Virechana, a Panchakarma Treatment, for Psoriasis at Veda5 Ayurveda & Yoga Wellness Retreats in Rishikesh, Kerala & Goa, India
INTRODUCTION
Psoriasis is a chronic autoimmune disease characterized by scaly patches with erythematous base over the skin. Psoriasis is a chronic inflammatory disease which gets aggravated by several factors such as psychological (anxiety, stress, depression), dietary (incompatible diet) lifestyle disturbances environmental changes, medications, etc.
In Ayurveda, skin disorders come under kustha roga. Kustha roga is one among the asta maharoga (major 8 diseases). Ekakustha is one among these which resembles with the symptoms of psoriasis.
According to ayurvedic classics, Acharyas have emphasized on Shodhana therapy (bio purification) in the management of all Kushtha which eliminates the vitiated doshas.
Virechana (therapeutic purgation) is a specific modality for the elimination of Pitta Dosha but it is also effective upon Vata and Kapha Dosha as well as in Rakta pradoshaj vikara. So, Virechana (therapeutic purgation) was selected for the Shodhana.
CASE STUDY
A 45 year male patient visited the opd, having complaints of skin lesion throughout the body mainly on, bilateral upper & lower limbs since last 4-5years.
Associated complaints were severe itching sensation on lesions along with other body surface. While scrapping patient complaint of shedding off of silvery white powder leaving tiny bleeding spots.
According to patient initially the lesions were small round shape started on bilateral upper limbs, trunk and bilateral lower limb and gradually throughout the body. The affected parts were of variable shape, red in color i.e. erythematous with surface covered with silvery scale.
Hence it was clear case of psoriasis. Personal history General condition of patient was good along with the routine investigation were within normal limit. Patient was vegetarian with good appetite. Sleep, micturition and bowel habit was normal and regular.
There was no personal history of autoimmune disorders. On local examination of lesion: Multiple, discrete, erythematous plaque with loosely attached silvery white scales present on bilateral upper and lower limbs also few on trunk. Auspitz sign positive.
TREATMENT
The patient was admitted for shodhana therapy (virechana) and internal medication for 2 months. Virechan karma, one of the basic procedures of detoxification followed by oral medication. All other medicine patient was taking were stopped. The details of the therapy are given below:
Virechana procedure
- Purva karma (pre-operative)
- Pradhana karma (operative)
- Paschat karma (post-operative)
Purvakarma Purvakarma comprises of deepana, pachana, snehana followed by abhyanga & swedaana. Deepena, pachana. Snehana was done internally by pancha tikta ghrita.
After obtaining of samyak snigdha lakshana (proper oleation) for 5 days patient was advised to do abhyanga with murchita taila and swedana – sarvanga baspa sweda by dashamool decoction for three days. During the time of snehana & swedana light warm liquid diet was given whenever patient was hungry. On fourth day pittaja kala virechana was performed in the morning.
Pradhana karma at the day of administrations of virechana yoga, Abhyanga followed by swedana was done. Vitals were noted (pulse, B.P., temperature, respiration rate). It was recorded in regular interval during pradhana karma.
Virechana yoga was administered in morning 9 am on empty stomach. Virechana yoga was prepared from 100ml trifala qwatha (decoction) + kutki churna 5gm + trivrit churna 5gm. Patient was given hot water and advised to take sip by sip repeatedly when needed. The patient was under strict observation to avoid complication. Number of vegas (motion) was counted till the symptoms of proper purgation like passing of stool with mucus in the last two motion and later sign and symptoms.
Paschat karma the time period in between the completion of vegas to intake of normal diet special food is designed known as Paschat karma.
Mainly its duration depends upon the type of shuddhi done during the procedure. As soon as purgation completed and patient felt hungry samsarjana karma (post dietetic management) according to the type of shuddhi patient was given thin rice gruel two times a day for 3 to 5 days.
RESULTS
Patient got relief from the symptoms of itching, silvery scales and burning sensation after the 3rd day of snehapana itself after 15 day of therapy there was marked improvement in the size and colour of lesion. 50 % relief in symptoms after the shodhana therapy and 70% relief after taking 2 month oral medicine was observed.
DISCUSSION
As per Ayurveda view, psoriasis is considered as a raktaja disorder having vitiation of doshas. In greater extent virechana karma is one of the treatment modality for this ailment pre-operative, operative and postoperative care during virechana karma is most important to yield better outcome in psoriasis.
The dosha situated in twak. Agni is dearranged therefore deepana, pachana medicine prior to snehapana are important which helps in Ama pachana and normalizing the Agni, generally arohana snehapana administered till samyak snigdha lakshana or maximum seven days.
Gradually increase the dose of sneha helps in loosening the bond between the dosha, dushya, which helps in breaking the pathogenesis of psoriasis. For the snehapana, panchatikta ghrita was taken.
It also pacified the symptoms like itching, discoloration and dryness due to aggravated Vata and Kapha doshas.
During the 15th day course of Virechana, patient had reported 50-60% improvement in his symptoms. He had got complete relief from itching.
The discolored skin and red scaly patches had developed quite normal lustre. The silver scales disappeared. Also the patient had developed normal bowel habit. Patient was planned shodhana therapy followed by shaman therapy.
Ghrita also having Rasayana property may be more beneficial in management of Kustha. Sarvanga Abhayanga and Swedana remove obstruction in Srotas and bring the vitiated Dosha from Shakha to Kostha.
Virechana karma does cleansing the Kostha and brings down the morbid Dosha from body and helps to maintain the Dosha and Dhatu Samya or keep up the homeostasis and leads to the refurbish and rejuvenation of body tissues and also boost the body. Immunity and cleanses the Srotas (micro channels). Therefore, virechana is very important therapeutic measure for psoriasis.
CONCLUSION
The disease psoriasis appears to be largely a disorder of keratinization. The basic defect is rapid displacement of epidermis in psoriatic lesion (3-4 days in-stead of 28 days in normal skin).
There is evidence that both hormonal and immunological mechanisms are involved at a cellular level. The raised concentrations of metabolites of arachidonic acid in the affected skin of people with psoriasis are related to the clinical changes.
Ayurveda believes in treating psoriasis through shodhana & shaman treatment. Virechana karma is commonly advocated in the management of psoriasis as it helps in correcting the basic pathogenic factors with pitta, rakta, Agni, twak. 50 % relief in symptoms after the shodhana therapy and 70% relief after taking 2 month oral medicine was observed in this particular case. Thus, Virechana karma (purgation therapy) followed by internal medications is considered as best line of management for skin disorders.
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