AYURVEDA MEDICINE INTERVENTION IN THE MANAGEMENT OF KITIBHA KUSHTHA (PSORIASIS): A CASE STUDY

ABSTRACT 
Kitibha kushtha is one of the common forms of disorder which can be correlated with psoriasis in modern medicine. According to Ayurveda classics, the disease arise mainly due to vitiation of Tridosha (Vata, Pitta, Kapha) and Rasa, Rakta, Mamsa, Medas and Kleda dhatu. This disease primarily characterized by Syava (silvery scaly lesions), Kinakara sparsha (Hard), and Parusha (rough to touch). It is observed that many Ayurveda treatment regimes have been used to treat Kitibha kushtha. Therefore, this study was accomplished to evaluate the Ayurvedic treatment regime for Kitibha kushtha.  A fourteen year old female patient was referred to Ayurvedic Teaching Hospital, Borella, Sri Lanka with two years history of Kitibha kushtha, presented with symptoms of Syava (silvery scaly lesions), Kinakara sparsha (Hard), Parusha (rough to touch and Kandu (severe itching) of the affected area of skin. These existing clinical features were graded and marked using a standard performa. Treatment regime conducted for nine weeks continuously and results were recorded through subsequent visits every week. At the end of the treatment period the patient was entirely relief (100%) from clinical features of the disease Kitibha kushtha. 
Key words: Kitibha kushtha, Treatment regime, Psoriasis, Ayurveda


INTRODUCTION
Kitibha kushtha is one of the Kshudra kushtha having the symptoms of Syava (silvery scaly lesions), Kinakara sparsha (Hard), and Parusha (rough to touch) 1 . Ayurvedic classics have considered Kushta disease to be a Tridoshaja manifestation and each type of Kushtha have Doshik identity it can be established on the basis of Dosha in the Samprapti. Kitibha kushtha is considered to be the close equalant in Ayurveda medicine to Psoriasis in modern medicine. Psoriasis is considered as a genetic, immunological, system disorder with a prevalence of 1-3% in worldwide 2 . In the other hand, the disease Psoriasis can be mainly known to dermatological disorder which can afflict the patient physically as well as mentally and also negligibility of this disorder can be badly affected the vital organs of the body 3 . Therefore, considerable attention should be given to this disease and it should be treated with a proper treatment plan. This I J -R I M case report would provide the positive impression of the disease Kitibha kushtha could be managed by the Ayurvedic treatment regimen with or without minimal side effects and this study is mainly focused on a patient who was suffering from Kitibha kushtha which is located most of the upper parts of the body. The objective of this study was to evaluate the efficacy of an Ayurveda treatment regime on a patient suffering from Kitibha kushtha.

CASE PRESENTATION:
A 14 year oil female patient was referred to an Out Patient Department (OPD) at Ayurveda Teaching Hospital, Borella, Sri Lanka on 8 th May 2020 with two years history of Kitibha kushtha, presence with the symptoms of whitish scaly patches, severe itching and whitish brown inflamed skin lesions all over the face, chest, back, hands and scalp and has severe constipation also. No history of any major ailment occurred. The patient had been undergone with both western and Ayurveda medicine during last 2 years, but the disease was not cured completely; recurrences occur. After the thorough examination of the patient, it was diagnosed that she was suffering from the disease Kitibha kushtha, which could be correlated with the Psoriasis according to modern medicine. Tridosha were associated with the disease but Vata pitta dosha were distinguished and as the most prominent Dosha and Rasa, Rakta, Mamsa dhatu were the most affected. The patient was Vata pitta prakriti and there was no one in her family suffering from any skin disorder such as Kitibha kushtha.
Existing symptoms i.e. Shyava, Kinakara sparsha, Parusha and Kandu were graded (o to 3) and marked using a standard performa. On laboratory investigation of blood routine test was normal.
The grades of symptoms of the patient before starting the treatment are mentioned below.  Shyava (severe brownish discolouration)grade 3  Kinakara sparsha (severe rough lesions on touch)grade 3  Parusha (severe hardness of lesions with scaly patches)grade 3  Kandu (very severe itching disturbing sleep and daily activities)grade 3  Candle grease sign was positive Treatment regime was planned according to the patient's Prakriti, symptoms appeared and associate Dosha with the diagnosed disease. Both internal and external treatments were consisting in the planned treatment regime. Agni dipana, Srotas shodhana, Virechana, Rakta shodhana and Samana chikitsa were used and the instruction regarding oil and paste application to the affected area was given to the patient and the guardian. In addition to that, the instruction regarding to food and habits which should be avoided were given to the patient. Planned treatment management was continued for 09 weeks continuously and results were recorded through symptomatic relief in subsequent visits on every week. Follow up period was once in a month for two months time. The prescribed treatment regime is revealed below. 1 st day to 8 th day Internally;  Tripal gugul decoction -120ml bd (before meals)  Pippalyadyasava -20ml bd (before meals)  Seetharama vati -03 bd with luke warm water (after meals)  Sudarshana pills -02 bd (after meals)  Gokshuradi guggulu-01 bd with warm water (after meals)

Results:
At the end of the 3 rd week; Shyava (Moderate brownish discolouration)grade 2, Kinakara sparsha (moderatly rough lesions on touch)grade 2, Kandu of the affected areas was grade 2 (moderate itching in some times), Candle grease sign slightly reduced and constipation also was reduced ( Fig. 1 and Fig. 2).  At the end of the 5 th week; Shyava (light brownish discolouration)grade 1, Kinakara sparsha (moderately rough lesions on touch)grade 2, Kandu of the affected areas was grade 1 (itching in some times) and after the 7 th weeks of treatment Shyava (light brownish discolouration)grade 1, Kinakara sparsha (slightly rough lesions on touch) grade 1, Kandu of the affected areas was grade 1 (itching sensation arise on and off) ( Fig. 3 and Fig. 4).