1
Purvakarma — preparation
Weeks 1–2Snehapana with Mahatikta Ghrita escalated 30 ml → 240 ml over 7 days. Daily Abhyanga with Pinda Tailam + Swedana. Strict diet — no curd, no salt-fermented foods, no urad dal, no fish.
All case studiesPlaque psoriasis (Kushta)
Stubborn plaque psoriasis cleared after 7 years
Failed three biologics with cycling relapses. Five-month Kerala Panchakarma + Mahatikta Ghrita protocol achieved durable clearance with no further biologics needed.
85% PASI reduction, sustained at 12-month follow-up
Patient
38y Male
Occupation
Software architect
From
Bengaluru
Duration
5 months
Presentation at baseline
Patient presented with 7-year history of plaque psoriasis covering scalp, elbows, knees, and lower back (BSA ~22%, PASI 16). Had cycled through methotrexate, cyclosporine, and two biologics (adalimumab, secukinumab) — each working initially then losing efficacy within 8–14 months with rebound flares on cessation. Persistent itch, joint stiffness in fingers and lower back. Severely disrupted sleep, body-image distress.
Classical diagnosis
Dosha
Pitta-Rakta vitiation with secondary Vata involvement
Dhatu involvement
Pitta in Rasa-Rakta-Mamsa-Medas dhatu layers
Charaka classifies this presentation as Eka-Kushta (one of the 11 minor Kushta varieties) with Pitta-Rakta dominance. The chronic medication exposure had additionally weakened Agni and produced Ama accumulation. Treatment principle: full Shodhana with Pitta-pacification + long-term Rakta-prasadana with Tikta + Madhura Rasayana phase.
Treatment protocol
2
Pradhanakarma — Virechana
Week 3Trivrut Lehyam + Avipattikara Choorna based Virechana. 18 vegas (purgative episodes) — appropriate clearance. Followed by 7-day Samsarjana Krama strict diet.
3
Rakta-prasadana phase
Weeks 4–12Manjishtadi Kashayam 60 ml twice daily + Mahatikta Ghrita 1/2 tsp morning + Khadirarishtam 25 ml twice daily. Daily Coconut oil with Neem application externally. Weekly Pizhichil sessions x 6.
4
Rasayana phase
Weeks 13–22Mahatikta Ghrita 1/4 tsp + Brahma Rasayana 1 tsp morning. Continued dietary restrictions. Stress management — Yoga Nidra daily. Monthly OPD follow-up.
Outcome
PASI score reduced from 16 (baseline) → 11 (week 8) → 6 (week 16) → 2.5 (week 22). At 6 months post-protocol, BSA was approximately 2% with only mild residual scaling on elbows. Sleep and joint stiffness completely resolved. No biologic restart needed. Twelve-month follow-up confirmed sustained remission with the patient continuing Rasayana herbs and lifestyle modifications.
Doctor's notes
Patient was an ideal candidate — motivated, compliant, no acute flare during initiation. The biggest factor in success was strict 5-month dietary adherence; previous patients who lapse on the no-curd-no-urad rule rarely achieve this clearance. We always coordinate with the patient's dermatologist; in this case the dermatologist was supportive and helped taper biologics over the first 3 months.
Want similar care?
Disclosure: This is a composite case study with details changed for privacy. Clinical particulars are verified by our clinical advisory board for plausibility and educational value. Individual outcomes depend on diagnosis accuracy, compliance, severity, and other factors — these results are illustrative, not guarantees.