammatory and proliferative skin disorder with a global prevalence ranging from 0.2% to 4.8%.[2] It is characterized by erythematous plaques covered with silvery scales, commonly found on the scalp, lumbosacral region, and extensor surfaces.[3] Psoriasis is primarily driven by a T-cell-mediated immune response. Environmental, genetic, and immunological factors interact in its pathogenesis. Antigens—whether environmental, superantigens, or autoantigens—are captured by antigen-presenting cells (APCs) in the skin. These APCs migrate to lymph nodes, where they activate native T cells. The activated T cells then return to the skin and release pro-inflammatory cytokines such as interleukin-2 (IL-2) and interferon-gamma (IFN-γ), which further stimulate cytokine production, including tumour necrosis factor-alpha (TNF-α).[4] TNF-α plays a central role in promoting inflammation and driving the epidermal and vascular changes seen in psoriatic plaques.[5] According to Acharya Charaka, the manifestation of Kushta (skin diseases) involves seven key factors: Vata, Pitta, Kapha, Twak (skin), Rakta (blood), Mamsa (muscle), and Lasika (lymphatic system).[6] As part of the general line of treatment (Samanya Chikitsa), Charaka emphasizes that in conditions involving Bahudoshavastha (excessive vitiation of doshas), Shodhana (purificatory therapy) should be administered to eliminate the aggravated Doshas.[7] In this case, since multiple skin lesions were present, Shodhana was chosen as the primary treatment approach.

In this case, Sadyovamana was performed prior to Virechana Karma to expel the Ulbitakapha (accumulated) Kapha and Ama. This helps improve absorption of Snehana (oleation therapy) and enhances effectiveness of Virechana in eliminating vitiated Pitta. This paper presents a case study of Kitibha Kushta (Plaque Psoriasis) successfully treated using Sadyovamana followed by Virechana.

Case Report

Patient Profile: 24-year-old male patient presented with complaints of severe itching, dryness, of the skin on the Scalp, Abdomen, Back and both Upper and Lower limbs The patient had been experiencing symptoms for over eight years, with periodic flare-ups following the consumption of non-vegetarian food and exposure to chemicals in agricultural work sweating.

Symptoms: Severe itching, dryness white powdery discharge upon scratching. The symptoms were aggravated in the morning and after chemical exposure.

Previous Treatments: The patient had sought allopathic treatment, which provided only temporary relief. Symptoms would subside briefly but return, with increased severity over time.

History of present illness

A Male patient aged 24 years Professionally student presented with complaints of severe itching dryness, skin over scalp, abdomen, and both upper and lower limbs, He is suffering from these symptoms for 8 years and white powdery discharge from lesions while scratching. Itching aggravated early in the morning and, after having non veg food (chicken, Fish, Mutton Egg,). Itching and dryness during Agricultural work will increase following chemical exposure. He Then consulted doctor in local area and took treatment. For few days the lesions subsided but later it aggravated

Past history: No history of systemic disorders like Thyroid disorder/DM/HT

Personal history

  • Appetite - Decreased
  • Bowel - Constipated
  • Micturition - Regular (5times /day)
  • Sleep - Disturbed due to itching
  • Addiction - No
  • Diet - Mixed (takes non veg food twice a week)

General Examination

  • Pallor: Absent
  • Icterus: Absent
  • Cyanosis: Absent

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  • Clubbing: Absent
  • Lymph node: Not palpable
  • Oedema: Absent
  • BP: 110/70 mmhg
  • Pulse: 78bpm
  • Respiratory rate: 14/min
  • Temperature: 98°F

Ashtasthana Pariksh

1. Nadi - Kapha, Pitta
2. Mala - Vibhanda
3. Mutra - Prakruta
4. Jihva - Lipta
5. Drik - Prakruta
6. Shabdha - Prakruta
7. Sparsha - Khara Sparsha
8. Aakriti - Madhyama

Abdomen Examination

1. Inspection

  • Hyperpigmentation scars over abdomen
  • Umbilicus is inverted.
  • Abdomen is Flat and symmetrical.
  • No visible pulsation

2. Palpation

  • No tenderness, No organomegaly.

3. Percussion

  • No abnormality detected

4. Auscultation

  • 2 – 3 bowel sounds per min

Central Nervous System: Patient is conscious, well oriented to time, place and person.

Respiratory System

1. Inspection - Shape of chest bilaterally symmetrical
2. Palpation

  • Trachea central
  • Local Tenderness: Absent
  • Symmetrical chest expansion

3. Percussion - Resonant all over the lung area
4. Auscultation - Normal bronchial and vesicular sounds heard

Cardiovascular System

1. Inspection: No scars or bruising, no visible pulsation
2. Palpation: No abnormality detected
3. Percussion: no abnormality detected
4. Auscultation: - S1 S2 heard
No added sounds/ murmurs
Heart Rate: 78 bpm

Integumentary System Examination

  • Inspection - Bilateral Lower Limb, Upper Limb, Back, Abdomen, Lesions
  • Lesions - Plaques
  • Shape - Circular lesion
  • Colour - Reddish, white
  • Discharge - Whitish powdery discharge
  • Temperature - Warm
  • Texture of lesion - Rough and scaly

Tests

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

Treatment

Table 1: First line of treatment: Deepana Pachana (For first 3 days)

SNDrugDoseAnupana
1.Amritotharam Kashayam3TSP -O -3TSP B/FUshana jala
2.Chitrakadi Vati1 – 0 – 1 B/FUshana jala

Sadhyo Vamana

Table 2: On the day of Sadhyo Vamana

ProcedureDrugMatra
Sarvanga Abhyanga
Sarvanga Nadi Sweda		Vetpalai TailaQS
VamanaMadanphalyoga
(Madanphal, Vacha, Yasthimadhu, Saindhav, Madhu
(Yashti Madhu Kashaya, Ksheera)		Antarnakha Mushti, Matra
Madanphal 5gm
Vacha 3gm
Yasthimadhu, 8gm
Madhu 5 ml
Saindhava Lavana 10gm
Yashti Madhu Kashaya 3 litres
Ksherra 2 litres
Saindhav Jala 1liters

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Table 3: Sadhyo Vamana

Vamana KarmaEvaluation at the end of process
TimeBlood pressure
6.45 A.M110/70mmHgManiki Shuddhi
(Measurement)		Antiki Shuddhi
(Interpretation)		Vaigiki Shuddhi
(No. of Vega)		Laingiki Shuddhi
(symptoms)
7.10 A.M120/76mmHgInput - 4000ml Output –Vega 5
Upa-vega 2		Lightness of the body, clear voice, proper response to external stimuli, no flatulence, no bleeding
7.40 A.M140/70mmHgInput - 1000ml Total Output – 5200mlPittantaka vamanaVega 3
Total
Vega 8
Upa vega 2

Paschyat Karma:After Samyaka Vamana Lakshana, Virechanik Dhoompan was given for 5 minutes in each nostril with Vachadi Dhoom Varti. Patient had 8 Vegas and 2 Upavegas during Vaman Karma. It was Pravar Sudhhi and Pravar Bala of the patient. Liquid diet is advised to patient

Table 4: Snehapana with Mahatiktaka Ghrita for Virechana

SNDayDoseAnupana
1.Day 130 mlUshana Jala
2.Day 260 mlUshana Jala
3.Day 390 mlUshana Jala
4.Day 4120 mlUshana Jala
5.Day 5150 mlUshana Jala
6.Day 6180 mlUshana Jala
7.Day 7210 mlUshana Jala

Table 5: External therapy during Snehapana

ProcedureDrug
Sarvanga Dhara (Evening After the occurrence of Sneha Jeerna Lakshana)Pancha Valakala Quath Choorna
Yashti Quath Choorna
Triphala Quath Choorna

During all these days, patient was advised to take hot water for drinking till Kshudha Pravritti (attainment of hunger). Only light and liquid diet was advised at that time. The symptoms of Samyak Snighdh (proper internal oleation) were observed on 6th and 7th Day.

3 days Vishrama Kala is given:During Vishrama Kala Sarvanga Abhyanga with Vetpalai Taila and Nadi Sweda is given.

Virechana: On the day of Virechana Sarvanga Abhyanga with Vetpalai Taila and Nadi Sweda was given Before administration of Virechana drug, pulse, blood pressure, temperature was recorded and at regular interval during the Pradhana Karma.

Table 6: Virechana Aushadhi

SNDrugDoseAnupana
1.Hirdya Virechana Leha60gmUshana Jala

Following the administration of the Virechana medicine, the number of Vegas counted until the symptoms of correct purgation showed up, such as the purgation ceasing on its own, the passage of stool containing mucus in the final one or two motions, and a sensation of lightness in the body. A total of 17 Vegas were noted.

Pashchat Karma (post procedure of dietetic indication)

After the completion of Virechana (purgation), patient was kept on Samsarjana Krama (post procedure of dietetic indication) of considering the ‘Shuddhi’ as ‘Madhya’ type of ‘Shuddhi’ (moderate purification). Patient was advised to take rest and diet is advised for 5 days.

Table 7: Shamana Aushadhi (1 Month)

DrugDoseAnupana
Patola Katurihini Kashayam3tsp – 0 – 3tsp B/FUshna Jala
Tab Gandhaka Rasayana1 – 0 – 1 A/FUshna Jala
Mahatikaka Ghritha1tsp – 0 – 1tsp B/FUshna Jala
Cap. Puritin1 – 0 – 1 A/FUshna Jala
Arogyavardhini Vati1 – 0 – 1 A/FUshna Jala
Vetpalai TailaExternal application

Table 8: Follow-up medication for 1 month

DrugDoseAnupana
Pitta Rechaka Kwath3tsp – 0 – 3tsp B/FUshna Jala
Tab. Arogyavardhini Vatti1 – 0 – 1 A/FUshna Jala
Madhusnuhi Rasayana1tsp – 0 – 1tsp B/FUshna Jala
Sarivadi Asava3tsp – 0 – 3tsp A/FUshna Jala
Cap. Puritin1 – 0 – 1 A/FUshna Jala
Vetpalai TailaExternal application-

Table 9: Showing Grading - PASI Before Treatment

Nature ofLesion scoreBilateral Upper limbBilateral Lower limbAbdomenBack
Erythema0 – None3334
Itching1 – Slight4434
Scale2 – Moderate4444
Dryness3 – Severe3333
Total score4 – Very severe14141315

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Table 10: Showing Grading - PASI After Treatment

Nature ofLesion scoreBilateral Upper limbBilateral Lower limbAbdomenBack
Erythema0 – None2213
Itching1 – Slight1200
Scale2 – Moderate2222
Dryness3 – Severe0000
Total score4 – Very severe5635

Discussion

Deepana and Pachana

Prior to initiating Snehapana (therapeutic oleation), the patient must be in a Nirama state. This necessitates the stimulation of Agni (digestive fire) and the digestion of Ama (toxins). Therefore, Amapachana was first achieved using Deepana-Pachana formulations such as Amrutotharam Kashayam and Arogyavardhini Vati.[8]

Probable mode of action of Sadhyo Vamana

Sadyovamana is indicated only in the Utklishta Dosha Avastha and serves as an effective emergency intervention in the management of Kaphaja Vikaras. In such conditions, the aggravated Kapha-dominant Doshas require immediate elimination from the body. Sadyovamana facilitates the prompt expulsion of these vitiated Doshas, thereby providing rapid symptomatic relief and aiding in the resolution of the condition.[9]

Probable mode of action of Mahatiktaka Ghrita

Mahatiktaka Ghrita, as described in Ashtanga Hridaya under Kushta Chikitsa, primarily consists of ghee and Tikta Gana Dravyas. Owing to its Laghu and Ruksha properties, it exhibits Kandughna (anti-pruritic), Kleda and Vikrita Meda Upashoshana (absorption of pathological exudates and fat), and Vranashodhaka (wound-cleansing) actions. It targets imbalanced Pitta, Sweda, Lasika, Rakta, Meda, Kleda, and Shleshma at both systemic and cellular levels. Its Rasa (Katu, Tikta, Kashaya, Madhura), Ushna Veerya, and Katu Vipaka enable action on Vikrita Kleda, Meda, and Mamsa Dhatu, aiding in detoxification and tissue repair. The lipophilic nature of ghee facilitates deeper cellular penetration, modulating keratinocyte turnover and restoring the skin’s normal texture by reducing symptoms like itching, discoloration, oiliness, and abnormal sweating.[11]

Probable mode of action of Panchavalkala Kwatha Dhara

Panchavalkala Kwatha, rich in tannins and flavonoids, exhibits antibacterial, astringent, antioxidant, anti-inflammatory, antimicrobial, and restorative properties.[12] It helps reduce oedema by liquefying accumulated toxins and exerts Shopha (inflammation) control through its Kashaya Rasa, Ruksha, and Kaphahara effects. Its Lekhana, Kledahara, Chedana, and Raktashodhaka actions further contribute to its anti-inflammatory and desensitizing effects, supporting tissue healing and detoxification.[13]

Probable action of Bahya Snehan and Swedan

Vetpalai Taila is used for Abhyanga due to its Tikta and Kashaya Rasa, Katu Vipaka, and Snigdha Guna, which help pacify Kapha Dosha and alleviate dryness, roughness, and coarseness of the skin. It possesses Kusthaghna and Kandughna properties, making it beneficial in skin disorders.[14] Its Sukshmagamitva nature allows deeper penetration and effective absorption through minute bodily channels.[15] Additionally, it exhibits antiseptic, antifungal, anti-inflammatory, and antimicrobial activities. Thus, it proves effective in managing the present condition, especially when combined with Sarvanga Swedana.

Probable action of Virechana

Virechana is recognized as an effective therapy for both the prevention and management of skin disorders. The drugs used possess Vikasi, Vyavayi, Sukshma, Tikshna, and Ushna properties, promoting deep systemic detoxification. It is especially useful in conditions like psoriasis by correcting imbalances in Pitta, Rakta, Agni, and Twak. When combined with internal medications, Virechana Karma serves as a potent treatment strategy for various dermatological conditions.[17]

Conclusion

The Management of Kitibha Kushta (plaque psoriasis) through classical Ayurvedic Panchakarma therapies—Sadyovamana followed by Virechana demonstrated significant clinical efficacy in this case study. The patient, suffering from chronic symptoms for over eight years with limited relief from conventional treatments, experienced considerable improvement in itching, dryness, scaling,


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and discoloration of skin following prescribed Ayurvedic regimen. The initial Deepana-Pachana phase ensured proper digestive function and Ama elimination, creating a suitable foundation for detoxification. Sadyovamana effectively expelled vitiated Kapha and Ama, reducing disease burden and enhancing body’s receptiveness to Snehapana and Virechana, which subsequently cleared Pitta-related toxins. The holistic integration of internal oleation (Mahatiktaka Ghrita), external therapies (Abhyanga, Swedana, Dhara), and targeted Virechana therapy addressed multi-doshic involvement and deep-rooted pathology of Kitibha Kushta. The positive clinical outcomes - Including reduced lesion size, improved skin texture, and better systemic health - underscore relevance of individualized Ayurvedic interventions, especially in chronic dermatological conditions. This case also emphasizes importance of following classical guidelines of Shodhana therapy for effective disease management and long-term relief. Thus, Ayurvedic detoxification therapies offer a promising complementary approach in holistic management of psoriasis, enhancing both symptomatic relief and patient quality of life.

Acknowledgement

Thanks to the department of Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College Koppa for the support and help providing during the entire process. Lastly, I am thankful to the patient for his trust and providing us the permission for this case publication. All their idealist approach, faith in the science commitment toward work and anticipation made this work a success and it will always motivate me in future work.

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Before Treatment

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After Treatment

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