Psoriasis is a common skin condition that is known to cause rapid skin cell reproduction resulting in red, dry, scaly patches of skin. It is prevalent in the winter season when the air is dry, the temperatures have dropped and there is less exposure to the sun. Psoriasis patients are known to experience a relapse of the disease, which commonly affects the skin of the elbows, knees, and scalp. The word Psoriasis is derived from Greek word Psora meaning itch and iasis, which means condition. In general Psoriasis is an itching skin condition. It is a chronic non-infectious skin disease that’s characterized by dry skin along with raised, rough, red areas on the skin that is covered with fine silvery scales. The sizes of these patches vary from small pinhead size to several centimeters in diameter. Psoriasis lesions commonly appear on the scalp, knees, elbows and torso. It may also progress anywhere including the nails, palms, soles, genitals and face. The lesions frequently seem to be appearing in a symmetrical fashion in both left and right side of the body. According to WHO, prevalence of psoriasis ranges between 0.09% and 11.43% in countries making it a serious issue worldwide. Nearly 100 million people are affected worldwide with psoriasis. Besides unfavourable weather, there are several other factors that can cause Psoriasis including, heredity, consumption of opposite foods (such as fish and milk together), trauma on skin like cuts, bruises or burns, some medicines or skin irritants, excessive smoking, alcohol consumption and mental stress or psychological trauma etc.

Ayurvedic Outlook to Psoriasis

Charaka explains psoriasis to be a type of Kushta (Kushta is a general terminology that is given for all skin diseases). Charaka explains 18 types of kushta out of which the first 7 are Maha Kushta and the next 11 are Kushdra Kushta. The table below gives brief information about the 18 types of Kushta:

Sl.No	Name of Kushta	Dosha Involved	Symptom
1	Kapala Kustha	Vata predominant	Skin looks like black and reddish pieces of earthen pot, skin lesions are dry, rough and thick to touch. Lesions are associated with excessive pain and it is difficult to cure.
2	Udumbara Kustha	Pitta aggravation	Skin lesions are associated with burning sensation, itching, and painfulness with redness. The hair on the patches turn brown and looks like ripe fruit of Udumbara.
3	Mandala Kushta	Kapha dominated	White, red, stable, extensive, unctuous, circular with elevated patches. Lesions are matted with each other and it is difficult to cure.
4	Rushyajihva Kushta	Vata – Pitta	Skin is rough, with red margins and internally blackish brown, painful patches. Skin looks similar to the tongue of Rushya (type of antelope with blue testicles)
5	Pundareeka Kushta	Kapha - Pitta	It is white in colour with red edges; it is elevated and resembles the leaf of lotus. Associated with burning sensation.
6	Sidhma Kustha	Vata – Kapha	Skin is white and coppery in colour. It is thin and when rubbed emits small particles of the skin in the form of dust. Lesions resemble the flower of alabu (Lagenaria siceraia), generally located in the chest region.
7	Kakanaka Kusta	Vata- Pitta – Kapha	Theses lesions are extremely painful and red in colour like the seed of Gunja (Abrus preccatorius Linn). It doesn’t get suppurated.
8	Eka Kushta	Vata – Kapha	There is absence of sweating and the lesions are extremely localized and resemble the scales of fish.
9	Charmakhya	Vata – Kapha	The skin over the patch becomes thick like the skin of the elephant
10	Kitibha	Vata – Kapha	It is blackish brown in colour. It is rough and hard to touch like a scar tissue.
11	Vaipadika	Vata – Kapha	Cracks in palms and soles of feet associated with excruciating pain.
12	Alasaka	Vata – Kapha	Nodular growth associated with excessive itching sensation, and redness.
13	Dadru	Vata – Kapha	Itching sensation, redness with pimples and circular patches with elevated edges.
14	Charmadala	Pitta – Kapha	Redness, itching, Pustules and boils that are painful to touch. Skin is cracked and tender.
15	Pama	Pitta – Kapha	Excessive itching, eruptions which are white, reddish or blackish brown in colour appear.
16	Sphota	Pitta – Kapha	Boils that are white or red appear on the skin and these boils have think skin.
17	Shataru	Pitta – Kapha	Several ulcerated patches that are red or blackish brown in colour associated with burning sensation and pain appears.
18	Vicharchika	Kapha	Blackish brown eruptions associated with itching sensation and excessive exudation appears.

Out of these the symptoms of Psoriasis resemble with the symptoms of Eka kushta, Kitibha, Sidhma and Mandala kushta. In Psoriasis there is vitiation of vata and kapha dosha predominantly. The causative factors of psoriasis according to Ayurveda are:

• Intake of incompatible food combinations such as milk with fish.
• Consuming drinks which are unctuous and heavy to digest.
• Suppression natural urges and vomiting.
• Physical exercise in excessive heat and after taking heavy meal.
• Haphazard food intake or consuming hot and cold food simultaneously.
• Drinking cold water immediately after exposure to scorching sun heat, exertion or exposure to terrifying situation.
• Consuming excess food or uncooked food and intake of food prior to digestion of previous meal.
• Not following the laws of Panchakarma treatments.
• Excessive ingesting of foods of freshly harvested grains, curd, fish, salt and sour substances.
• Excessive use of Masha (black gram), Mulaka (radish), Pastry, Tila (Sesame seeds) and Jaggery.
• Indulging in sexual act while suffering from indigestion.
• Sleeping during day time
• Some of the other factors such as stress, obesity, infection or family history may also trigger the cause of psoriasis.

Due to the above said factors Vata and Kapha doshas aggravate and accumulation of ama (toxins) starts in the skin. This ama then starts to accumulate in deeper tissues like rasa (plasma), rakta (blood), mansa (muscles), and lasika (lymphatic channel). There is further contamination of the deep tissue resulting in psoriasis. Psoriasis is also known to cause mental and emotional trauma as patients may lose his self-esteem and get isolated from the society, leading to anxiety, stress and depression. Along with this a psoriatic patient may be affected with psoriatic arthritis, irritable bowel syndrome, cardio vascular disease or some of the metabolic disorders. Psoriasis is also counted one among auto-immune disorders. Western medicine offers treatment based on the site and percentage of the disease. Three modalities of treatment are offered such as tropical application such as lotions, shampoos; second is light therapy such as UVB and laser therapy and third is systemic medication that includes internal medication and injections. Though the effect of the medication is remarkable even when the disease is at its worst condition yet it is not devoid of the side effects. Some of the side effects include decreased production of white blood cells and platelets, liver damage, IBS, kidney problems and hypertension. Also chances of regression are always present. On the other hand Ayurveda management of Psoriasis aims to clear the root cause of the disease.  Treatment modality offered in Ayurveda for psoriasis includes counselling, lifestyle management, changes in dietary habits, Panchakarma procedures, oral medications, immune modulators and yoga with meditation. Acharya Charaka mentions in his classics that repeated Shodhana or detoxification is required for patients having excessive dosha vitiation. Repeated Vamana (Emesis) and Virechana (Purgation) is given to remove the ama and to bring back the dosha to balance. In some cases Raktamokshana (bloodletting) is also given to remove excessive toxins from the blood. In case of Psoriasis affecting the scalp Shirodhara may also be advised. External application may be given if the lesions are hard and dry along with fomentation to make the skin soft by scraping the thickened skin. Bacuchyadi taila, durvadi taila, Psorakot liniment, Psoralin ointment, Lippu oil, 777 oil, Kharanjadi lepa, Gomutradi lepa, Kajali K?daya malhar, Vishataila, Chakramardadi Lepa, etc are some of the formulations used externally. Panchatikta ghrita, Mahatiktaka ghrita, Mahakhadiraka ghrita, Guggulutiktaka ghrita, Guggulutiktaka kashaya, Mahatiktaka kashaya Patolakaturohinyadi kashaya, Khadirasava, Vasaguduchyadi kashaya, Arogyavardhini vati, Kaishora guggulu, Gandhaka rasayana, Padavaladigana kashaya, Patolamooladi kashaya, Amritabhallatak avaleha, etc are some medicines that are prescribed internally. Herbs such as Nimba (Neem/ Azadirachta indica), Khadira (Acacia catechu), Sariva (Hemidesmus indicus), Guduchi (Tinospora cordifolia), Manjishta (Rubia cordifolia), Chandana (Santalum alba), Raktachandana (Pterocarpus santalinus), Patola (Trichosanthes dioica), Yashtimadhu (Glycyrrhiza glabra), Haridra (Turmeric/ Curcuma longa), Daruharidra (Berberis aristata), Bacuchi (Psoralia corylifolia), etc. may be used either single or in combination. Abstinence from the etiological factors is advised. Old rice, barley, green gram, bitter vegetables and meat of wild animals are considered to be wholesome. Avoid spicy, salty, fried and sour food items. Use of fish with milk, and meat of marshy animals, pepper, jiggery, black gram, sesame seeds, alcoholic drinks are contraindicated. Psoriasis is also considered to be a psychological disorder, in today’s world where stress is a leading cause for many psychological and auto-immune disorders. In order to fight psoriasis, it is necessary to beat stress and make the mind and body strong. Yoga and meditation is recommended to help increase one's  positive aura and curb stress. Psoriasis may or may not be cured completely with Ayurveda but I can assure you that the relapsing time may be increased with Ayurveda treatment. Symptomatic relief is better achieved through the detoxification treatment than with western medication. Also there is no life threatening side effects seen with Ayurveda and yoga therapies. There are cases of psoriasis that have been permanently cured through Ayurveda treatment. Ayurveda and Yoga together helps in combating the problem of psoriasis.