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P
ISSN No. : 2584-2757
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DOI
: 10.5281/zenodo.21370782
Reg. No. : MAHA-703/16(NAG)
Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding Author: Dr.Mangesh Udmale
ORCID ID: 0000-0001-8054-6502
ISI Impact Factor (2025-26): 1.345
IIFS Impact Factor (2026-27): 6.0
Article Info: Article Received on : 29/06/2026 Article Reviewed on: 05/07/2026 Article Published on : 15/07/2026
Cite this article as: - Khan, S. B.& Udmale, M. (2026). The Gut–Skin Axis in Psoriasis: An Ayurvedic Perspective on the Role of
Agni, Ama, and Intestinal Dysbiosis in the Pathogenesis of Kitibha Kushta. International Journal of Diagnostics And Research,
3(4), 34–55. https://doi.org/10.5281/zenodo.21370782
Abstract
Introduction: The idea of the gut-skin axis has gained significance as a conceptual framework for understanding the
interconnection between intestinal well-being, immune regulation, systemic inflammation, and various skin
conditions. Psoriasis is an autoimmune-mediated dermatological condition characterized by immune system
dysregulation, changes in the composition of the gut microbiome and high intestinal permeability. This perspective is
explained by Ayurveda using the concepts of Agni, Ama, Dosha and Rakta Dushti. Kitibha Kushta can be understood
in terms of alterations in the GI tract. Objectives: To discuss the significance of the gut-skin axis in psoriasis from a
contemporary perspective and an Ayurvedic viewpoint, especially considering Agni, Ama and Kitibha Kushta.
Methods: An integrative review of the topic was performed utilizing classical texts of Ayurveda like Charaka
Samhita, Sushruta Samhita and Ashtanga Hridaya, along with recent scientific literature about psoriasis, gut bacteria,
permeability and systemic inflammation. Results: Recent scientific research reveals that dysbiosis in the gut,
intestinal barrier dysfunction, and immunologically mediated inflammatory responses play significant roles in the
pathogenesis of psoriasis. The Ayurvedic literature presents similar concepts by discussing Agnimandya, which leads
to the formation of Ama, Srotorodha, and the vitiation of Rasa and Rakta Dhatu. Kitibha Kushta elucidates the role of
metabolic and dietary factors in the pathogenesis of dermatological conditions. Conclusions: The ancient Ayurvedic
wisdom of Agni and Ama offers an elaborate explanation for understanding the gut-skin axis in psoriasis. An
integrative strategy based on the principles of digestion correction and dietary regulation may be beneficial for the
prevention and treatment of psoriasis. Clinical significance: Understanding the gut-skin axis underscores the
importance of gut health, digestion, and systemic inflammation in the pathogenesis of psoriasis. The study of psoriasis
from an Ayurvedic perspective, focusing on Agni and Ama, offers an integrated approach to its prevention and
treatment.
Keywords- Agni, Ama, Gut dysbiosis, Gut-Skin Axis, Kitibha Kushta, Psoriasis
The Gut–Skin Axis in Psoriasis: An Ayurvedic Perspective on the Role of Agni, Ama, and
Intestinal Dysbiosis in the Pathogenesis of Kitibha Kushta
Dr. Saima Begum Istekhar Khan
1
, Dr. Mangesh M. Udmale
2
1
Postgraduate Scholar,Department of Rognidan Vikritivijanana,Dr. D. Y. Patil College of Ayurved,
Hospital and Research Centre, Pimpri, Pune, Dr. D. Y. Patil University (Deemed to be), Pimpri, Pune
2
Professor and HOD,Department of Rognidan Vikritivijanana,Dr. D. Y. Patil College of Ayurved, Hospital
and Research Centre, Pimpri, Pune, Dr. D. Y. Patil University (Deemed to be), Pimpri, Pune
G
A
R
V
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Introduction :
The human gastrointestinal tract performs several
vital functions, including digestion, metabolism,
immune regulation, and maintenance of systemic
homeostasis. Recent scientific achievements have
emphasized the importance of gut microbiota in its
impact on multiple organs, including skin. The
interaction between the intestine and the skin via
immunological, metabolic, hormonal, and
inflammatory signaling pathways is referred to as
the gut-skin axis
[1,2]
. Psoriasis is an inflammatory
skin condition with a chronic course, characterized
by erythematous papules with silvery scaling, due
to an immune response. Psoriasis affects about 2-
3% of the global population and is known to be
associated with systemic inflammation, metabolic
disorders, obesity, insulin resistance, and stress.
[3,4]
Even though the precise etiology of psoriasis is
multifaceted, recent research has shown gut
microbial imbalance and intestinal permeability as
the potential triggers of the disorder.Emerging
evidence indicates that patients with psoriasis
exhibit changes in their gut microbial profile,
reduce microbial biodiversity, increased intestinal
permeability, and elevated levels of
proinflammatory mediators, including Tumor
Necrosis Factor Alpha (TNF-alpha), Interleukin-17
(IL-17) and Interleukin-23 (IL-23)
[5,6]
.According to
Ayurveda, disease genesis occurs through a certain
pathway that includes Agni, Dosha, Dhatu, Mala
and Srotas. Digestive malabsorption, or
Agnimandya is said to be the primary cause of
many diseases. Digestive disturbances lead to Ama,
which spread throughout the body and obstructs the
pathways and functions of tissues.Regarding skin
diseases, ancient Ayurvedic texts provide detailed
descriptions of Kushta. Kitibha Kushta shows
clinical similarities to psoriasis, including
roughness, dryness, discoloration, and skin scaling.
According to Ayurveda, inappropriate dietary
practices, ingestion of incompatible foods,
consumption of Guru and Snigdha Ahara, stress
and disturbances in lifestyle are considered
significant factors contributing to the development
of Kushta.
[7,8,9]
The modern scientific concept of
the gut-skin axis reflects the Ayurvedic concept of
Agnimandya, which leads to the formation of Ama
and causes Dhatu Dushti.Psoriasis is known to be a
systemic inflammatory condition rather than simply
a skin ailment. Apart from the typical skin
symptoms, people living with psoriasis also display
metabolic syndrome, obesity, insulin resistance,
heart conditions, and inflammatory bowel disease.
Several recent studies have shown alterations in the
gut microbiota in patients with psoriasis, suggesting
a possible role for gut dysbiosis in the pathogenesis
of the disease. Gut bacteria are known to be active
regulators of immune responses by producing
microbial metabolites, maintaining epithelial
barrier integrity, and controlling inflammatory
pathways. This way, the gut-skin axis has become a
promising tool for investigating psoriasis as a
systemic disease and for identifying novel
treatment targets. In Ayurveda, these discoveries
mirror the concepts of Agnimandya, Ama
production, and Rakta Dushti, which, together,
describe the Patho mechanism of the development
of skin diseases due to disturbances in the
gastrointestinal system. Kitibha Kushta is one such
skin ailment.
[10,11, 12]
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Aim and Objectives:
Aim:
To critically examine and analyze the concept of
the gut-skin axis in psoriasis in view of Ayurveda.
Objectives:
1. To study the scientific literature available
regarding the alterations in gut microbiome,
gut dysbiosis, and gut-skin axis involvement
in psoriasis.
2. To study the role of the Ayurvedic
principles of Agni and Ama in the
pathogenesis of skin diseases with particular
attention to psoriasis.
3. To correlate the concept of Kitibha Kuṣṭha
with the current concept of psoriasis.
4. To correlate gut dysbiosis and the
inflammatory pathway with the Ayurvedic
pathogenesis of psoriasis based on Agni,
Ama, and Rakta Duṣṭi principles.
5. To study the relevance of improving
digestion and metabolism in the
management of psoriasis from an Ayurvedic
and gut-skin axis perspective.
Materials and Methods of Review:
This particular study is based on a conceptual
review that combines traditional knowledge from
Ayurveda and modern science to understand the
connection between the gut-skin axis in psoriasis
and the concept of Agni, Ama, Rakta Duṣṭi, and
Kitibha Kuṣṭha in Ayurveda. The objective of
conducting this review is to combine various
existing pieces of literature to find a conceptual
connection between modern and
Ayurvedicunderstanding of psoriasis.
Sources of Data
References from classical Ayurveda pertaining to
Agni, Ama, Kuṣṭha, Rakta Duṣṭi, and causation of
diseases were sourced through reliable sources like
Charaka Saṃhitā, Suśruta Saṃhitā, Aṣṭāṅga
Hṛdaya, and other commentaries on Ayurveda.
Contemporary sources were collected using
database searching tools like PubMed and Google
Scholar.
Search Strategy
A combination of the Mesh terms, free text, and
Boolean operators was used for searching through
the literature. The primary search terms used were:
“Gut dysbiosis AND Ayurveda,” “Gut-skin axis
AND Psoriasis,” and “Psoriasis AND Ayurveda.”
Articles written in English and published between
January 2016 and January 2026 were included in
the search. The inclusion criteria for the articles
were original research articles, review articles,
meta-analysis, guidelines, and classical Ayurvedic
literature related to the objectives of the current
review.
Inclusion criteria
Studies that: investigated gut-skin axis in psoriasis
,examined gut microbiome, gut dysbiosis, gut
permeability, immunomodulation, or systemic
inflammation in psoriasis, studied cytokine
pathway, IL-17, IL-23, TNF-α (Tumor Necrosis
Factor Alpha ) in psoriasis, which discussed the
concepts in Ayurveda associated with Agni, Ama,
Rakta Duṣṭi, Kuṣṭha, or Kitibha Kuṣṭha or appeared
in any peer-reviewed journal articles or classical
Ayurvedic.
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Criteria for Exclusion
These include: publications not written in English,
abstracts of conferences and those abstracts which
did not have complete papers, editorials, letters to
the editor, and unpublished works, papers not
specifically addressing psoriasis, gut–skin axis or
Ayurveda concept correlation.
Study Selection :
Title and abstracts found from electronic databases
were filtered based on their relevancy to the aim of
the review. Articles that met the inclusion criteria
were reviewed thoroughly for inclusion in the
conceptual synthesis. In total, 112 articles were
collected from electronic databases, including 62
articles from PubMed and 50 articles from Google
Scholar. Out of 112 articles, 45 duplicate articles
were removed, leaving 67 articles to be screened.
Among 67 articles, 31 articles were discarded as
they were not relevant to the review question or did
not meet the inclusion criteria. Thus, 36 articles
were included in the conceptual review. Classical
Ayurvedic texts were chosen due to their relevancy
to Agni, Ama, Rakta Duṣṭi, and Kitibha Kuṣṭha. The
study selection process is illustrated using PRISMA
2020 flowchart as mentioned in Figure1.
PRISMA 2020 flow chart – Figure 1
Review Results:
1. Gut–Skin Axis: Modern Understanding
The gut–skin axis is defined as the relationship between
gut microbiota, immune system mechanisms and skin
physiology. The gut microbiome includes billions of
organisms that facilitate metabolic processes, modulate
immunity and maintain mucosal integrity.
[4, 5]
Normal functioning of gut microbiota provides
Immunological tolerance, Formation of short-chain fatty
acids, Structural integrity of the gut barrier and
Regulation of Inflammation. Any imbalance in the
microbial flora, or gut dysbiosis, can lead to the
development of inflammatory diseases such as psoriasis.
Records identified
from PubMed
(n = 62)
Records identified
from Google
Scholar (n = 50)
Total records
identified
(n = 112)
Duplicate records
removed
(n = 45)
Records screened
(n = 67)
Records excluded
(n = 31)
Studies included in
conceptual review
(n = 36)
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Gut-Skin axis: (Figure -2)
(Figure 2: Pathogenesis of psoriasis)
a. Gut Dysbiosis
Individuals with psoriasis exhibit an imbalance in the
microbiota, with a decline in beneficial bacteria and an
increase in pro-inflammatory bacteria.
b. Increased Gut Permeability
Intestinal tight junction damage leads to increased gut
permeability, or leaky gut syndrome, causing the release
of toxins, bacterial by-products, and inflammatory
molecules into the bloodstream.
c. Inflammation
Circulating inflammatory mediators stimulate pathways
that drive skin inflammation. High levels of cytokines,
such as IL-17, IL-23, and TNF-alpha, are crucial for the
development of psoriasis.
[13]
d. Dysregulation of Immunity
Gut-associated lymphoid tissue (GALT) can influence
the systemic immune response and contribute to the
development of chronic inflammatory skin conditions.
Gut Microbiota in Psoriasis:
The human intestine harbors billions of
microorganisms, collectively known as the gut
microbiota. The main bacterial phyla of the gut
include Firmicutes, Bacteroidetes, Actinobacteria,
and Proteobacteria. They are vital for nutrient
metabolism, vitamin production, maintenance of
intestinal barrier function, and regulation of the
immune response. The balanced composition of the
gut microbiota is important for immune tolerance,
as it produces short-chain fatty acids (SCFAs) that
regulate the function of regulatory T cells (Tregs).
[14,15, 16 ]
The latest studies have revealed substantial
changes in the gut microbiota in patients with
psoriasis. This microbial imbalance, referred to as
gut dysbiosis, involves reduced microbial diversity
and changes in certain bacterial species. Psoriatic
individuals were found to have decreased levels of
beneficial microorganisms, including Akkermansia
muciniphila, Faecalibacterium prausnitzii, and
Bacteroides species.
[17, 18, 19,20]
Akkermansia muciniphila is particularly significant
because it contributes to the formation of the
intestinal mucus layer and helps maintain intestinal
barrier function. A reduction in their numbers can
negatively affect intestinal permeability and lead to
the translocation of bacterial products into systemic
circulation. In addition, Faecalibacterium
prausnitzii produces anti-inflammatory metabolites
and helps maintain intestinal immune homeostasis.
Their reduction is associated with chronic
inflammatory diseases such as psoriasis.
[21,22]
Several mechanisms by which dysbiosis affects
psoriasis can be discussed. First, changes in the
composition of the microbial population can impair
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intestinal barrier function and increase tight
junction permeability, allowing the transfer of
bacterial lipopolysaccharides (LPS) and other
inflammatory mediators into the systemic
circulation. In turn, these mediators stimulate an
immune response, causing systemic inflammation.
Second, dysbiosis affects microbial metabolite
production, specifically SCFAs (Short-Chain Fatty
Acid), leading to decreased anti-inflammatory
signaling and increased risk of chronic
inflammation.
[23, 24, 25]
Multiple studies have shown a link between
changes in gut microbiota and psoriasis severity.
Lower microbial diversity correlates with disease
activity and increases levels of inflammatory
markers. Therefore, changes in the intestinal
microbial community can be considered a cause of
psoriasis.
[26,27]
According to Ayurveda, gut dysbiosis could be
considered a sign of Agnimandya, leading to the
production of Ama. Poor metabolism and digestive
function disrupt the balance of the gastrointestinal
system, leading to the accumulation of toxic waste
products and disturbances in physiological
processes. Formation of Srotorodha and Dhatu
Dushti is like the concept of microbial dysbiosis
and intestinal dysfunction in modern medicine.
Thus, modern research on gut microbiota supports
the idea that disturbances in the gastrointestinal
system can lead to systemic and skin diseases, such
as Kitibha Kushta.
Immunological mechanism in Psoriasis as
described in Figure 3.
(Figure 3. Immunological Basis of the Gut–Skin Axis in
Psoriasis and its Ayurvedic Correlation Unhealthy
eating habits and Viruddha Ahara cause Agnimandya
and Ama Utpatti, which causes dysbiosis and leaky gut
syndrome. Antigenic proteins and LPS gain access to
the bloodstream, triggering the dendritic cells to secrete
IL-23 and differentiate Th17 cells. The IL-17, IL-22 and
TNF-α secreted by these Th17 cells leadto systemic
inflammation, Rakta Dushti and keratinocyte activation,
causing psoriasis Lesions and eventually lead to Kitibha
Kushta.)
At present, psoriasis is viewed as an immune-
inflammatory disease where dysfunction of both
innate and adaptive immunity is involved in its
pathogenesis. The IL-23/Th17 axis has emerged as
the key immunological mechanism mediating
psoriasis inflammation.
[28,29,30]
The intestinal
microbiome, under normal conditions, helps
maintain immune tolerance and control
inflammatory responses. But gut dysbiosis alters
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the interaction between the intestinal microbiome
and the immune system. Intestinal
hyperpermeability promotes the passage of
microbial antigens, endotoxins, and
proinflammatory substances through the intestinal
barrier, triggering immune cells in gut-associated
lymphoid tissue (GALT).
[31,32]
Dendritic cell
activation within the intestines initiates the
production of interleukin-23 (IL-23), an important
cytokine responsible for differentiation and
proliferation of T-helper 17 (Th17) cells. In turn,
Th17 cells release inflammatory cytokines such as
IL-17A (Interleukin-17A), IL-17F(Interleukin-
17F), IL-22(Interleukin-22) and TNF-alpha. All
these cytokines circulate throughout the body to
facilitate chronic inflammation at the remote site,
which is usually the skin.
[33,34,35]
IL-17(Interleukin-
17) is especially significant in the development of
psoriasis. This cytokine is responsible for
stimulating keratinocyte proliferation,
inflammatory mediator production and neutrophil
recruitment into psoriatic lesion. IL-23 functions as
a maintenance cytokine for Th17and TNF-alpha
intensifies inflammatory cascades, thereby
increasing the action of IL-17. Therefore, increased
levels of IL-17, IL-23and TNF-alpha are always
present in psoriatic patients and become a
cornerstone of several biological treatments.
[36,37,38]
According to the gut-skin axis, chronic intestinal
inflammation causes systemic immune activation
by constant stimulation with microbial and
inflammatory mediators. As a result, the response
from Th17 cells is maintained and leads to chronic
inflammation and the development of psoriatic
plaques.
[39,40 ]
There is emerging research indicating that
microbial metabolites influence the differentiation
of T regulatory cells and Th17 cells. Inadequate
production of short-chain fatty acids owing to
dysbiosis in the gut can weaken immune regulatory
responses and cause proinflammatory reactions.
This results in chronic immune activation.
[41]
From the perspective of Ayurveda, this
phenomenon may be related to Ama-induced Dosha
imbalance and Rakta Dushti. Agnimandya causes
the formation of Ama, which subsequently
circulates throughout the body and affects
physiological balance. Accumulated Ama triggers
inflammation which, like cytokine-related immune
dysregulation, is explained by modern
immunology. Increased levels of IL-17, IL-23and
TNF-alpha can be considered signs of biological
manifestation of chronic Dosha imbalance and
Rakta vitiation. Therefore, current knowledge of
immunology confirms the hypothesis that disorders
occurring in the gastrointestinal tract have an
impact on systemic immunity and can play a
significant role in the development of psoriasis.
2. Psoriasis: Current Concept
Psoriasis is a chronic inflammatory disorder of the
skin featuring hyper proliferative process of
keratinocytes. Clinical Findings such as Red
patches, silver scales, Dryness and pruritus with
Persistent and recurring pattern. Associated Factors
are hereditary tendency, Excess weight, Stress,
Tobacco smoking, alcohol consumption, Western
dietary habits and metabolic syndrome.
[42]
Current evidence suggests that psoriasis is
characterized by both skin inflammation and
alterations in the gut, such as gut microbial
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dysbiosis, decreased microbial diversity, changes in
abundance of particular microbial species, and
increased intestinal permeability. There is evidence
from a number of clinical and observational studies
showing that there are particular changes in gut
microbial composition in patients with psoriasis
and psoriatic arthritis in comparison with healthy
participants. Specifically, Scher et al. found that
patients with psoriatic arthritis had lower bacterial
diversity and microbial composition similar to that
seen in inflammatory bowel disease, thus pointing
to a connection between psoriasis and gut
dysbiosis. Tan et al. found that Akkermansia
muciniphila was a unique microbial signature in
psoriasis, whereas Codoner et al. revealed
differences in gut microbial composition in
psoriasis and healthy subjects. Moreover, based on
literature reviews, there are consistent findings of
decreased numbers of beneficial bacteria,
alterations in short-chain fatty acid metabolism,
impairment of the intestinal barrier, and chronic
low-level inflammation as key features of the gut-
skin axis in psoriasis. The major results of the
research on the connection between psoriasis and
gut microbiota alterations are presented in Table 1.
[43, 44, 45,46,47,48,49]
Table 1. Studies demonstrating relationship
between psoriasis and changes in gut microbiota
and gastrointestinal inflammation.
Table- 1 Studies demonstrating relationship
between psoriasis and changes in gut microbiota
and gastrointestinal inflammation
Author,
year
Study
type
Major findings
Scher et
al.,
2015
[12]
Observatio
nal study in
psoriatic
arthritis
Reduced gut bacterial diversity in
psoriatic arthritis patients was
shown. This microbial profile
indicated dysbiosis observed in
inflammatory bowel disease and
reflected the close relationship
between psoriatic disease and the
alteration in gut microbiome.
Tan et
al.,
2018
[13]
Clinical
microbiom
e
study
Discovered that A. muciniphila is
one of the characteristic microbes
of psoriasis, indicating alteration in
the gut microbe composition in
such individuals.
Codoñe
r et al.,
2018
[14]
Comparativ
e clinical
study
Discovered significant alterations in
the gut microbial composition of
psoriasis patients compared to
healthy individuals, confirming gut
dysbiosis of psoriasis patients.
Hidalgo
-
Cantab
rana et
al.,
2019 [3]
Review
article
Summary of evidence for the
correlation between psoriasis and
gut dysbiosis, decreased beneficial
microbiota, and immune
dysregulation, highlighting the
relevance of the gut–skin axis
theory in disease pathology.
Buhaș
et al.,
2022 [5]
Review
article
Found that patients with psoriasis
have gut dysbiosis, low diversity,
impaired intestinal barrier integrity,
and increased inflammatory
signaling, contributing to disease
development.
Woo et
al.,
2022
[19]
Review
article
Discussed the relationship between
the gut and skin in psoriasis,
highlighting intestinal permeability,
gut dysbiosis, and immune
activation by cytokines as key
factors connecting the two sites.
Sikora
et al.,
2020
[20]
Updated
review
Pointed out the changes observed in
microbiome composition, decrease
in short-chain fatty acids-producing
bacteria, immune dysregulation,
and inflammation in psoriasis
patients.
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3. The Concept of Agni in Ayurveda
The concept of Agni is the key factor that governs
digestion, metabolism, tissue nutrition and
immunity.
Types of Agni: Sama Agni - Normal Digestion,
Mandagni - Weak Digestion, Tikshnagni - Strong
Digestion, Vishamagni - Irregular Digestion.
Out of all these types, Mandagni plays an important
role in the formation of diseases.
If Agni works normally, then: Digestion will be
proper, Nutrient Absorption will be proper, Tissues
will be nourished properly, Ojas and immunity will
remain healthy.
4. Theory of Ama:
Ama represents the poorly digested and assimilated
toxic substance formed due to Agnimandya.
Properties of Ama - Guru (weight), Picchila
(sliminess), Avila (cloudiness), Srotorodhakara
(obstruction).
Ama flows in the body and causes: Obstruction in
channels, Nutritional deficiency in tissues,
Inflammation and Disease formation.
The idea of Ama is comparable to inflammatory by-
products, endotoxins and immune stimulants
formed due to intestinal malfunction.
Rakta is viewed as one of the most important
Dhatus responsible for providing nourishment,
energy, healthy coloration of the skin and skin
integrity in the Ayurvedic medical system. In
classical Ayurvedic literature, there are many
mentions about the close connection between Rakta
and Twak and several dermatological conditions
caused by Rakta Dushti.
[50,51]
Agnimandya causes development of Ama and its
entering Rasavaha and Raktavaha Srotas. The
presence of Ama in the Rakta causes alterations
called Rakta Dushti. The manifestations of the
vitiated Rakta condition include discoloration of the
skin, itching, inflammation, burning sensation and
different types of Kushta.
[52,53, 54]
The pathogenesis of Kitibha Kushta includes
dominance of Vata-Kapha and the involvement of
Rakta. The circulation of the Ama through the body
and obstruction of the microchannels lead to
malfunctioning of the skin nourishment processes,
causing roughness, dryness, desquamation and
discoloration of the skin. These symptoms are like
signs of psoriasis.
[55]
Current studies have shown that psoriasis is
associated with systemic inflammation that
includes increased concentrations of inflammatory
cytokines, oxidative stress, endothelial dysfunction
and immune system dysregulation. Elevated
concentrations of TNF-alpha, IL-17and IL-23 lead
to chronic inflammatory processes not only in the
skin but also systemically.
[56,57]
This way, Rakta Dushti in Ayurveda can be linked
to systemic inflammation in psoriasis. As vitiated
Rakta causes pathological processes to spread
through the body, inflammatory mediators in the
circulation contribute to immune activation and the
development of diseases. This connection can
establish a link between ancient Indian medicine
and immunopathology.
Therefore, Rakta Dushti can be considered an
intermediary stage between Agnimandya, formation
of Ama and Kitibha Kushta manifestation.
Knowledge of the importance of Rakta makes the
theory of the gut-skin axis in Ayurveda clearer and
explains possible methods of its correction.
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5. Kitibha Kushta and Psoriasis
According to Ayurveda, Kushta describes a variety
of skin conditions characterized by Dosha and
Dhatu derangement. Kitibha Kushta shows clinical
similarity with psoriasis.
Clinical Symptoms of Kitibha Kushta are Shyava
Varna (darker pigmentation), Kina Khara Sparsha
(roughness), Parushata (dryness).
Nidana of Kushta: Some causes that are known to
cause Kushta according to ancient Ayurvedic
literature are; Viruddha Ahara, over consumption
of Guru and Snigdha Ahara, Adhyashana, Ajirna
Ahara Sevana, Day sleep (Diwaswapna), Stress and
emotional disturbances. They weaken the Agni,
causing Ama production.
[58, 59, 60]
6. The Ayurvedic Concept could be correlated
with Modern Concept as described in Figure-4.
(Figure-4 –Correlation with Modern Concept as
described)
Current developments in immunology have
revealed that the IL-23/Th17 pathway represents
the key molecular mechanism behind the
development of psoriasis. Dysbiosis and increased
permeability of the intestine allow for the transfer
of microbial antigens, endotoxins and other
inflammatory substances into the systemic
circulation. These substances trigger activation of
antigen-presenting cells (primarily dendritic cells)
in the gut-associated
lymphoid tissue (GALT). In this case, a series of
inflammatory processes occurs. Activated dendritic
cells secrete the IL-23 cytokine, which is important
for differentiation, proliferation and survival of T-
helper 17 (Th17) cells.
[61,62, 63]
The activated Th17 cells start producing several
pro-inflammatory cytokines such as IL-17A, IL-
17F, IL-22and TNF-α. Among these cytokines, IL-
17 serves as an effector molecule that causes
hyperproliferation of keratinocytes and
maintenance of psoriasis. It activates keratinocytes
to produce chemokines, antimicrobial proteins and
other inflammatory mediators; thus, causing a
continuous inflammatory circle in the skin. On the
other hand, TNF-α stimulates further inflammatory
signal transduction and leukocyte migration, while
IL-23 keeps the ongoing immune response
mediated by Th17 cells. High concentrations of
these cytokines have been found in individuals who
suffer from psoriasis.
[64,65,66]
In terms of Ayurveda, this inflammation cascade
can be interpreted as the systemic response arising
due to the development of Ama and Rakta Dushti
due to Agnimandya. Chronic formation of Ama due
to the impairment of digestion may cause
Srotorodha and Dosha Vridhi, eventually leading to
the involvement of Rasa and Rakta Dhatu. This
inflammation process is quite similar to the
increased secretion of IL-17, IL-23and TNF-α seen
in patients with psoriasis. Hence, the IL-23/Th17
pathway in modern medicine can be considered as
the manifestation of Ama, Rakta and Kitibha
Kushta pathology in Ayurveda.
[67,68,69,70]
The process of pathophysiology can be explained
as mentioned in Figure- 5.
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(Figure 5. Ayurvedic Pathogenesis of Kitibha Kushta
showing the importance of Agnimandya and Ama in
manifestation of skin disease.)
Discussion:
This review demonstrates remarkable parallels
between the modern theory of the gut-skin axis and
the Ayurvedic concepts of Agni and Ama.
Modern concepts of gut-related inflammation and
classic Ayurvedic theory of disease development
have much in common. The latest scientific
achievements tend to confirm the crucial role of
intestine in regulation of immunity, while
Ayurveda focuses on the importance of Agni for
maintaining a good state of health. Dysfunction of
Agni causes creation of Ama, which in turn affects
various physiological processes and results in
development of diseases. Such ideas correspond to
the modern notions of the influence of gut
dysbiosis, permeability of the gut barrier and
bacteria endotoxins translocation on development
of inflammatory processes.Another common
feature is the notion of systemic inflammation. The
modern IL-23/Th17 axis, considered a key
component of psoriasis, shows how intestinal
changes could affect distant tissues by means of
immune mechanisms. IL-17, IL-23 and TNF-α
contribute to keratinocyte proliferation and chronic
inflammation in psoriatic skin lesions. It can be
compared with the mechanism of development of
Kitibha Kushta according to Ayurveda, when Ama
moves from intestine to Rasavaha and Raktavaha
Srotas, causing Rakta Dushti and leading to
appearance of Kitibha Kushta. Thus, modern ideas
about inflammation caused by cytokines confirm
the classical Ayurvedic theories of systemic disease
development.
[71, 72,73,74]
Current science shows that the gut microbiome is
integral to immune regulation and systemic
homeostasis. Changes in microbial composition
result in increased intestinal permeability and
inflammation, leading to psoriasis.
[75, 76, 77]
Similarly, according to Ayurveda, impaired
digestion is the initial mechanism in disease
causation. Agnimandya leads to Ama production,
characterized by obstruction and inflammation.
This substance enters the bloodstream through
Rasavaha and Raktavaha Srotas and precipitates
dermatological conditions.
Kitibha Kushta pathogenesis is a systemic disease
process rather than a purely cutaneous one. Dietary
antagonism, poor digestion and tissue disturbance
mirror the current model of gut-induced
inflammation.
Elevated levels of inflammatory cytokines, such as
TNF-alpha, IL-17 and IL-23, have been found in
psoriatic patients.
[78,79,80]
. These molecules can be
viewed from an Ayurvedic point of view as
symptoms of chronic Dosha aggravation and Rakta
Dushti, due to Ama build-up.
Moreover, behavioral risk factors such as
psychological stress, sleep disorders, physical
inactivity and inappropriate nutrition affect the
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45
gastrointestinal tract and the severity of psoriasis.
Ayurveda advocates Nidana Parivarjana,
normalization of Agni and detoxification of Ama as
key therapeutic approaches.
While there is increasing evidence of gut-skin
interaction, integrative research that correlates
changes in gut microbiota composition with
Ayurvedic concepts of Agni, Ama and Prakriti is
still less. Such future research might lead to the
discovery of objective markers for an Ayurvedic
evaluation and integrative dermatology.
Role of Dietary Intake, Gut Function and
Viruddha Ahara:
Diet is crucial not only for the proper functioning
of the gastrointestinal tract but also for the
development of inflammatory disorders. The
current research shows that high consumption of
saturated fats, refined carbohydrates, processed
foods and sugars can influence the composition of
gut microbiota, damage intestinal epithelial barrier
and cause systemic inflammation. The diet
mentioned above is characterized by a high risk of
developing obesity, metabolic syndrome and
psoriasis.
[81,82,83]
It was also shown that westernized dietary intake
leads to low gut microbial diversity and increased
permeability of the intestinal wall. Excessively high
consumption of processed foods stimulates the
growth of the inflammatory bacteria and reduces
the number of the beneficial microorganisms that
maintain immune balance. Several dietary factors
are mentioned in Ayurveda as causing disturbances
in the proper functioning of digestion and
triggering disease development. Among them,
Viruddha Ahara (incompatible foods), Adhyashana
(overeating), Ajirna Ahara Sevana (consumption of
food without complete digestion of previous meal),
excessive intake of Guru Ahara and Snigdha Ahara
plays a special role in Kushta causation.
[84, 85]
Viruddha Ahara is a combination of incompatible
foods in respect of properties, processing, quantity,
time or digestive action. It is known from the
classical literature that the habitual intake of
incompatible foods leads to disturbance of Agni,
Ama formation and provokes the development of
chronic diseases, including skin ones.
[86, 87, 88]
Similarities between Viruddha Ahara and the
phenomenon of diet-induced inflammation can be
found. Both approaches state that improper diet
leads to disruption of normal digestive process and
metabolism and production of inflammatory
substances that negatively influence general
condition of a patient. Agnimandya, Ama formation
and Srotorodha coincide with the concepts of
dysbiosis, metabolic disturbances and chronic
inflammation
. [89, 90]
In addition, dietary correction is considered to play
an essential role in modern and Ayurvedic
approach to therapy. In Ayurveda, there is an
emphasis on Nidana Parivarjana, intake of proper
food and digestion in a healthy manner. Thus, diet
becomes the important linkage between the two
diseases and proves the theory that diet regulation
is very important for healthy digestion as well as
healthy skin.
Implications for Future Treatment Approaches
The emerging information regarding the gut-skin
axis could serve as the basis for formulating an
integrative strategy to manage psoriasis. In the light
of Ayurveda, the interventions to increase Agni and
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decrease Ama could be theoretically applicable,
especially in cases of patients with symptoms
indicating the presence of digestive disorders and
metabolic dysfunctions. The diet modifications in
accordance with Ayurveda and interventions to
restore gut microbiota, such as probiotics,
prebiotics, and nutrition interventions, could impact
the balance in the intestine and systemic
inflammatory response. Furthermore, the lifestyle
modification and reduction of stress can be
beneficial due to the established involvement of
psychosocial stress in the development of gut
malfunction and psoriasis. The Pancakarma
interventions can also deserve attention as
supportive measures, but their applicability should
be studied further. Future research should be
oriented towards the clinical and translational
studies regarding the connection between changes
in gut microbiota and Ayurvedic concepts of Agni,
Ama, and Kuṣṭha samprapti.
Conclusion:
Understanding of the interaction between the
gastrointestinal system and skin would benefit from
the knowledge of the gut-skin axis phenomenon. In
psoriasis pathogenesis, there are emerging
evidences for the influence of gut dysbiosis,
intestinal permeability and immune dysregulation,
especially due to the activation of inflammatory
pathways like IL-23/Th17 pathway. Similar
pathogenetic processes occur in the context of
Ayurveda with the involvement of Agnimandya,
Ama, Srotorodha, and Rakta Duṣṭi, providing
another conceptual basis to understand the
mechanisms of psoriasis beyond the scope of just
skin disease. Such similarities point out that
psoriasis should be considered as systemic
inflammatory disorder, having significant
involvement of the gastrointestinal tract and
immune system. Integration of such elements as
digestive physiology, nutrition, lifestyle regulation,
and immune-inflammation modulation could have
an important role in the treatment of this disorder.
Nevertheless, further scientific study is necessary to
validate these conceptual connections and provide
evidence-based integrative treatment approaches.
Key message:
Psoriasis is not a local skin disease but systemic
inflammatory disorder, in which gut dysbiosis,
immune dysregulation and disorders of digestive-
metabolic processes take place, making gut-skin
axis and Ayurvedic concepts of Agni and Ama
important perspectives for further research.
Clinical significance:
The knowledge gained from the gut-skin axis
broadens the scope in the management of psoriasis
since it focuses on the significance of
gastrointestinal wellbeing, immunity regulation and
systemic inflammation as key factors contributing
to the development of disease. The Ayurveda
principles relating to Agni, Ama and Kitibha Kushta
share close similarities with the modern-day
knowledge about gut dysbiosis and inflammatory
pathways that play an important role in psoriasis
pathogenesis. Therefore, an integrative approach
can help understand the relevance of addressing the
problem related to poor digestion, dietary practices
and lifestyle interventions in the management of
psoriasis.
Strengths and Limitations of the Review
There are a number of strengths to this review.
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Firstly, it presents an integrated conceptual
synthesis of the modern evidence regarding the gut-
skin axis in psoriasis along with classical Ayurveda
concepts of Agni, Ama, Rakta Duṣṭi, and Kitibha
Kuṣṭha. This allows a broader view of the
mechanisms of development of psoriasis as a
system-wide condition rather than simply a skin
disorder, since the review connects the concepts of
the modern biomedical studies, such as gut
dysbiosis and leaky gut syndrome, and the
principles of disease development according to
Ayurvedic tradition. Secondly, the review
combines the evidence from modern scientific
databases and classical Ayurvedic literature, thus
providing the cross-disciplinary interpretation
which can help develop hypotheses for further
integrative studies. Finally, by indicating the
possible significance of digestive-metabolic
disorders, imbalanced gut microbiota, and
inflammatory pathways in the development of
psoriasis, the review opens up certain avenues for
translation and clinical studies in the framework of
integrative medicine. However, there are also some
important limitations associated with this review.
First of all, the present review is a narrative
conceptual review where many suggested
correlations between the constructs of Ayurveda
and the mechanisms of modern biomedicine have
not been validated yet. At the moment, there is a
lack of well-designed clinical and translational
studies investigating the connection between
Ayurvedic parameters (Agni, Ama, and Rakta
Duṣṭi) and the objective parameters of gut
microbiome composition, intestinal permeability or
inflammation in patients with psoriasis. Besides, at
the moment, most of the studies of the gut
microbiome in patients with psoriasis are
observational and are characterized by
heterogeneous sample size, methodology and
microbial signature reported. Another problem is
that there are no standardized and universally
accepted markers for some of the Ayurvedic
constructs like Ama. Moreover, as this review
includes only scientific literature in English, there
is a chance that this study is biased because of the
publication bias, language bias and interpretative
bias. Thus, the suggested conceptual correlations
should be considered hypothesis-generating, and
more validation studies are needed.
Scope for Future Research:
Future studies should seek to make objective
associations between microbiome structure and
traditional Ayurvedic parameters such as Agni,
Ama, Prakriti and Rakta Dushti. Research
involving the examination of microbiome
variations in response to Ayurvedic therapy might
offer insight into the underlying biological
principles behind traditional treatment methods.
Further research into the effects of food control,
Deepana-Pachana treatment, Panchakarma
treatment and Rasayana treatment on microbiome
composition and inflammation might be useful.
These studies may help create an integrative
framework that combines the strengths of
traditional medicine and conventional biomedicine
to manage psoriasis.
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50
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52
47. Codoñer FM, Ramírez-Boscá A, Climent E,
Carrión-Gutierrez M, Guerrero M, Pérez-
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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Mangesh Udmale Inter. J.Digno. and Research IJDRMSID0127 |ISSN :2584-2757
56
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ISSN: 2584-2757
DOI : 10.5281/zenodo.2137078
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