ABSTRACT

Background: Psoriasis affects about 2–3 % of the global population, roughly 30 million people in India alone, and plaque-type lesions account for nearly 85 % of all cases. Beyond high-visibility dermal plaques, this condition carries an elevated risk of psoriatic arthritis, cardiometabolic syndrome, anxiety, and depression, imposing significant quality-of-life and economic burdens. Current management depends on topical steroids, phototherapy, systemic immunosuppressants, and cost-intensive solutions; these options provide transient control yet are limited by relapse on withdrawal, cumulative organ toxicity, immuno-suppressive risk, and affordability constraints. In Ayurveda, plaque psoriasis corresponds to Visarchika, a tridoṣaja condition requiring a staged approach: lipid-mediated internal oleation (Snehapana) to mobilise morbid doshas, emesis (Vamana) and purgation (Virecana) for Kapha-Pitta elimination, followed by cooling therapies such as Takradhara and targeted Shamana medicines to stabilise Vata and rebuild tissue homeostasis. Case: A 41-year-old female software engineer with a three-year history of plaque psoriasis presented with pruritic, silvery plaques over elbows, forearms, shins, lumbosacral region, and buttocks, involving 32 % body-surface area. Baseline indices confirmed severe disease: PASI 18.4, ESR 31 mm h⁻¹, CRP 7 mg L⁻¹. Prior intermittent clobetasol cream provided only short-lived relief and she declined systemic immunosuppressants because of safety and cost concerns. Intervention: The patient completed three-week Panchakarma treatment – Shodhana (Phase 1) followed by Shamana (Phase 2). Phase- 1 Shodhana regimen began with graded Snehapana using Mahatikthaka ghritham (40 to 180 mL, days 1–5), followed by Vamana on day 9, daily Sarvanga Takradhara with pre-massage on days 13–19, and Virechana with Avipatti choornam on day 17. From day 21 a 60-day shamana regimen - Patolakatukurohinyadi kwath, Khadirarishtham, Guluchyadi kwath, oral and topical Mahatikthaka ghritham, and Artisor - was administered. A laghu-tikta vegetarian diet excluded dairy, gluten, sugar, fried items, and nightshades; daily yoga and fixed sleep cycles were maintained. Outcome: In Phase 1 reduced PASI by 70 % (18.4 to 5.2) in 21 days, and lowered ESR from 31 to 17 mm h⁻¹ and in Phase 2, complete remission (PASI 0) with further ESR normalization to 12 mm h⁻¹ was achieved. Over 12 months of follow-up, only two ≤ 2 cm diet-related micro-flares occurred, each resolving within a week of topical Mahatikthaka ghritham. No adverse events or laboratory abnormalities were observed. Conclusion: Sequential, doṣha-specific Panchakarma viz., Snehapana, Vamana, Sarvanga Takradhara, and Virechana, followed by targeted shamana therapy and disciplined pathya produced durable, steroid-free remission in severe plaque psoriasis. The clinical trajectory supports classical Kapha-Pitta shodhana principles and aligns with emerging immunologic evidence, highlighting Ayurveda’s potential as a patient-centered, systems-biology strategy for chronic inflammatory dermatoses. Key words: Visarchika, Kshudra kushta, Tridoshaja, Panchakarma, Vamana, Virechana, Takradhara, pathya-Apathya, Shodhana, Shamana, Lepa, Abhyanga