CTRI

Psoriasis is an immune-mediated inflammatory disorder characterized by marked inflammatory changes in the epidermis and dermis.According published report 0.44-2.8% prevalence of Psoriasis reported in India, it predominantly affects people in their third or fourth decades, with males two times higher than females .In Ayurveda ,all the skin disease is described under kushtha. Psoriasis can be diagnosed as Ekakushtha, Kitibha Kushtha, Sidhma Kushtha which are considered as the Kshudra Kushtha.They are said to be Tridoshaja with the dominance of Vata-Kapha Dosha. The classical symptoms of Kitibha Kushtha described in Ayurveda resemble with Psoriasis. Clinical features of Psoriasis [Rupa of Kitibha Kushtha] are Blackish skin lesions (Shyava), Scarring of skin (Kinna), Rough skin (Kharasparsha), Dry cracked skin (Parusha), Itching (Kandu), Thickened skin (Ghana). Due to the complex pathophysiology and chronic and relapsing nature of psoriasis. Nowadays everyone interested in the molecules involved in the dynamic interplay that leads to psoriasis, as well as gene products that may serve as a connection between predisposing genetic factors and the immune and inflammatory processes involved in the diseaseâ€™s pathogenesis.⁴ Hence biomarkers could be relevant, for assessment of disease activity and severity, and for prediction of the outcome of a therapeutic intervention. The presence of high levels of TNF-a, IFN-a, IL-2, IL-6, IL-8, IL-12 and reduced levels of IL-1, IL-4, IL-5 and IL-10 in psoriatic skin lesions suggests that psoriasis is an immune- response disease. ⁵In Various studies an association of psoriasis with inflammation, indicated by higher levels of the inflammatory markers such as C-reactive protein (CRP), haptoglobin, fibrinogen, and C3 and C4, which increase with severity of disease.Acharya Charaka mentions repeated Shodhana in context of Bahudosha Avastha Janya Vyadhi â€œKushthaâ€. It deals mainly with elimination of aggravated Doshas from the body.

These Doshas should be eliminated naturally the nearestroute the body.There are various studies on the efficacy of Shodhana Karma in Psoriasis (Kitibha Kushtha).Such studies reported significant relief in sign and symptoms of psoriasis and better quality of life with no further episodes of recurrence after repeated Shodhana karma in regular interval of time.

It is the need of an hour to overview the role of immunological and inflammatory biomarkers that can help us to understand the role of Ayurvedic management Shodhana Karma and its influence on autoimmune biomarkers Specific to Psoriasis. Hence this study is proposed to explore the importance of Shodhana Karma (Vamana followed by Virechana Karma) in autoimmune disease-Psoriasis on immunological and inflammatory biomarkers.

70 patients suffering from psoriasis who fulfill the inclusion criteria will be selected from OPD & IPD of All India Institute of Ayurveda,Gautampuri ,Sarita Vihar,New Delhi .Written consent of each patient will be taken for examination,photography and investigation.

It is an Open Label single Arm Clinical study where Rookshana will be done by Aargvadha Patra + Haridra Kashaya Dhara for 30 mins daily along with Deepana â€“Pachana with Panchkola Choorna given 3gm twice daily for 7 days or until Samayak Rookshana Lakshana obtained whichever is earlier. After assessing Rookshana Lakshana, Snehapana will be given with Indukanta Ghrita in Arohana Matra starting with 30 ml and thereafter increasing the dose every day by calculating the time taken for digestion of Sneha for7 days or until Samayaka Snigdha Lakshanaobtained whichever is earlier. After assessing Samayaka Snigdha Lakshana, For 1 day of Vishrama Kala Sarvanga Abhyanga with Marichyadi Taila followed by Sarvanga Mridu Bashpa Swedana with Dashmoola Kwatha will be done. Kaphautkleshakara Aahara (Dadhi Rice, Mashakheera, Ksheera) will be given prior to Vamana Karma. Vamana Karma will be done with Madanphala pippali choorna 10 gm + Kutaja Beej Choorna 10gm + Maddhuka, Nimba, Patola Kashaya approx.400 ml (16gm each drug has been taken and boiled with 768 ml water and reduced to its half 384ml )+ Madhu+ Saindhava. After Sarvanga Abhayanga and Mridu Bashpa Swedana. After Vamana karma Peyadi Samsarjana Karma will be followed as per Shuddhi(3- 7days).After 1 day gap, Again Snehapana with Indukanta Ghrita will be given starting with 30 ml and there after increasing the dose every day by calculating the time taken for digestion of Sneha for 5 days or until Samyaka Snigdha Lakshana obtained whichever is earlier. After assessing Samayaka Snigdha lakshanas, for 3 days of Vishrama Kala, Sarvanga Abhyanga with Marichadi Taila and Sarvanga Mridu Bashpa Swedana with Dashmoola Kwatha will be done. Virechana Karma will be done with Triphala,Trivrit and Danti Kashaya ²⁶(100ml) The Kashaya will be prepared by taking 8 gm each drug that is boiled in 400 ml water and reduced to Â¼ that is 100ml) after Sarvanga Abhyanga and Mridu Bashpa Swedana. After Virechana karma, Samyaka Shodhana lakshana will be assessed and Peyadi Samsarjana Karma will be followed as per Shuddhi. After completion of Intervention patient will be followed upto 40 days. On 80^th day assessments will be taken.