A Study of application of Jalauka(Medicinal Leech) with and without Vamana Karma(Therapeutic Emesis) in the Management of Mandal Kushtha(Psoriasis).
- Conditions
- Papulosquamous disorders, (2) ICD-10 Condition: L409||Psoriasis, unspecified,
- Registration Number
- CTRI/2018/08/015534
- Lead Sponsor
- National Institute of Ayurveda
- Brief Summary
**Introduction:**
Psoriasis is chronic inflammatory skin disorder clinically characterized by erythematous, sharply demarcated papules and rounded plaques. Since characteristics features of psoriasis are much closer to *Mandal Kushtha* hence *Mandal Kushtha* can be compared with psoriasis. *Mandal Kushtha* is *Kapha* predominant disease. The etiology of *Mandal Kushtha* can be understood on the basis of general etiology of *Kushtha. Swetarakta* (faint reddish white), *Utsannamandalam* (raised patches), *Sthiram* (stable), S*nigdham* (unctous), A*nnyonyasansaktm (*patches joined with each other) are important clinical features of *Mandal Kushtha.*Although there are advancements in the management of psoriasis still it is challenge to treat due to recurrent nature. Prevalence of psoriasis ranges between 0.09% and 11.5%. Prevalence in India is 0.44 – 2.2%, with average incidence of 2.2%.As mentioned by *Acharya Charaka* “*Bahudosha Samsodhya……..â€*. There is a need of study to rule out the effective, safer and economical methods *of Dosha Sodhana* for the management of *Mandal Kushtha*. There is also need to evaluate the comparative efficacy of different types of *Sodhana Karma* based on the predominance *Dosha* for the better management of diseases.
**Materials and Methods**:
30 patients suffering from *Mandal Kushtha*(psoriasis) attending OPD and IPD section of NIA, Jaipur (Raj) fulfilling the inclusion criteria of the study were randomly selected, irrespective of religion, occupation and socio-economic status. Patients were randomly divided into two groups (15 patients in each group). In Group A *Vamana Karma* followed by *Jalaukavacharana* was done in 15 patients and in Group B only *Jalaukavacharana* was donein 15 patients.
*Vamana* procedure **-** First of all *Deepana*, *Pachana* with *Panchakol Choorna* (3 gm) twice a day before food till appearance of *Nirama Lakshana* was given. *Snehapana* with *Go-Ghrita* for 3-7 days as per *Kostha* was done till the appearance of *Samyaka Snigdha Lakshana*. *Sarvanga* A*bhyanga* by *Dashamoola Taila* and *Sarvanga Swedana* by the *Dashamoola Kwatha* was done for 2 days. *Vamana* was induced by administrating *Vamaka Yoga.*After *Vamana Karma*, *Dhoompana* was done followed by S*amsarjana Karma* as per the type of S*huddhi*.
*Jaluakavacharan* procedure**-**Affected part were made free from any ointment, application of local *Swedana (Nadi Swedana )* was done. Patients were given 4 seating of *Jalaukavacharana* once per week. 6 *Jalauka* was applied (2 on upper extremities, 2 on lower extremities, 2 on trunk and head region) and *Jalauka* was be reused only for the same patient. Removal of *Jalauka*, *Vamana* of *Jalauka*, labelling of *Jaluaka* container was done in proper way. Dressing up was done and cotton bandages were used.
**TRIAL DRUGS-***Deepan Paachan* drugs**-***Panchakol Choorna(A.H.Su 6/166).*Drugs of *Jeemutak Yoga* for *Vamana Karma. **Vamanopag*** **drugs-** *Madhuyashtiphanta (Glycyrrhiza glabra).*
PASIscore was used as the objective parameter. Assessment was done on the basis of PASI and Ayurveda parameter before treatment, after treatment and during last follow up.
**Result**:
Wilcoxan Rank Sum test and Mann-Whitney test were used for the statistical analysis.
Effect on *Mandal* *Roopa*:
The study shows that Group A (*Vamana Karma* followed by *Jalauakavacharana*) provided very significant (p<0.05) results in *Mandal Roopa* with percentage of relief by 20.35% after treatment and on follow-up, it shows very significant relief of 26.54% with p value (p<0.05) in within group comparison. Group B (*Jalauakavacharana*) provided relief by 2.43% in *Mandal Roopa* after treatment which is statistically not significant (p>0.05) and on follow-up also, it shows non-significant result with p value (p>0.05) with relief of only 8.13%. Thus both group have efficacy on *Mandal Roopa* but Group A patient shows marked improvement. Inter group comparison shows that statistically there is no any significant between Group A and Group B. But we can found marked difference in mean rank sum of both groups. Mean rank of *Mandal Roopa* (18.10) in Group A is greater than that of mean rank of *Mandal Roopa* (12.90) in Group B.
Effect on *Kandu*:
Present study shows that in group A (*Vamana Karma* followed by *Jalauakavacharana*) provided extremely significant variation with percentage of relief by 48.71% after treatment In group B (*Jalauakavacharana*) provided extremely significant variation with percentage of relief by 45.45% after treatmen
Hence both the group has shown extremely significant effect in the *Kandu* parameter when compared within group.
Inter group comparison shows that statistically there is no any significant between Group A and Group B. Mean rank of *Kandu* (18.00) in Group A is greater than that of mean rank of *Kandu* (13.00) in Group B. Thus, based on mean rank we can say that Group A is slightly more effective than Group B on reducing the *Kandu* in psoriasis patients.
Effect on Chinta:
Present study shows that Group A (*Vamana Karma* followed by *Jalauakavacharana*) provided extremely significant (p<0.001) results in *Chinta* with percentage of relief by 39.91% after treatment and on follow-up, it showed extremely significant (p<0.001) results with relief of 45.92%. Group B (*Jalauakavacharana*) provided relief by 10.75% in *Chinta* after treatment which is statistically not significant (p>0.05) and on follow-up also, it shows non-significant result with p value (p>0.05) with same relief of only 10.75%.
Inter group comparison shows that there is very significant variation in both groups after treatment in the parameter of *Chinta* (p<.001). Group A is found more effective than Group B. Stress is a common trigger for psoriasis disease.
Effect on PASI:
This study shows that after treatment on group A (*Vamana Karma* followed by *Jalauakavacharana*) showed very significant (p=0.001) results in PASI Scorewith percentage of relief by 46.75% after treatment and on follow-up also, it shows very significant relief of 56.38% with p value (p=0.001).
Thus, within-group comparison shows that both the group have significant improvement on PASI.
Whereas intergroup comparison shows that there is significant variation in both groups after treatment in the parameter of PASI Score.
The Group A (mean rank 20.07) has shown significant decrease in the PASI Score than group B (mean rank 10.93).
**Conclusion:**
Group A (Vamana Karam followed by Jalaukavacharana) is more effective than Group B, thus null hypothesis is rejected and alternative hypothesis is accepted.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Closed to Recruitment of Participants
- Sex
- All
- Target Recruitment
- 30
- a)Patients between 18 to 60 years of age.
- b)Patients with the classical features of Mandal Kushtha (psoriasis).
- c)Patients not taking any other medicine for Mandal Kushtha (psoriasis).
- d)Patients fit for Vamana and Jalaukavacharana.
- e)Patients willing to sign consent form for trial.
- 1.Pregnant women and lactating mothers.
- 2.Patients suffering from systemic disorders as Cardiac Problem, Uncontrolled Diabetes mellitus, Uncontrolled Hypertension, Paralysis, Malignancy, HIV, HBsAg, Leprosy.
- 3.Patients unfit for Vamana karma and Jalaukavacharana.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Assessment of changes in specific signs and symptoms of Mandal Kushtha (psoriasis). 60 days
- Secondary Outcome Measures
Name Time Method A Any adverse effect in the values of hematological test and in clinical signs and symptoms. 60 days
Trial Locations
- Locations (1)
PG Department of Panchkarma, OPD Room no 2, National Institute of Ayurveda
🇮🇳Jaipur, RAJASTHAN, India
PG Department of Panchkarma, OPD Room no 2, National Institute of Ayurveda🇮🇳Jaipur, RAJASTHAN, IndiaDr Pravesh SrivastavaPrincipal investigator9340901447ayurpravesh064@gmail.com