E-ISSN:2456-3110

Review Article

Psoriasis

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 3 MARCH
Publisherwww.maharshicharaka.in

An overview of Kitibha Kushtha (Psoriasis) and the methods used in Ayurvedic scriptures to manage it

Gujjar P1*, Mishra P2, Charan D3
DOI:10.21760/jaims.10.3.49

1* Pooja Gujjar, Post Graduate Scholar, PG Department of Kayachikitsa, Post Graduate Institute of Ayurved, Jodhpur, Rajasthan, India.

2 Pramod Mishra, Professor and HOD, PG Department of Kayachikitsa, Post Graduate Institute of Ayurved, Jodhpur, Rajasthan, India.

3 Divyasingh Charan, Assistant Professor, PG Department of Kayachikitsa, Post Graduate Institute of Ayurved, Jodhpur, Rajasthan, India.

The skin, as the largest organ of the human body, plays an essential role in maintaining overall health, performing functions such as insulation, temperature regulation, sensation, vitamin D and B synthesis, and protection against harmful pathogens. Skin disorders, such as psoriasis, can significantly impact physical health and lead to emotional distress and social embarrassment. In Ayurveda, skin disorders are broadly classified under Kustha, with subcategories of Mahakustha and Kshudrakustha. A condition under Kshudrakustha, Kitibha Kustha, presents with symptoms resembling plaque psoriasis, including red, dry, silvery scales, intense itching, and the absence of sweating. The Ayurvedic approaches to treating Kitibha Kustha and psoriasis have been evaluated. It might include the identification and classification of Ayurvedic herbs and treatments, clinical studies, and comparison of these remedies to conventional treatments in terms of safety and efficacy. Research into the pathophysiology of Kitibha Kustha and psoriasis in both modern and Ayurvedic contexts. The results of Ayurvedic treatments for skin conditions like Kitibha Kustha (and psoriasis) could be outlined. Key findings might include reports of symptom relief, reduction in severity of itching, scaling, and redness, as well as improvements in overall skin health and regeneration. The comparative effectiveness of Ayurvedic treatments in contrast to conventional treatments, along with any observed long-term benefits without severe side effects, would be presented. Psoriasis is a prevalent dermatological disease requiring lifelong management. Conventional treatments, although providing relief, often come with significant limitations, including potential side effects like hepatotoxicity and renal failure. This has prompted an increasing interest in Ayurveda, which offers holistic approaches with regenerative actions and potentially long-lasting effects. Ayurvedic remedies for managing Kitibha Kustha and psoriasis seem to be a promising alternative, offering a safer and more sustainable option.

Keywords: Kitibha Kushtha, Kshudra Kushtha, Twak Rog, Shodhana Chikitsa, Psoriasis, Chronic skin disorder, Plaque Psoriasis

Corresponding Author How to Cite this Article To Browse
Pooja Gujjar, Post Graduate Scholar, PG Department of Kayachikitsa, Post Graduate Institute of Ayurved, Jodhpur, Rajasthan, India.
Email: 		Gujjar P, Mishra P, Charan D, An overview of Kitibha Kushtha (Psoriasis) and the methods used in Ayurvedic scriptures to manage it. J Ayu Int Med Sci. 2025;10(3):326-331.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-02-08 2025-02-24 2025-03-04 2025-03-14 2025-03-24
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© 2025 by Gujjar P, Mishra P, Charan D 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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Pooja G et al. An overview of Kitibha Kushtha (Psoriasis)

Introduction

The skin, being a highly complex organ, plays a vital role not only in physical protection but also in maintaining mental well-being. As one of the five sensory organs of perception, it is essential in experiencing the sense of touch, also known as ‘Sparsa Gyan’ in Ayurveda. When the skin remains healthy and intact, it serves as the body's natural protective barrier, safeguarding it from external pathogens and environmental threats. However, when damaged, the skin becomes vulnerable to numerous health issues, including various skin diseases.

In Ayurveda, skin diseases are collectively referred to as "Kushtha."[1] These are classified into two major categories: Mahakushtha (major or severe skin diseases) and Kshudrakushtha (minor skin disorders).[2] The Ayurvedic texts describe Kushtha in terms of its symptoms, the Dosha imbalances (Vata, Pitta, and Kapha) responsible for the disease, and its severity. Treatments are individualized based on these factors.

A notable condition described under Kushtha is Kitibha Kushtha, which bears a close resemblance to plaque psoriasis. This condition is primarily linked to the dominance of Vata and Kapha Doshas. Common symptoms of Kitibha Kushtha include dry, scaly, and rough skin that produces a sound when scratched. The skin may appear blackened and is often accompanied by intense itching.[3] In modern medicine psoriasis severity analysis can be done on the basis of PASI score. The Psoriasis Area and Severity Index (PASI) score is a tool used to measure the severity and extent of psoriasis. It evaluates the intensity of redness, thickness, and scaling of the psoriasis, as well as the percentage of the body affected. The score ranges from 0 to 72, with higher scores indicating more severe psoriasis.[4]

The PASI score is calculated:

1. Intensity: The intensity of redness, thickness, and scaling is assessed for each body region (head and neck, upper limbs, trunk, lower limbs) and rated from 0 (none) to 4 (very severe).

2. Area: The percentage of the body affected by psoriasis is evaluated for each region and scored from 0 (no involvement) to 6 (90-100% involvement).

3. Calculation:

The intensity scores for each region are added up, and then multiplied by the area scores and the body surface area represented by that region. The final PASI score is the sum of these calculations.

Twacha Shareera

Sushruta compares the formation of Twacha (skin) to the layer of cream that develops on the surface of boiled milk, illustrating its delicate and superficial emergence following fertilization. Acharya Vaghbhata reinforces this concept, describing Twacha as a component of Matruja Bhava, a fundamental factor in fetal development.

He further explains that the skin forms through the Paka (maturation) of Rakta Dhatu (blood tissue), guided by the influence of Dhatwagni (the metabolic fire governing tissue transformation).

By the sixth month of fetal growth, this process culminates in the skin’s final structure, achieved through the maturation and drying of Rakta Dhatu.

This perspective underscores Ayurveda’s comprehensive approach to fetal development, emphasizing the essential role of elements like Dhatwagni in shaping bodily structures.

It highlights the interconnected nature of the human system, where various Dhatus (tissues) mature in harmony, contributing to the formation of integrated physiological structures such as the skin.

1.Avabhasini1/18thVarana-Chaya Prasadaka, Adhishtana of Sidma and Padmakantaka
2.Lohita1/16Adhishtana of Tilakalaka, Vyanga and Nyaccha
3.Shweta1/12Adhishtana of Charmadala, Ajakallika and Mashaka
4.Tamra1/8Adhishtana of Kilasa Kushtadi
5.Vedini1/5Adhishtana of Kushta, Visarpa
6.RohiniVreehi PramanaAdhishtana of Granti, Apache, Arbuda, Sleepada and Galaganda
7.MamsadharaVreehi DwayaAdhishtana of Bhagandara, Vidradi and Arsha

Relation between Twacha and Dosha-Dushya

Vata - Sparanendriya is the Adhishtana of Vata and the Adhishtana of Samana Vata includes Swedavaha Srotas which in turn is present in Twacha of Kapha Dosha.

Pitta - Bhrajaka Pitta is present in Twacha.


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Kapha - Direct reference is not available of the presence or Adhishtana of Kapha Dosha. But the Mardavata and Snighdhata of the Twacha may be understood as the contribution

Rasa - Rasa Sara Purusha is assessed by the skin texture of the person. Rukshta of Twacha indicates Rasa Kshaya and Shaitya indicates the Rasa Vrudhi.

Rakta - Karma of Rakta Dhatu is told as Sparsa Jnana and Varna Prasadana. The Adhistana of Rakta Dushti Rogas like Kushta, Neelika, Visarpa etc. are Twacha. Hence one can conclude that there is a relationship between Twacha and Rakta Dhatu.

Mamsa - The six layers of Twacha formation is from the Prasada Bhaga of Mamsadhatu.

Sweda - Karma of Sweda is stated as maintenance of Shareera Ardrata and Twak Sukumaryata. Also, the Kshaya and Vrudhi of Sweda Lakshanas will be manifested in Twacha.

Kushta

According to Amarakosha, the etymology of the word Kushta is derived from the root ‘Kush’ which means that comes from the inner part.

The meaning can be understood by the appearance of affected Twacha because of the vitiation in the factors like Rakta, Lasika, Ambu and Tridoshas of the body.

According to Shabdakalpadruma, Kushta means which causes despise and contemptible.

Acharya Vagbhata has defined the Kushta Roga as that which causes Vaivarnya and Dushti to the Twacha.

According to Shabdhakalpadruma, the word meaning of Kitibha is Kesa Keeta.

According to Monier Williams, the word Kitibha in English gives the meaning louse (a parasitic insect, infecting the human hairs and skin and transmitting various diseases).

Nidana

Specific Nidana for Kitibha Kushta has not been explained in the Ayurvedic classics. Hence the general Nidana for the Kushta Roga (Samanya Kushta Roga Nidana) are to be considered. Study of Nidana helps in planning of the treatment as well as to revalidate them to the present study. Nidana can be categorized as follows:[5]

Aharaja Nidana

  • Mithyahara Vihara
  • Adhika Madhu, Dadhi, Snigdha Padartha Sevana
  • Adhika Madhura, Amla, Lavana Sevana, Tila Sevana
  • Chilichima Matsya along with Dugdha
  • Paya Sevana after Amla Sevana
  • Phanita
  • Atimatrahara etc.

Viharaja Nidana

  • Diwaswapna
  • Maithuna
  • Vyayama
  • Vyavaya after Ahitasana
  • Chardi Vegadharana
  • Sheetodaka Sevana after Bhaya, Shrama, Santapa

Lakshana

Lakshana is the term used to denote the characteristic features of a Roga. Rupa and Linga are the synonyms of Lakshana. Lakshana of a Roga will appear on the fifth stage of the Kriyakala, also this stage is called as Vyakta. The Lakshanas of Kitibhakushta is available in various Ayurvedic texts are as following.[6]

  • Shyava Varna - because of Vata Dosha
  • Khartwam - Vata Dosha,
  • Karkasha Sparsha will be present.
  • Parusham - Rukshata of the Twacha will be present; again it shows the involvement of Vata Dosha.
  • Krishna Varna - Aruna Varna of
  • Snigdha - This is a contradictory statement given by Acharya Sushruta. This can be understood as Snigdha Sparsa when there is an excessive Kleda Guna is present. Also, when there is predominance of Kapha Dosha in Kitibha this may be observed.
  • Srava - Pitta
  • Ugrakandu - Kapha Dosha
  • Vridhi - increase in the size of the lesion

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  • Guru/Dhrudam/Ghana - indicates the thickness of Vrana Sthana (Kina)
  • Prashanthani Cha Puna Punarutpadhyante / Vartate Cha Samutpnnam - the disease reoccurs after its complete disappearance.

The Lakshanas of Kitibhakushta mentioned by Acharya Charaka is as following, Shyava Varna, Kharasparsha and Parushata.

Sushruta, Madhavanidana, Vagbhata, Yogaratnakara, Kasyapa has been followed the same as that of Charaka.

Samprapti

The process beginning with the vitiation of Doshas, due to specific Nidana and which lead to the full-fledged manifestation of the disease after the Dosha-Dushya Sammurchana is called Samprapti. The knowledge of Samprapti helps the physician to understand the specific features of a disease, like the involvement of particular Dosha, Agni etc. The planning of Chikitsa is told as vain if it is not according to the Samprapti Ghataks. Since there is no detailed Samprapti of Kitibhakushta is mentioned in texts, Samprapti of Kitibhakushta is being derived here on the basis of Kushtaroga. Kushta is a Tridoshajanya Vyadhi. It is believed that this Roga cannot manifest with a single Dosha involvement. The classification of Kushta is based on the Amshamshakalpana of Dosha. The Sapta Dravyas of Kushta are Tridoshas, Twak, Rakta, Mamsa and Ambu. According to Acharya Charaka, Nidana Sevana leads to Prakopa of Tridosha and thus the vitiated Doshas will get Ashraya in Twak, Rakta, Mamsa and Ambu causing the Shaithalyatha in these Dhatus leading to the manifestation of Kushta Roga. Further in Chikitsasthana, he has been explained that the Vatadi Doshas get Prakopa and does Dushana of Twak, Rakta, Mamsa and Ambu leading to seven or eleven types of Maha and Kshudrakushta respectively.[7]

Samprapti Ghatak

  • Dosha - Tridosha Pradhan
  • Dushya - Twak, Rakta, Mansa, Lasika
  • Srotas – Raktvahsrotas
  • Rogamarga - Bahiyarogmarga
  • Adhisthana - Twak & Mansa
  • Shrotodushti - Sanga

  • Savabhava - Chirkari (Chronic)
  • Upsarga - Raktaj Krimi

Sadhyasadhyata

Sadhyasadhyata of the Kushta is explained in Ayurvedic classics, but however the explanation of Sadhyasadhyata of Kitibha is not dealt separately. Before explaining Chikitsa, Acharyas have briefed about the condition of Sadhya and Asadhyata of the Roga, thus it gives a comprehensive hint to the physicians for treatment.[8]

Sadhya Kushta - Eka Dosholbana, Vata-Kapha Pradhanata, which has affected only Twak, Rakta and Mamsa, in this condition always have a chance of good recovery.[9]

Kruchra Sadhya Kushta - The chance of getting cure in this Avastha becomes with great effort, if it is either of Kapha Pitta Mishrita or of Vata Pitta or of alone Pitta Dosha.

Yapya Kushta - If the Doshas are in Medo Dhatu and the Rogi takes proper Bheshaja and follows Pathya, he will be free from the sufferings of the Roga. Once he stops the Aushadhis and follows the Apathya, relapse of Vyadhi is likely.

Asadhya Kushata - If the following features like, Sarva Lingayukta, Abala, Trushna, Daha, Santhagni, presence of Jantu, Doshas which have reached Asthi, Majja and Shukra Dhatus are considered as Asadhya Kushta Lakshanas.

Upadrava

Upadravas may arise either after the full manifestation of the disease or during its progression. The complications associated with Kushta include the following:

  • Prasravana
  • Angabheda
  • Patana Anyangavayavanam
  • Trushna
  • Jwar
  • Atisara
  • Daha
  • Dourbalya
  • Arochaka
  • Avipaka

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Pathya-Apathya[8]

Pathya - Laghu Anna, Tikta Shaka, Bhallataka, Triphala, Nimbayukta Anna and Ghrita, Purana Dhanya, Jangala Mamsa, Mudga, Patola.

For Pana, Snana and Parisheka Khadira Kashaya is advised.

Apathya

According to Acharya Sushruta, Mamsa, Vasa, Dugdha, Dadhi, Taila, Kulatha, Masha, Nishpava, Ikshu, Amla, Virudha Ahara, Adhyasana, Ajeerna, Vidahi and Abhishyandi are said as Varjya.

Acharya Charaka says Guru, Amla, Payas, Dadhi, Anupamamsa, Matsya, Guda, Tila as Apathya.

Chikitsa

Skin diseases tend to be prolonged, challenging to cure, and demand patience for extended treatment durations. Kushta Roga arises only when the Tridoshas become imbalanced. As its development originates from Nidana, the primary approach to treatment should focus on Nidana Parivarjana, which helps prevent further progression by limiting Dosha vitiation. The therapeutic process aimed at the complete elimination of underlying pathogenic factors is known as Samshodhana. According to Acharya Sharangadhara, Kushta Roga occurs due to Dosha Bahulyata. These Doshas are Tiryagami and very difficult to treat by Shamana Aushadhi. Acharya Vagbhata says that, Snehapanam is given to the Kushta Rogi in the Purvarupa Avastha.[9]

Acharya Charaka emphasizes that in Vata Dosha-dominant Kushta, Virechana should be administered first, followed by Niruha Basti using Madhuphaladi Sidha Taila. Since Kushta is a Tridoshajanya Vyadhi, the primary focus should be on treating the predominant Doshas before addressing the secondary Anubandha Doshas. The periodic recommendation of Panchakarma procedures signifies the level of Dosha involvement in Kushta Roga, with Shodhana Karmas advised in cases of Bahudoshaavastha. For Kaphapradhana and Doshotklesa Kushta, Vamana Karma is prescribed in Charaka Chikitsasthana,[10] with Raktamokshana performed every six months, Virechana every month, and Vamana every 15 days.

Shamana therapy plays a crucial role in managing Kushta, particularly after completing Shodhana Karma, as it helps pacify the remaining Doshas.

Given the demands of modern lifestyles, where individuals may struggle to dedicate time to Shodhana therapy, Shamana therapy serves as a practical alternative. Charaka describes Shamana therapy using Tikta and Kashaya Dravyas, which are more effective when administered post-Samshodhana. Additionally, external therapies hold significance in Kushta Roga, as its site of manifestation (Sthanasamasraya) and expression (Vyaktasthana) is the skin (Twacha). The relevance of external applications is reinforced by numerous references to Lepa Yoga in classical texts.

Discussion

Skin Diseases recognized in modern medicine can be correlated with Kushtha Roga in Ayurveda, a chronic and challenging disorder to treat. Various factors, including dietary habits, lifestyle choices, environmental influences, genetic predisposition, and immunological mechanisms, contribute to its pathogenesis, with psoriasis being a notable example. Psoriasis is a persistent, complex, and inflammatory condition characterized by excessive proliferation of keratinocytes, leading to an accelerated turnover of epidermal cells. It predominantly appears on the elbows, knees, scalp, lumbosacral region, intergluteal folds, and glans penis, and in approximately 30% of cases, it also affects the joints. An imbalance in Kapha Dosha is believed to trigger immunological changes that facilitate psoriasis development. Ayurveda classifies Kushtha Roga into various subtypes, encompassing ailments such as psoriasis, eczema, and leprosy, based on severity and clinical presentation. Psoriasis, marked by scaling, inflammation, and itching, is closely linked to disturbances in Vata and Kapha Doshas - where Vata induces dryness and scaling, while Kapha leads to excessive skin accumulation.

Treatment in Ayurveda focuses on balancing the Doshas, particularly Kapha, through detoxification therapies like Panchakarma, dietary modifications, and the use of herbal remedies. Anti-inflammatory herbs such as Turmeric (Curcuma longa), Guduchi (Tinospora cordifolia), and Guggulu (Commiphora wightii) are commonly used to manage symptoms and reduce the intensity of the disease.

In modern medicine, the treatment of psoriasis includes topical treatments, systemic medications, phototherapy, and biologics,


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which aim to reduce inflammation, control the hyperproliferation of skin cells, and address the immune system's role in the disease.[10] The connection between environmental and genetic factors in psoriasis highlights the complexity of the disease, which, while treatable, often requires lifelong management. The stress component you've mentioned also aligns with modern understandings of psoriasis, where emotional and psychological stress is seen as a significant trigger or exacerbating factor. In Ayurveda, the mind (Mana) is tightly connected to the body’s health, and any disruption in the mental state can manifest as physical ailments, including skin diseases like psoriasis.

Understanding psoriasis from both a modern medical and Ayurvedic perspective can help in holistic treatment approaches, where the patient is treated both physically and mentally to manage the chronic nature of this disorder.

Conclusion

Kushtha is among the oldest diseases known to humanity and is recognized as one of the most persistent ailments in Ayurveda. The skin’s involvement in sensory perception, communication, and its connection to mental health (Mana) highlights the profound interrelationship between physical and psychological well-being in Ayurvedic thought. Notably, Ayurvedic treatments adopt both pharmacological and non-pharmacological methods, integrating herbal formulations, lifestyle modifications, and stress management techniques to strengthen immunity and alleviate skin disorders. This comprehensive approach seeks to harmonize the mind and body, addressing underlying factors that may contribute to dermatological conditions. Ayurveda emphasizes that by managing stress and enhancing immunity, many skin ailments can be effectively controlled in a natural manner, often with fewer side effects compared to conventional therapies.

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