Therapeutic Efficacy of Virecana with Trivrt Avaleha Following Panchatikta Ghrta Snehapana in the Management of Ekakushtha (Psoriasis): A Comprehensive Case Report

Abstract

Eka Kushtha is a chronic Kushtha Roga described in Ayurvedic texts that clinically resembles plaque psoriasis. It is characterized by thick, dry, scaly patches that often fail to respond to topical measures and can cause considerable psychosocial distress. Classical texts advocate Pancakarma, especially Virecana, for its management. Trivrt Avaleha, a compound preparation of Trivrt (Operculina turpethum), is a potent purgative indicated in Kushtha. Despite centuries of use, detailed modern case documentation is scarce. We report the case of a 38-year-old non-smoking male patient who attended the Panchakarma OPD at R.N. Kapoor Memorial Ayurvedic Medical College and Hospital, Indore with a 5-year history of dry, scaly plaques over the elbows, knees and lower back associated with intermittent itching. Baseline Psoriasis Area and Severity Index (PASI) was 14.5 and Dermatology Life Quality Index (DLQI) was 16. The patient underwent Snehapana with Panchatikta Ghrita for five days followed by Abhyanga and Svedana, and then Virecana with Trivrt Avaleha 80 g. Post-procedure Samsarjana Krama was followed for seven days. Clinical and patient-reported outcomes were recorded at baseline, post-Snehapana, post-Virecana (4 weeks), and 12-week follow-up. PASI improved from 14.5 at baseline to 4.3 at 4 weeks and 3.8 at 12 weeks. DLQI decreased from 16 to 5 and pruritus VAS from 7 to 1. No adverse events occurred. The patient reported improved confidence and social functioning. This case highlights the potential role of Virecana with Trivrt Avaleha following Panchatikta Ghrta Snehapana in achieving marked symptomatic relief in Eka Kushtha. Structured documentation using standardized severity scores may strengthen evidence for integrating classical Pancakarma therapies into routine management of chronic dermatoses.