Article by Dr Raghuram Y.S. MD (Ay)
EkaKushta and Kitibha are generalized terms to describe Psoriasis. Kushta – skin disorders are of 18 types. Among these, the clinical presentation of two types of Kushta resembles the lesions of psoriasis. They are Kitibha Kushta and Ekakushta or Charma Kushta.
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स्यावं किण खर स्पर्शं परुषं किटिभं मतम्।(च.चि.)
Shyaavam kina khara sparsham kitibham matam (Ref – Charaka Chikitsa)
The lesions in Kitibha kushta are blackish brown / ash colour, rough on touch just like the scar of wound, hard and dry in nature. Similar lesions are seen in Psoriasis.
अस्वेदनं महावास्तु यत् मत्स्य शकल उपमम्।
तद् एककुष्ठं चर्माख्यं बहुलं हस्ति चर्मवत्॥(च.चि)
Asvedanam mahaavaastu yat matsya shakala upamam
Tad eka kushtam charmaakhyam bahulam hasti charmavat (Ref – Charaka Chikitsa)
The lesions in Eka kushta or charma kushta resemble the upper layers of fish, scaly in nature and also thick, hard and rough resembling the skin of an elephant. The lesions will be devoid of sweating (the skin around the lesion will not sweat). This too resembles the lesions in psoriasis.
Just like any other kushta, kitibha and eka kushta also can enter deep into the tissues causing damage of those tissues including bone, muscles and joints and cause joint related pathology. Since psoriatic arthritis is associated with psoriasis (skin condition), the asthigata stage of kitibha or eka kushta can be considered as Psoriatic arthritis and should be treated accordingly.
Treatment of Kitibha and Eka Kushta –
The same line of treatment and formulations used in the treatment of Kushta in general (as explained above) shall be implemented in combating Kitibha and Eka Kushta also. When they are effectively handled, they may not progress to cause arthritis. If Eka kushta or kitibha is already associated with psoriatic arthritis, the treatment of these diseases in specific and treatment of kushta and vatarakta in general shall be adopted.
Specific formulations for Kitibha and Ekakushta –
Aragwadha lepa – Paste of Aragwadha (Cassia fistula) made in Kanji (sour fermented medicated drink) should be applied
Kasamarda lepa – The roots of Kasamarda (Cassia occidentalis) should be ground with Sauveeraka (fermented herbal wine) should be applied
Mulaka beejadi lepa – Paste made from mulaka beeja (seeds of radish), sarshapa beeja (mustard seeds), laksha rasa (lac), haridra (turmeric), daruharidra (Berberis aristata), chakramarda (seeds of Cassia tora), shreeveshtaka (extract of Pinus roxburghii), shunti (ginger), maricha (pepper), pippali (long pepper), vidanga (Embelia ribes) and kushta (Saussurea lappa), made in gomutra (urine of cow) should be applied
Chakramardadi lepa – paste of chakramarda (seeds of Cassia tora) and twak (cinnamon) made in milk should be applied
Arkadi lepa – paste of Arka (Calotropis gigantean) and Veta (bamboo) made in cows urine should be applied
Pippalyadi lepa – application of paste made from pippali (long pepper), puti karanja (Caesalpinia bonducella), haritaki (Terminalia chebula), Kushta (Saussurea lappa), go pitta (bile of cow) and chitrak mula (roots of Plumbago zeylanica) should be applied
Gomutradi lepa – paste made from gomutra (urine of cow), manashila (realgar), kasisa (ferrous sulphate, green vitriol), tuttha (purified copper sulphate) is applied
Kitibha is predominantly caused by vitiated duo Kapha and Vata. If Vata is predominant in the combination we can notice excessive dryness and flaking and if Kapha is predominant we can find silvery wet scaling with lot of itching and considerable swelling. It is generally that the lesions get dry and on itching the flakes fall in the form of dust and wet lesion (kapha) is seen. Again the flakes are formed and the condition looks like a vata predominant one. Thus we can tell that both Vata and Kapha symptoms are present together at any given point of time.
Vamana followed by Virechana is always the best option of treatment in Kitibha and Ekakushta. Snehapana can be considered in excessive scaling and dryness, anyhow snehapana is administered as pre-treatment procedures (purva karma) for Vamana and Virechana. Vasti or herbal enemas will be highly useful when psoriasis is associated with psoriatic arthritis or when psoriatic arthritis presents as an individual component of the disease.
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