Psoriatic Arthritis: Ayurveda Treatment, Clinical Experience, Limitations

Article by Dr Raghuram Y.S. MD (Ay)
Psoriatic arthritis develops as a complication to Psoriasis. It may develop individually without psoriasis. Psoriasis is a long lasting autoimmune disease which is characterized by patches of abnormal skin. These skin patches are typically red, itchy and scaly (silvery scales). This disease changes the life cycle of the skin cells. 

Psoriasis causes cells to build up rapidly on the surface of the skin. Patches are usually seen on elbows, knees, scalp, face, palms and feet.
Thus we have an autoimmune skin condition and also an arthritis involving in this picture.

Treating Psoriatic arthritis on the lines of Kushta and Vatarakta Chikitsa
According to Ayurveda, psoriatic arthritis can be put into a component between Vatarakta (joint disorder caused due to pathological amalgamation of morbid vata and rakta i.e. blood) and Kushta (skin disorders).

Even in practice we have seen that the medicines and treatments applicable to Kushta are also beneficial in Vatarakta. When the Kushta, especially complicated skin conditions not responding to any medicines or treatments advised in Kushta when treated with some formulations explained in treatment of Vatarakta have found to give stunning results.

Ayurvedic treatises give a clear idea that certain skin disorders are related to joint disorders and they can be dealt in identical ways by identical approaches in terms of formulations and treatment strategies.

Thus Psoriatic arthritis should be treated either on the lines of Kushta or Vatarakta or both.
If the skin component is more i.e. if the psoriasis is evident by the skin picture and if the patient also has joint involvement, we shall treat on the basis of Kushta treatment line up.

If the skin component is less or if it has been treated so that the lesions are not available or feebly available and if the patient has developed the arthritis component on a later period (as a complication of kushta), we shall treat that condition on the lines of Vatarakta. In these conditions, the joint manifestations are superseding those of skin.

If the joint pains or arthritis has been diagnosed as Psoriatic arthritis by modern parameters (in the absence of skin psoriasis), our job becomes easy. In these conditions we can skilfully mix up the treatments of both Vatarakta and Kushta, giving importance to Vatarakta line of treatment.
Read related: Psoriatic Arthritis: Useful Home Remedies, Diet, Yoga, Lifestyle Tips

Vatarakta line of treatment

Treating Psoriatic Arthritis on the lines of VataRakta:
If there are clearcult Vatarakta symptoms, then this condition can be treated on the lines of Vatarakta.
Read related: Vatarakta: Causes, Pathogenesis, Types, Treatment

Treatment principles of Vatarakta and its subtypes as applicable to Psoriatic Arthritis –
The psoriatic arthritis which has arthritis developing on the backdrop of skin psoriasis and in which the joint symptoms are less in comparison to skin complaints can be treated on the lines of uttana vatarakta.

Uttana Vatarakta can be effectively handled with:

• Lepa – external application of medicinal pastes
• Abhyanga – herbal oil massage
• Parisheka – stream pouring or sprinkling or showering of medicinal liquids like decoctions, medicated milk, oil etc over the afflicted areas
• Avagahana – dipping the afflicted parts or joints in the medicinal liquids mentioned below
• Upanaha – poultice

These treatments are of immense use in Psoriatic arthritis.

Clinical experience

My clinical experience:
I have always tried one or the other of the above mentioned treatments in combating Psoriatic arthritis, especially in those which are not very severe or not complicated. The results are outstanding. When skilfully combined they reduce pain and swelling and give good relief to the patients. Of course they should be combined with disease modifying medicines and formulations according to the involved dosha along with a regular laxative for detoxification.

When systemic involvement has been found and when psoriatic arthritis is a chronic one or has developed on the backdrop of chronic psoriasis, I have always preferred Panchakarma as the first line of approach, because in these cases the immunity is highly compromised to deal them with simple applications, stream pouring of medicines or formulations.

Though these strategies are explained to be done in Uttana Vatarakta wherein the joint pain or involvement is not too much, the medicines used for these treatments strategically attend the symptoms of psoriatic arthritis very effectively. These should be essential part of treatment approach towards psoriatic arthritis immaterial of the disease being uttana or gambhira with multiple tissue and organ involvement. But if the disease is complicated with joint damage etc, these treatments might just be a waste of time or may provide temporary relief of pain etc symptoms but will not be capable of reverting or checking the disease process.

Panchakarma

Virechana and Basti are always my favourites when I am dealing psoriatic arthritis. They form a wonderful combo. They not only detoxify the body but also reduce the pain and inflammation. They expel the morbid vata, rakta and pitta. After a course of vasti, people find it easy to move their joints. As I said earlier, I always combined these treatments with effective external treatments. Getting treatments into the strategy of uttana vatarakta (though not specified) and getting external measures in gambhira vatarakta (though not mentioned) has always helped me to get good results. I always admire the concept of yukti (situational understanding of a disease and making essential changes in treatment strategies) given by Ayurveda and never hesitated adopting it in my clinical practice. They have never betrayed me. I would always advertise the doctors to combine external and internal therapies in the management of pains, (psoriatic arthritis in this scenario).

Kushta line of treatment

Treating PsA on the lines of Kushta Chikitsa
How Kushta is formed?
The 3 doshas (Vata, Pitta and Kapha) aggravated by the above said causative factors on contaminating Twak (skin), Rakta (blood), Mamsa (muscles) and Ambu (water component or fluid compartment of the body) causes 18 types of Kushta.

Dhatugata Kushta

In the chapter of Kushta (skin disorders), we get to see a concept called Dhatugata kushta (kushta manifesting and deep penetrating at the tissue level). This means to tell that though the skin, blood and muscles are involved in the initial conditions of the disease, the pathology would penetrate deep into the tissues in later condition (when the initial conditions are not managed properly). Then the other tissues meda (fat), asthi (bone), majja (bone marrow) and shukra (semen) are also involved.

The involvement of bones i.e. asthigata kushta can be considered as (conceptually) psoriatic arthritis, though the symptoms do not match.

The stage of kushta before the manifestation of dhatugata kushta (complications of kushta) can be compared closely with uttana vatarakta (wherein the skin and muscles are involved).

The dhatugata kushta can be considered similar to gambhira vatarakta (wherein deeper tissues and organs are involved).
All these hint towards identical management of both these conditions. Even in practice it has been evident that the vatarakta chikitsa when administered gives good results in kushta and vice versa.
Thus the treatment line up of kushta and vatarakta can be adapted in the treatment of psoriatic arthritis.

Kushta samanya chikitsa

General line of treatment of Kushta –
In Vata predominant Kushtas – Sarpi or intake of medicated ghee is the treatment of choice
In Kapha predominant Kushtas – Vamana or therapeutic emesis is the treatment of choice
In Pitta predominant Kushtas – Virechana or therapeutic purgation and Raktamokshana or bloodletting are ideal treatments

In amalgamation and dual or triple manifestation of morbid doshas in Kushta, the treatments and formulations have to be planned skilfully according to the nature of the disease and strength of the diseased.

After the morbid doshas have been removed by the administration of above mentioned treatments and once the disease has been brought under control, Rasayanas (immune-modulators) should be administered on a regular basis to prevent the recurrences of the disease.

External treatments

External treatments and Applications (Lepa) –
Chakramardadi lepa – Paste of Chakramarda beeja (seeds of Cassia tora) and Twak (Cinnamon) made in milk
Simhasyapallava lepa – paste of tender leaves of Vasa (Adhatoda vasica) and Haridra (turmeric) made in gomutra (urine of cow)

Gandhakadi lepa – paste of gandhaka churna (powder of purified sulphur) made in sarshapa taila (mustard oil)
Aragwadha lepa – Paste of Aragwadha (Cassia fistula) made in Kanji (sour fermented medicated drink)
Shikari rasadi lepa – Paste of juice of Apamarga (Achyranthes aspera) and seeds of Mulaka (radish)
Saindhavadi lepa – paste of Saindhava lavana (rock salt) and Kushta (Saussurea lappa) made in ghrita (ghee)
Tulasi swarasa – applying fresh juice of basil leaves (Sheetapitta – urticaria)

Pathyadi Lepa: Paste of Haritaki (Terminalia chebula), Karanja (Pongamia pinnata), Sarshapa (mustard), Haridra (turmeric), Krishna Jeraka (Caram carvi), Saindhava Lavana (rock salt) and Vidanga (Embelia ribes)
Karanja beejadi lepa – Paste of seeds of Karanja (Pongamia pinnata), Chakramarda beeja (seeds of Cassia tora) and Kushta (Saussurea lappa) made in gomutra (urine of cow)

Durvadi Lepa – Paste of Durva (Cynodon dactylon), Chakramarda beeja (seeds of Cassia tora), Saindhava Lavana (rock salt), Haritaki (Terminalia chebula), Tulasi (Holy basil) made in Kanji (sour fermented medicated drink) and Takra (buttermilk)

Vidangadi Lepa – Paste of Vidanga (Embelia ribes), Chakramarda beeja (paste of Cassia tora), Kushta (Saussurea lappa), Haridra (Turmeric), Saindhava (rock salt) and Sarshapa (mustard) made in Kanji (fermented medicated drink)

Saindhavadi lepa – paste of Saindhava lavana (rock salt), Chakramarda beeja (seeds of Cassia tora), Sarshapa (mustard) and Pippali (long pepper) made in Kanji (fermented medicinal drink)

Internal medications

Khadirodaka – Juice, decoction, powder of Khadira (Acacia catechu) should be used for anointing, upward massage, application, bathing, drinking and eating (mixed with food)

Khadira rasa – pieces of bark, wood, leaves, roots of Khadira plant (Acacia catechu) should be boiled in a big vessel, when they are processed well, filter, mix juice of Indian gooseberry, ghee and honey and should be used internally

Nimbadi kalka – eating mixture of leaves of Nimba (neem plant) and Amalaki (Indian gooseberry)

Vidangadi kalka – Paste of Vidanga (Embelia ribes) and Bakuchi (Psoralea corylifolia)

Vidangadi Churna – Powder of Vidanga (Embelia ribes), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Pippali (long pepper) mixed in honey

Nimba patra yoga – Powder of Nimba patra (leaves of neem plant) with ghee or powder of neem leaves and Indian gooseberry with ghee

Guluchyadi Kwatha – Decoction of Guduchi (Tinospora cordifolia), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica) and Daruharidra (Berberis aristata) added with powder of purified Guggulu (Commiphora mukul)

Khadirashtaka – decoction of Khadira twak (bark of Acacia catechu), Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Nimba twak (bark of neem tree), Patola patra (leaves of pointed gourd), Guduchi (Tinospora cordifolia) and Vasa (Adhatoda vasica)

Navaka Kashaya – Decoction of Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Nimba twak (bark of neem tree), Patola patra (leaves of pointed gourd), Manjishta (Rubia cordifolia), Katuki (Saussurea lappa) and Haridra (turmeric)

Vardhamana Pippali – Long pepper treatment in which the powder, decoction or paste of long pepper (pippali) is given in an ascending way (increasing the dose gradually) and later tapered (gradually decreasing the dose and ending with the dose with which the treatment was started).

The above mentioned formulations enlisted from the Ayurvedic treatises are not only effective in healing the skin conditions in psoriasis but also combat complications like psoriatic arthritis.

Kitibha, Ekakushta treatment

On the lines of Kitibha and Ekakushta:
Both the above skin diseases are compared with psoriasis and hence, treatment on these lines is very uesful.
Read related: Kitibha and Ekakushta: Symptoms, Treatment, Medicines

Amamvata treatment

Treating of Psoriatic Arthritis on the lines of Amavata:
Amavata is more often compared with rheumatoid arthritis, however, some features of psoriatic arthritis are also seen when inflammation is more.
Read related: Amavata: Causes, Pathology, Treatment, Panchakarma, Medicines

Raktavaha Sroto dushti chikitsa

Treating on the lines of Raktavaha sroto dushti
Since the rakta or the blood component is inevitably contaminated in kushta or vatarakta vis-à-vis psoriatic arthritis, the raktavaha srotas (channels carrying the blood or components of blood) are also contaminated at the backdrop. The treatment of the same will help in the treatment of PsA.

Management of vitiation of Raktavaha Srotas –
Vidhi shonita adhyaaye raktajaanaam bhishak jitam (Ref – Charaka Sutra 28/25)

The diseases caused due to vitiation of Rakta vaha srotas should be managed on the lines of treatment and management explained in the chapter ‘Vidhi shonitiya’ of Charaka Sutra sthana.

Kuryaat shonita rogeshu rakta pitta harem kriyaam
Virekam upavaasam cha sraavanam shonitasya cha (Ref – Charaka Sutra 24/18)

The management includes:
Raktapitta hara kriyam – Treating on the lines of management of Raktapitta (bleeding disorders)
Virechanam – therapeutic purgation
Upavaasam – starvation / langhana therapy
Rakta mokshana – bloodletting

Ashtivaha Sroto dushti Chikitsa

Treating on the lines of Asthivaha sroto dushti:
Since joint pain and bone pain is the main symptom of Psoriatic arthritis, the channels responsible for nourishing the bones (asthi vaha srotas) and carrying the nutrients to them are also contaminated. The treatments given to correct the contamination of asthi vaha srotas will be handy in handling PsA.

Treatment of vitiation of Asthi vaha srotas –
Asthi aashrayaanaam vyaadheenaam panchakarmani bheshajam
Vastayaha ksheera sarpishi tikta kopa hitaani cha (Ref Charaka sutra 28/27)

The diseases getting their origin from the vitiation of Asthivaha srotas should be managed by the administration of –

Panchakarma – 5 cleansing measures / treatments, including Vamana (therapeutic emesis), Virechana (therapeutic purgation), Asthapana Vasti (decoction enemas), Anuvasana Vasti (oil enemas) and Nasya (nasal medication)
Vasti – Medicated enemas
Tikta ksheera and sarpi – Milk and or ghee processed with medicines having bitter taste

Majjavaha Sroto dushti Chikitsa

Treating on the lines of Majjavaha sroto dushti
The roots of Majja vaha srotas (channels carrying the nutrients to the bone marrow or helping in their formation) are said to be asthi (bones) and sandhis (joints). These are the main components which are diseased in PsA. Therefore the treatments explained in correction of Majja vaha srotas vitiation will also help in Psoriatic arthritis.

Management of vitiation of Majjavaha Srotas –
Majjaa shukra samutthaanam aushadham svaadu tiktakam
Annam vyavaaya vyaayaamau shuddhihi kale cha maatrayaa (Ref – Charaka Sutra 28/28)

The treatment of vitiation of Majjavaha srotas are as below mentioned –
Madhura tikta anna – foods which are predominant in sweet and bitter tastes
Maithuna – indulgence in sexual activities (intercourse)
Vyaayaama – indulgence in exercises
Shodhana – evacuatory treatments like Vamana (therapeutic emesis), Virechana (therapeutic purgation) etc should be administered in proper dose in proper time or season (like administration of Vamana in Vasanta or spring season, Virechana is Sharad or autumn period etc)

Panchakarma for Psoriatic Arthritis

Role of Panchakarma in the management of Psoriatic arthritis
Below mentioned Panchakarma methods are useful:

• Snehapana – internal administration of medicated ghee and oils
• Swedana – sweating treatment or steaming
• Vamana – therapeutic emesis
• Virechana – therapeutic purgation
• Niruha Vasti – decoction enemas
• Anuvasana or sneha vasti – oil or ghee enemas
• Ksheera vasti – enemas with medicated milk

The panchakarma treatments keep flushing out the toxins and morbid doshas and malas (excreta) on regular basis. This makes sure that the disease doesn’t progress further and the pathogenesis takes a halt at the initial stages. As the treatments are repeated on regular basis we can see the regression of pathology and the skin getting its normal texture, colour, complexion and contour. The inflammatory symptoms, pain, itching etc come down in due course of time. When combined with external treatments like abhyanga (massage), dhara (stream pouring of medicated liquids) etc, the pain and inflammation in the joints will reduce and the movements are seen to improve. Vasti comprehensively combats the psoriatic arthritis and is therefore a preferred line of treatment in the later stages of the disease. Vasti is beneficial when administered after Vamana and or Virechana.

External treatments

External Treatments in Psoriatic Arthritis
External treatments should essentially be conducted in Psoriatic arthritis. When combined with Panchakarma treatments and oral administration of disease modifying formulations and medicines, the results are fortified. Below mentioned are the best treatments which can be conducted over the sore and inflamed joints:

• Abhyanga – massage with medicated herbal oils
• Swedana – steaming
• Dhara – stream pouring of medicated oils, ghee, decoctions and or milk over the painful joints is beneficial in relieving the symptoms of psoriatic arthritis. Takra dhara (stream pouring of medicated buttermilk) over the entire body (skin psoriasis) and scalp (scalp psoriasis) is an ideal and result-oriented treatment in handling psoriasis.
• Lepa – application of medicinal pastes
• Upanaha – poultices
• Avagahana – dipping of joints in the medicinal liquids
• Kati Vasti – oil pooling over the low back region in low back pain
• Janu Vasti – oil pooling over the knee joints in knee pain
• Griva vasti – oil pooling over the back of the neck in neck pain
• Pinda sweda – bolus fomentation including leaf bolus fomentation (patra pinda sweda), shashtika shali pinda sweda (rice bolus fomentation) etc

Ayurvedic medicines

Classical Ayurvedic medicines for psoriatic arthritis:
Kashayam (herbal decoctions) –

• Rasnaerandadi Kashayam
• Rasnasaptakam Kashayam
• Guluchyadi Kashayam
• Balaguluchyadi Kashayam
• Rasnapanchakam Kashayam
• Kokilaksham Kashayam
• Guggulutiktakam Kashayam
• Mahamanjishtadi Kashayam
• Amrutottaram Kashayam
• Gandharvahastadi kwatha
• Prasarinyadi kashayam
• Punarnavadi kashayam
• Sahacharadi kashayam
• Mustadi marma kashayam

Churnam (herbal powders) –

• Vaishwanara Churna
• Shaddharana Churna
• Ajamodadi churna
• Chopachinyadi churna
• Amritadi churna
• Triphala churnam
• Avipatti churnam
• Panchakola churnam
• Pathyadi churnam

Churnam for external application and poultice –

• Rasnadi churnam
• Kottamchukkadi churnam
• Jatamayadi churnam
• Grihadhumadi churnam
• Kolakulatta churnam
• Dashanga lepa churnam

Vati (tablets) Ras (herbomineral preparations) and Guggulu preparations –

• Amavatari ras
• Amritadi guggulu
• Simhanada Guggulu
• Saptavimshati guggulu
• Kaishora Guggulu
• Triphala Guggulu
• Vatari guggulu
• Yogaraja guggulu
• Mahayogaraja guggulu
• Vyoshadi guggulu
• Trayodashanga guggulu
• Brihat vata chintamani rasa
• Maha vata vidhwamsini rasa

Ghrita (medicated ghee for intake or for snehapana) –

• Guggulutiktakam ghritam
• Tiktakam ghritam
• Rasnadi ghritam
• Mahatiktakam ghritam
• Patoladi ghritam
• Aragwadhadi ghritam
• Ardraka ghritam
• Dhanwantaram Ghritam
• Ashwagandhadi ghritam

Tailam (oils for external application) –

• Mahavishagarbha tailam
• Kottamchukkadi tailam
• Ksheerabala tailam
• Pinda tailam
• Mahapinda tailam
• Chandanabala lakshadi tailam
• Sahacharadi tailam
• Dhanwantaram tailam
• Murivenna tailam
• Saindhavadya tailam
• Prasarini tailam
• Mahanarayana tailam

Rasayana / Leham (immune-modulators, confections) –

• Kalyana gulam
• Trivrit leham
• Danti haritaki
• Narayana gulam
• Manibhadram leham
• Dashamula haritaki
• Amrita bhallataka lehya

Proprietary medicines –

• Cap Arjit Forte / Arjit liniment (Capro)
• Tab Myostal (Solumiks)
• Tab Rumastal Forte (Gufic)
• Tab Shallaki / Shallaki Plus (Gufic)
• Syp Lobak (Pentacare)
• Tab Paenwin (Baidyanath)
• Cap Amavatari (Pavaman)
• Tab Alopagesic (Alopa)
• Cap Arnopen (Phyto Pharma)
• Cap Arthozen (ZEN)
• Cap Arthrum Plus (Vitalcare)
• Cap Boswella plus (Ayush)
• Cap Dazzle (Vasu)
• Cap Orthofit (Fizikem)
• Cap Penwel (Ayulabs)
• Tab R-Compound (Alarsin)
• Tab R-Pairyn (Ban)
• Tab Rheuma Off Gold (Unjha)
• Cap Rheumarthro with Gold (Baidyanath)
• Tab Rhumayog with Gold (Zandu)
• Tab Rumalaya / Rumalaya Forte (Himalaya)
• Tab Rumastal (Gufic)
• Amrutayolepam churna (Vaidyaratnam)
• Tripalayolepam churna (Vaidyaratnam)
• Punarnavayolepam churna (Vaidyaratnam)

External application –

• Arnopen liniment (Phyto Pharma)
• Arthrum oil (Vital care)
• Dazzle ointment / oil (Vasu)
• Mobyl ointment (Ayulabs)
• Myaxyl liniment (KAPL)
• Rheukot tablets and ointment (AVS Kottakkal)
• Arthorub liniment (AVN)
• Oleum Arthnex (Sagar)
• Orthofit tab / oil / gel (Fizikem)
• Penwel oil (Ayulabs)
• Pyroflex liniment / gel (Solumiks)
• Rheumat liniment (Nagarjuna)
• Rhuma oil (Baidyanath)
• Rhumasyl ointment (Zandu)
• Rumalaya cream and gel (Himalaya)

Pathya

Pathya (beneficial foods, lifestyle) –

• Yava – barley
• Shashtika shali – paddy or rice grown in 60 days
• Aruna shali – red rice
• Godhuma – wheat
• Chanaka – Bengal gram
• Mudga – green gram
• Tuvara – Tor dal
• Makushtaka – Vigna aconitifolia
• Avi ksheera – sheep milk
• Aja ksheera – goat milk
• Mahisha ksheera – Buffalo milk
• Go ksheera – cow milk
• Upodika – Basella rubra
• Kakamachi – Solanum nigrum
• Vetragra – Garcinia indica
• Sunishannaka – Blepharis edulis
• Vaastuka – Chenopodium album
• Kaaravellam – bitter gourd
• Tanduleeyam – Amaranthus polyganus
• Patolam – pointed gourd
• Dhatree phalam – gooseberry fruit
• Srungavera – ginger
• Soorana – Amorphophallus campanulatus
• Sharkara – sugar or candy
• Mrudveeka – raisins
• Kushmanda – ash gourd
• Navaneetam – butter
• Navam ghritam – fresh ghee
• Mamsa – flesh of lava (common quail), tittira (black partridge), varteeka (bush quail), tamrachuda (cock), vishkira (wild birds), pratuda (pecker birds like pigeon etc), shuka (parrot), kapota (pigeon), chataka (sparrow), shasha (rabbit), daatyooha (big sized parrots) etc
• Karpura (camphor)
• Agaru – Aquilaria agallocha
• Devadaru – Cedrus deodara
• Sarala kashta – Stem of Pinus roxburghii
• Mardana – massaging or tapping with herbal oils and ghee
• Tikta – bitter foods and vegetables

Apathya

Apathya (unwholesome food, lifestyle) –

• Diwaswapna – day sleep
• Agni santapa – exposure to the heat of sun
• Vyayama – excessive exercise
• Atapa – heat of sun
• Maithuna – excessive indulgence in sex
• Masha – black gram
• Kulattha – horse gram
• Nishpava – flat bean
• Kalaaya – peanut
• Kshara – alkalis
• Andaja – meat of animals and birds which are born from eggs (fish, birds etc)
• Anupa mamsa – meat of animals living in marshy areas
• Viruddha ahara – mutually incompatible foods
• Dadhi – curds
• Ikshu – sugarcane
• Moolaka – radish
• Madira – excessive consumption of alcohol
• Kanji – fermented drinks
• Tila – sesame
• Katu – excessive consumption of pungent foods
• Ushna – excessive consumption of hot foods
• Guru ahara – excessive consumption of heavy (to digest) foods
• Lavana – excessive consumption of salty foods

Single herbs

Single herbs used in the treatment of Psoriatic arthritis

• Guduchi – Tinospora cordifolia
• Devadaru – Cedrus deodara
• Kushta – Saussurea lappa
• Bala – Sida cordifolia
• Atibala – Abutilon indicum
• Guggulu – Commiphora mukul
• Shallaki – Boswellia settata
• Agnimantha – Clerodendrum phlomidis
• Eranda – Ricinus communis
• Pippali (long pepper)
• Pippalimula (root of long pepper)
• Chavya (Piper retrofractum)
• Chitraka (Plumbago zeylanica)
• Shunti (ginger)
• Shatavari – Asparagus racemosus
• Punarnava – Boerhavia diffusa
• Dashamula – Roots of 10 drugs
• Rasna – Alpinia galanga
• Kokilaksha – Asteracantha longifolia
• Haridra – Turmeric
• Daruharidra – Berberis aristata
• Vidanga – Embelia ribes
• Nimba – Neem
• Chakramarda – Cassia tora
• Aragwadha – Cassia fistula
• Khadira – Acacia catechu
• Vasa – Adhatoda vasica
• Vacha – Acorus calamus
• Manjishta – Rubia cordifolia
• Katuki (Picrorrhiza kurroa)
• Amalaki (Emblica officinalis)
• Haritaki (Terminalia chebula)
• Bibhitaki (Terminalia bellirica)
• Chandana (sandal wood)
• Yashtimadhu (Glycyrrhiza glabra)
• Patola – pointed gourd
• Prapaundarika – lotus variety
• Ushira – Vetiveria zizanioidis
• Padmakashta – stalk of lotus
• Atasi – flaxseed
• Kumari – Aloe vera

Clinical experience

My experience in handling Psoriatic Arthritis through Ayurveda –
I have already discussed this component in bits and parcels through the length of the blog. I should admit that I don’t get to see too many cases of psoriatic arthritis in comparison to other forms of arthritis with which the patient comes i.e. osteoarthritis, gout, rheumatoid arthritis etc. I was lucky enough to get a few cases of PsA without the skin component, already diagnosed by the other systems and it was an easy affair to deal them every time. Some stubborn cases were not totally relieved but with Ayurvedic treatments and medications, I could make sure that the pain, inflammation and swelling reduced and also that the movements improved, enough for them to maintain their life-style activities.

In those cases wherein I could not get appreciable results, I was not too disappointed because those patients were either not very sincere nor serious about their recovery, many had negative vibes in them and they were sure that no one can help them and many people were having other systemic diseases at the backdrop which hindered the healing of PsA symptoms.

When the skin component of psoriasis was present along with psoriatic arthritis, the diagnosis was clear. I always preferred starting the treatments with both Vamana and Virechana, because the kapha component was always there. Many times only Vamana or only Virechana was enough to get good results, especially in mild to moderate cases. With Vamana and or Virechana I had observed the pain and inflammation of the arthritis reducing and the patient getting substantial relief; especially I would salute the utility of virechana and vasti in these conditions. When the skin condition came under control, I used to plan for vasti in PsA cases.

External therapies like abhyanga, dhara, lepa etc were simultaneously conducted.

When the patients were not in a position to undergo the cleansing treatments due to some reasons or when they were not fit enough to undergo them, I generally give the disease modifying medications and applications to be done at home. I always advice simple methods like abhyanga, swedana (hot water fomentation), lepa, upanaha etc.which could easily be done at home so that the patients can manage doing them by themselves or with someone else’s help at home.

I make sure, in such cases to prescribe Nitya Virechana or daily cleansing programme to flush off the toxins and morbid doshas. I generally use one of the below mentioned medicines –

• Nimbamritadi eranda tailam
• Gandharvahastadi eranda tailam
• Avipatti churnam
• Shaddharana churnam
• Vaishwanara churnam
• Narayana churnam
• Trivrit leham
• Dashamula haritaki
• Kalyana gulam etc

Dietetic corrections, lifestyle corrections, exercise recommendations and prescriptions of Rasayanas (immune-modulators) are essential part of my practice in handling psoriatic arthritis.
Read related: Psoriatic Arthritis: Causes, Symptoms, Diagnosis, Epidemiology, Treatment

Limitations

Limitations in handling Psoriatic Arthritis through Ayurveda –
Psoriasis carries with it an immunological component. The disease is autoimmune in nature. Thus the disease tends to wax and wane. Psoriatic arthritis when is associated with skin psoriasis will share its autoimmune nature. Arthritis is found to manifest in chronic psoriasis (wherever it is associated with psoriasis). Thus it is a late complication of psoriasis. When the psoriasis is running its full course, waxing and waning due to the effect of medicines, diet and lifestyle changes and disease modifying treatments like Panchakarma, the arthritis component will be developing slowly at its backdrop. PsA which develops individually will look like any other arthritis unless it is diagnosed. Thus its cause and manifestation is less understood especially when it is not a part of psoriasis. In either case, it is not easy to handle this condition.

Ayurveda offers a lot of treatment options in the form of Panchakarma as discussed above. The oral medications which we use (disease modifying medicines and formulations) helped by proper diet and lifestyle advices and immune modulators in the follow up will help in recovery from the signs and symptoms of psoriatic arthritis. If the joints are damaged to irreversible proportions it will take a lot of time to give at least a reasonable relief. Or else the prospectus of getting good relief is optimum.

In the conditions associated with psoriasis, the skin component should be totally eradicated for the joint manifestations not to occur. This is not possible totally as psoriasis has a nature of relapsing. But Panchakarma treatments will also help in expanding the distance between relapses initially and make it rare with passage of time. Chances of getting good results are even better when the psoriatic arthritis is an independent component, i.e. not associated with psoriasis of skin.

Ayurveda advices repeated Shodhana or cleansing in the form of Vamana and Virechana, not only in psoriasis but in all the skin disorders. This shows that the skin disorders are not ‘just skin conditions’ but are reflections of some interior pathology. The patient should undergo at least 2-3 courses of Shodhana in a year. Such courses should be repeated for 3-4 years continuously. This religious approach is needed for psoriasis or its joint component, arthritis to be knocked out of the body. But still the chances of relapse may be after a pretty long period cannot be ruled out and this fact should be intimated to the patient. Thus the patient is always leading a life with the disease in a concealed and ‘want to manifest’ condition, ‘burning coal hidden amidst silent ashes’ condition to be precise.

To sum up, the results for psoriatic arthritis with ayurvedic medicines and panchakarma can be declared to be ‘good and great’ if the disease is not too complicated (to the level of irreversible damage of joints and soft tissues) and if the immunological component of the patient is good. If the patient is obedient enough and has a will to recover, then the results are bound to magnify!!

Just before finish –
Though Ayurveda provides best and unparalleled cure in psoriatic arthritis, the patients of psoriasis or psoriatic arthritis cannot take ‘cure’ or ‘relief’ for granted. They need to be double cautious regarding their lifestyle, food and stress. ‘Conscious living’ is a key. The disease has left its imprint in the body and they are bound to get darker at any time. But regular cleansing in the form of Panchakarma and keeping up with the immunity and metabolism, being choosy about good foods and keeping away the incompatible or allergic foods away, good exercise and stress free life can guarantee a ‘long standing and long sustained relief’. Ultimately it depends on how determined the patients are ‘to keep the disease’ away forever!!!
Click to Consult Dr Raghuram Y.S. MD (Ayu)