29/9/2014
Thiruchirappalli,
Kerala Ayurveda Hospital.
CASE : 3
PULSATOR PSORIASIS
Psoriasis is a common chronic inflammatory dermatosis affecting 1 % to 2 % of the population. In rare cases it is associated with arthritis, myopathy, enteropathy and spondylitic heart disease.
Pathogenesis :
Its an immunologic disease with contributions from genetic susceptibility and environmental factors. It is not known if the inciting antigens are self or environmental. Sensitized population of T cells enter the skin, including dermal CD4+ TH1 cells and CD8+ T cells that accumulate in the epidermis. Tcells that induce keratinocyte hyper-proliferation, resulting in the characteristic lesions. Psoriatic lesions can be induced in susceptible individuals by local trauma, a process known as Koebner phenomenon. The trauma may induce a local inflammatory response that promotes lesion development. While reserved for use in severe psoriatic arthritis , recent therapeutics exploit advances in our understanding of T-cell biology. Various clinically useful agents block (1) T cell activation and proliferation (2) Tcell trafficking and keratinocyte interaction with T cells (3) binding of tumor necrosis factor to its receptor thus inhibiting T cell functions.
Clinical features :
Psoriasis most frequently affects the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal cleft, and glans penis. The most typical lesion is a well demarcated, pink to salmon coloured plaque covered by loosely adherent silver white scales. Nail changes occur in 30% of cases of psoriasis and consist of yellow brown discoloration, with pitting, thickening, and crumbling and separation of the nail plate from the underlying bed (oncholysis). In most cases, psoriasis is limited in distribution, but it can be wide spread and severe on occassion. There are a variety of clinical subtypes of this disease, defined by the severity and pattern of involvement.
Psoriasis in Ayurveda
Almost all skin diseases in Ayurveda come are treated with reference to the chapter Kushta roga. Accordingly the classical symptom of psoriasis "The most typical lesion is a well demarcated, pink to salmon coloured plaque covered by loosely adherent silver white scales", is discussed under the sub-heading Sidhma kushta / Kidibha kushta. The sloka is as under...in Madhava Nidana...
निदान:
"विरोधीन्यन्न पानानि द्रव स्निग्ध गुरूणि च
भजतामागतिम् छर्द्दिम् वेगाम्स्चान्यान् प्रतिघ्नताम्
व्ययाम अतिसन्ताप अतिभुत्वा निशेवणाम्
खर्म्म् श्रम भयार्त्तानाम् द्रुतम् शीताम्बु सेविनाम्
अजीर्ण्णाद्यशिनाण्चैव पन्चकर्मापचारिनम्
नवान्न दधि मत्स्यदि लवनाम्ल निंशेवणम्
मश मूलक पिश्टान्न तिल क्शीर गुडाशिनाम्
व्यवाय अपि अजीर्ण्णेण निद्रा च भजताम् दिवा
विप्रान् गुरून् ध्रर्श्यताम् पापम् कर्म्म् च कुर्वताम्
वातादयः त्रयो दुश्टा त्वक् रक्तम् माम्समम्बु च
दूशयन्ति स कुश्टानाम् सप्तको द्रव्य सन्ग्रह:
अत: कुश्टाणि जायन्ते सप्त च एकादशैव च "
पूर्वरूपम्
अति स्लश्ण खर स्पर्श स्वेदास्वेद विवर्ण्णता
दह: कन्डू त्वचि स्वाप: तोदः कोटः उन्नतिः भ्रमः
व्रणानाम् अधिकम् शूलम् शीघ्रोल्पत्तिः चिरः स्तिथिः
रूडानामपि रूक्शत्वम् निमित्तेल्पेति कोपनम्
रोम हर्शोस्रजः कर्श्न्यम् कुश्ट लक्शनम् अग्रजम्
सिद्ध्म कुश्ट् लक्शनम्
श्वेतम् ताम्रम् तनु चयद्रजोकुरुश्तम् विमुन्चति
परयस्चोरसि तत् सिध्म मलाबु कुसुमोपमम्
Thiruchirappalli,
Kerala Ayurveda Hospital.
CASE : 3
PULSATOR PSORIASIS
Psoriasis is a common chronic inflammatory dermatosis affecting 1 % to 2 % of the population. In rare cases it is associated with arthritis, myopathy, enteropathy and spondylitic heart disease.
Pathogenesis :
Its an immunologic disease with contributions from genetic susceptibility and environmental factors. It is not known if the inciting antigens are self or environmental. Sensitized population of T cells enter the skin, including dermal CD4+ TH1 cells and CD8+ T cells that accumulate in the epidermis. Tcells that induce keratinocyte hyper-proliferation, resulting in the characteristic lesions. Psoriatic lesions can be induced in susceptible individuals by local trauma, a process known as Koebner phenomenon. The trauma may induce a local inflammatory response that promotes lesion development. While reserved for use in severe psoriatic arthritis , recent therapeutics exploit advances in our understanding of T-cell biology. Various clinically useful agents block (1) T cell activation and proliferation (2) Tcell trafficking and keratinocyte interaction with T cells (3) binding of tumor necrosis factor to its receptor thus inhibiting T cell functions.
Clinical features :
Psoriasis most frequently affects the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal cleft, and glans penis. The most typical lesion is a well demarcated, pink to salmon coloured plaque covered by loosely adherent silver white scales. Nail changes occur in 30% of cases of psoriasis and consist of yellow brown discoloration, with pitting, thickening, and crumbling and separation of the nail plate from the underlying bed (oncholysis). In most cases, psoriasis is limited in distribution, but it can be wide spread and severe on occassion. There are a variety of clinical subtypes of this disease, defined by the severity and pattern of involvement.
Psoriasis in Ayurveda
Almost all skin diseases in Ayurveda come are treated with reference to the chapter Kushta roga. Accordingly the classical symptom of psoriasis "The most typical lesion is a well demarcated, pink to salmon coloured plaque covered by loosely adherent silver white scales", is discussed under the sub-heading Sidhma kushta / Kidibha kushta. The sloka is as under...in Madhava Nidana...
निदान:
"विरोधीन्यन्न पानानि द्रव स्निग्ध गुरूणि च
भजतामागतिम् छर्द्दिम् वेगाम्स्चान्यान् प्रतिघ्नताम्
व्ययाम अतिसन्ताप अतिभुत्वा निशेवणाम्
खर्म्म् श्रम भयार्त्तानाम् द्रुतम् शीताम्बु सेविनाम्
अजीर्ण्णाद्यशिनाण्चैव पन्चकर्मापचारिनम्
नवान्न दधि मत्स्यदि लवनाम्ल निंशेवणम्
मश मूलक पिश्टान्न तिल क्शीर गुडाशिनाम्
व्यवाय अपि अजीर्ण्णेण निद्रा च भजताम् दिवा
विप्रान् गुरून् ध्रर्श्यताम् पापम् कर्म्म् च कुर्वताम्
वातादयः त्रयो दुश्टा त्वक् रक्तम् माम्समम्बु च
दूशयन्ति स कुश्टानाम् सप्तको द्रव्य सन्ग्रह:
अत: कुश्टाणि जायन्ते सप्त च एकादशैव च "
पूर्वरूपम्
अति स्लश्ण खर स्पर्श स्वेदास्वेद विवर्ण्णता
दह: कन्डू त्वचि स्वाप: तोदः कोटः उन्नतिः भ्रमः
व्रणानाम् अधिकम् शूलम् शीघ्रोल्पत्तिः चिरः स्तिथिः
रूडानामपि रूक्शत्वम् निमित्तेल्पेति कोपनम्
रोम हर्शोस्रजः कर्श्न्यम् कुश्ट लक्शनम् अग्रजम्
सिद्ध्म कुश्ट् लक्शनम्
श्वेतम् ताम्रम् तनु चयद्रजोकुरुश्तम् विमुन्चति
परयस्चोरसि तत् सिध्म मलाबु कुसुमोपमम्
C/O:
Rashes formation all over body:For past 9 yrs
Problem increased:For past 10 days
Occassional itching
B/L UL,LL pain:While folding & extending
H/O:
Problem occurs regularly in winter but subsides after taking
medicine.
Took siddha medicine 1 month before then problem subsided
but problem relapsed after discontinual.
G/E:
Appetite : Reduced
Bowel : Normal
Sleep : Normal
Urine : Normal
BP : 130/90 mmhg
Pulse : 82/mt
O/E:
Rashes seen all over body
NOT A KNOWN CASE OF DM/HTN/CAD
PULSATOR PSOARIASIS
Blood report
ESR:30/60
RBS:138
SGOT:09
SGPT:12
ALP :129
UREA:18
CREATININE:1.2
NA:145.7
K:4.8
CL:105.5
CBC:
WBC:10.6
HB :14.2
DC :Normal
PLT:271
Urine Routine
COLOUR:Pale Yellow
APPEARANCE:Normal
REACTION:Acid
ALBUMIN:Trace
SUGAR:+
BILE SALT:-ve
BILE PIGMENT:-ve
DEPOSIT:
Pus cells:4-6
Epithelial CellS:3-5
OTHERS:Nil
RED CELLS:Nil
Treatment details
Abhyangam:14 days
Takra Dhara:13 days
Virechanam:01 day
Internal medicines
Maha thikthaka ks:15ml 6am/6pm b/f
Avipathi choornam:1/2 tsp with ks 6pm b/f
Tab.Psorakot:1-1-1 a/f- (PATOLA, KATUROHINI, CHANDANA, MADHUSRAVA, GUDUCI ,PATA ,JIRAKA)
Tab.Biogest:1-1-1 a/f- (Gugul, Punnarva, Amla, Haritaki, Bibhitaki, Kokilaksha, Sariba and
Chayilyam.)
ON FIRST DAY
ON THE FOURTH DAY
ON FIFTH DAY.
ON SIXTH DAY
ON NINTH DAY
ON ELEVENTH DAY
TWO WEEKS AFTER IP TREATMENT
CONTINUING MEDICATIONS
