ISSN International, Peer reviewed, Open access, Monthly Online Journal

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1 ISSN International, Peer reviewed, Open access, Monthly Online Journal Research article A CLINICAL STUDY ON THE EFFICACY OF KARANJA BEEJA TAILA ALONG WITH DOOSHIVISHARI AGADA IN THE MANAGEMENT OF PSORIASIS Ittoop J Ancheril 1*, Ashwin Kumar Bharati 2, Sailekha P 3, Niveditha PN 4, Deepthi Ittoop 5 1, 3, 4 Final year Postgraduate Scholar, Department of Agada tantra, SDM College of Ayurveda, Hassan, Karnataka, India 2 Professor and H.O.D.- Department of Agada tantra, SDM College of Ayurveda, Hassan, Karnataka, India 5 Resident Medical Officer, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India *Corresponding Author: ittoopjancheril@gmail.com ABSTRACT Received: 22/06/2015; Revised: 20/07/2015; Accepted: 10/08/2015 Psoriasis is one of the oldest recorded skin diseases. The prevalence of psoriasis in our society is increasing day by day.because of its un-known etiology, recurrence and unsuccessful treatment; it is still a challenge to the medical fraternity. Here an effort is made to see the efficacy of Karanjabeejataila (seed oil of Pongamia pinnata) along with dooshivishariagada tablet in psoriasis. This is a single group study with a sample size of 30 patients. Diagnosed cases of psoriasis were selected and were administered karanjabeejataila for external application along with dooshivishariagada administered internally for 14 days. All the results were analyzed statistically for comparing the net effects before and after treatment. Follow up was done on 7 th & 14 th day. The overall result was that the therapy got highly significant results in reducing main parameters like scaling by 84 % and thickness of lesions by 57 %. It was concluded that the combination of Karanjabeejataila along with dooshivishariagada showed significant results in reducing parameters like scaling, erythema, thickness of lesions, degree of involvement of the lesions and in reducing the total PASI score of psoriatic cases. KEY WORDS: Psoriasis, Karanjabeejataila, DooshivishariAgada, PASI score, Pongamia pinnata Cite this article: Ittoop J Ancheril, Ashwin Kumar Bharati, Sailekha P, Niveditha PN, Deepthi Ittoop (2015), A CLINICAL STUDY ON THE EFFICACY OF KARANJA BEEJA TAILA ALONG WITHDOOSHIVISHARI AGADA IN THE MANAGEMENT OF PSORIASIS, Global J Res. Med. Plants & Indigen. Med., Volume 4(8):

2 INTRODUCTION: Psoriasis is a non-infectious chronic skin disease. The precise cause of psoriasis is still unknown. The prevalence of psoriasis in our society is increasing day by day. It varies from 0% to 11.8% in different populations around the world. In India the prevalence of psoriasis patients among total skin patients is 2.3% & male to female ratio is 2.46:1 (Dogra S, 2010). The cause of psoriasis is generally believed to be due to damage in factors of immune system & enzymes that control skin cell division. Abnormal immune response causes rapid production of immature skin cells and inflammation.weather, stress, injury, infection,incomplete protein digestion, bowel toxemia, immunological factors and certain medicationtriggers the disease process leading to the onset and worsening of psoriasis.various food,environmental & cosmetic factors have been suggested as causing & aggravating psoriasis- environmental pollutants & toxicants, chemical cosmetics like deodorants, shampoos, gels, sprays, conditioners, colors& hair dye etc.role of drugs such as beta blockers, NSAIDs, synthetic anti-malarial drugs,tetracycline& lithium in the induction & exacerbation of psoriasis have also been studied (Tsankov N, Angelova I, Kazandjieva J, 2000). Withdrawal of corticosteroids (topical steroid cream) can aggravate the condition due to so called 'rebound effect'.simple sugars in soft drinks,cakes and candies,caffeine containing foods and saturated fats in red meat and eggs are some other aggravating factors (August McLaughlin, 2013) of psoriasis. Because of its unknown etiology, recurrence and unsuccessful treatment, it is still an untackled challenge to the medical fraternity. The existing pattern of Ayurvedic approach to psoriasis is through the principles of treatment of kushta (skin diseases) according to nidana (etiology) and samprapti (pathogenesis), but still recurrences are not infrequent. In Ayurvedic dermatology, normal skin complexion and pathological lesions of skin are attributed to diet & regimens of the individual. Kushta is the banner which is used to explain almost all dermatological ailments in Ayurveda with utmost clarity. Even though kushta (skin disease) is considered as a disease of bahyarogamarga (external route of disease causation) (Srikantamurthy K.R, 2000), the initiation of pathogenesis is within the gastrointestinal tract. Acharya Charaka emphasizes the unparalleled influence of diet in the etiopathogenesis of all diseases. At the present context people are frequently exposed to various kinds of toxins in food as well as the environment which in turn leads to accumulation of toxins in our body.this state is considered under the concept of dooshivisha (cumulative toxicity) which could be manifested as various skin disorders (Srikanthamurthy K.R 2005; Sharma P.V., 2000). Acharyas mentions rakthadushti (vitiated blood) (Srikantamurthy K.R, 1997) and kushta (skin diseases) as manifestations of dooshivisha. Dooshivishajanyakushtaroga (skin diseases caused by cumulative toxicity) cannot be treated effectively with common kushta (dermatological) treatment only, whereas it can be more effectively managed with vishahara (anti-toxic) drugs. It is the need of the hour to develop economic, easily available and an efficacious medicine for psoriasis. Use of agada (anti-toxic drugs) in chronic kushtaroga (skin diseases) have been mentioned in classics (Sharma P.V, 2000),In this regard, karanjabeeja (seed of Pongamia pinnata) which is a potent vishashamana (anti-toxic) and kushtagna (curing skin disease) drug (Ayurvedic pharmacopoeia of India, 1999; Pandey G,2001;Srikantamurthy.K.R, 2004) has been taken for the study to analyze the efficacy of its taila (oil) applied externally along with Dooshivishariagada (Srikantamurthy K.R, 1997), a potent anti-toxic formulation for internal administration in the management of psoriasis. MATERIALS AND METHODS Data were collected from patients attending OPD of SDM College of Ayurveda and Hospital, Hassan, Karnataka, India fulfilling the clinical criteria. Patients were randomly

3 selected irrespective of their socio-economic, educational or religious status. Ethical clearance Number SDMCAH/IEC/50/13 14 was granted from the institution for the study. Preparation of drug Karanjabeejatailam: Karanjabeeja (seeds of Pongamiapinnata) was collected from Sidhvaidyasramam, kerala and 20 liters of oil was obtained from it. The oil was bottled into 200 ml air tight amber colored bottles. The drug was checked with the criteria mentioned in the classical Ayurvedic texts and modern botanical parameters with experts before using them in the study. Table 1: Ingredients of DooshivishariAgada: Sl No DRUG BOTANICAL NAME Part used Form 1 Pippali Piper longum Linn. Fruit Powder 2 Dhyamaka Cymbopogon martinii Leaves Powder (Roxb.)Wats. 3 Jatamamsi Nardostachys jatamamsi DC.(N. Root Powder grandiflora) 4 Lodra Symplocos racemosa Roxb. Stem bark Powder 5 Ela Elettaria cardamomum Maton Fruit Powder 6 Suvarchika Tribulus terrestris Linn. Fruit Powder 7 Kutannatum Oroxylum indicumlinn. (Benth. Root bark Powder ExKurz. 8 Natam Valeriana wallichii D.C Root Powder 9 Kusta Saussurea lappa C.B. Clarke. Root Powder 10 Yastimadhu Glycyrrhiza glabra Linn. Root Powder 11 Chandana Santalum album Linn. Heart wood Powder 12 Gairika Red ochre Powder Collection of drug: Raw drugs were collected from Sidhavaidyasramam, Thrissur district, Kerala, India Preparation: All the drugs were taken in equal quantity. They were made into powder separately. Then they were mixed together and sufficient quantity of water was added. Bhavana (ticturation) was done for 3 days until vatipaka (pill form) was obtained. Then they were made into vati (pills) and kept for drying. Dried pills were used for the clinical study.the drugs were send to S.D.M. centre for research in ayurveda and allied sciences, Udupi, for analysis - 266/ Diagnostic criteria Diagnosed cases of Psoriasis Inclusion criteria: 1. Psoriasis patients which were diagnosed as per the criteria. 2. Patients within the age limit of years. Exclusion criteria: 1. Subjects with uncontrolled metabolic disorders like diabetic dermopathy pretibial myxedema that may interfere with the course of treatment. 2. Pregnant women & lactating women Assessment criteria: PASI Scoring: The current gold standard score for assessment of Psoriasis (Carlin CS, 2004). Erythema Thickness Scaling Degree of involvement

4 Table 2: Scoring pattern Sl.No. Domain Criteria Score 1. Erythema none 0 light red 1 red,but not deep red 2 very red 3 extremely red 4 2. Scaling none 0 Scaling is visible by scratching skin 1 moderate powderiness with small lifting scales 2 heavy powderiness with cracking & lifting scales 3 heavy cracking & lifting scales, scaling falls without rubbing 4 3. Thickness none 0 barely palpable elevation 1 slight elevation 2 moderate elevation 3 marked ridge 4 4 Degree of Involvement none % % % % % % 6 Overall assessment Overall assessment of the results was made by considering the collective effect on all the parameters and total PASI score. Medicines used in the study are: 1. Karanjabeejatailam-For external application 2. DooshivishariAgada- For internal administration Sampling methods: Convenient sampling method was adopted. 30 psoriasis patients were selected from OPD according to the criteria. Study design: A clinical survey of patients attending OPD of SDMCA, Hassan, Karnataka, India was made and patients fulfilling the criteria as per the proforma were selected for the study. A clinical evaluation of patients wasdone by collection of data through information obtained by detailed history & physical examination. The study was an open label clinical study in a single group at OPD level in 30 patients. They were given Karanjabeejataila for external application and DooshivishariAgada tablet internally daily for 14 days. The patients were assessed before and after treatment. Follow up Study- The changes with the treatment were tobe observed & recorded on 7 th & 14 th day in the proforma of case sheet prepared for the study. Assessment of results: The parameters of base line data to the follow up and post medication status were compared for assessment of the results. All the result analysis was done by using SPSS ver.20 software, and obtained results were interpreted statistically for p value. RESULTS Erythema of head: treatment for variable erythema of head with

5 Wilcoxon s test, significant results were obtained with Z vaue of and P value Erythema of upper limb treatment for variable erythema of upper limb with Wilcoxon s test, significant results were obtained with Z vaue of and P value Erythema of trunk treatment for variable erythema of trunk with Wilcoxon s test, significant results were obtained with Z vaue of and P value Erythema of lower limb treatment for variable erythema of lower limb with Wilcoxon s test, significant results were obtained with Z vaue of and P value Thickness at head treatment for variable thickness at head with Wilcoxon stest, highly significant results were obtained with Z vaue of and P value Thickness at upper limb treatment for variable thickness at upper limb with Wilcoxon stest, highly significant results were obtained with Z vaue of and P value Thickness at trunk treatment for variable thickness at trunk with Wilcoxon stest, highly significant results were obtained with Z vaue of and P value Thickness at lower limb treatment for variable thickness at lower limb with Wilcoxon stest, highly significant results were obtained with Z vaue of and P value Scaling at head treatment for variable scaling at head with Wilcoxon s test, highly significant results were obtained with Z vaue of and P value Scaling at upper limb treatment for variable scaling at upper limb with Wilcoxon stest, highly significant results were obtained with Z vaue of and P value Scaling at trunk treatment for variable scaling at trunk with Wilcoxon stest, highly significant results were obtained with Z vaue of and P value Scaling at lower limb treatment for variable scaling at lower limb with Wilcoxon stest, highly significant results were obtained with Z vaue of and P value Degree of involvement at head treatment for variable degree of involvement at head with Wilcoxon s test, significant results

6 were obtained with Z vaue of and P value Degree of involvement at upper limb treatment for variable degree of involvement at upper limb with Wilcoxon stest, significant results were obtained with Z vaue of and P value Degree of involvement at trunk treatment for variable degree of involvement at trunk with Wilcoxon stest, significant results were obtained with Z vaue of and P value Degree of involvement at lower limb treatment for variable degree of involvement at lower limb with Wilcoxon stest, significant results were obtained with Z vaue of and P value Total pasi score When the total PASI score results were analysed using repeated anova test, highly significant results were obtained in all pair wise comparisons with P value of Table no. 3: Results-Wilcoxon s signed rank test: Parameter Negative ranks Positive ranks Ties Total Z P Remark N MR SR N MR SR Value value Erythema head S Erythema-upper limb S Erythema-trunk S Erythema-lower limb S Thickness-Head HS Thickness-Upper Limb HS Thickness-trunk HS Thickness-Lower Limb HS Scaling-head HS Scaling-Upper Limb HS Scaling-trunk HS Scaling-Lower Limb HS Degree-of involvementhead S Degree-of involvement S Upper Limb Degree-of involvementtrunk S Degree-of involvement- Lower Limb S N- Number of samples, MR- Mean ranks, SR- Sum of Ranks, S- Significant, HS- Highly significant

7 Table 4: Repeated ANOVA Test- PASI Score Parameter N Mean Df F value P value Size effect PASI 1 st day Green house geisser error df Remark PASI 7 th day HS PASI 14 th day DISCUSSION There is no single variety of kushta, which can be rightly correlated to psoriasis.psoriasis can be chiefly divided into four types on the basis of its appearance namely- plaque, guttate, erythrodermic and pustular. Plaque psoriasis is characterized by well defined, noninflammatory lesions covered with uniform scales, while guttate is characterized by multiple, small, oval, drop like lesions with scaling (Roxanna Gunter, 2011). Here, an effort has been taken to correlate plaque and guttate types with features of ekakushtha (a type of skin disease). In ekakushtha, the characteristics are aswedanam (absence of sweat), mahavastum (larger extent) and matsyashakalopamam (fishy scales) (R.K Sharma et al., 1988). The lesions of plaque type is also found all over the body and though small and drop like, guttate psoriasis is also found all over the body which can be correlated with ekakushtha. Other striking similarity found was, scaling with characteristic shiny appearance found both in ekakushtha and plaque guttate types of psoriasis. The lesions of plaque and guttate type are dry and rough which can be correlated to ekakushtha. Also, other symptoms pertaining to vata (humour) and kaphadosha (humour) are present in both types. E.g- rukshata (dry skin vata) and bahalatva (macules and papules- kaphadosha), kandu (Itching-kaphadosha) etc. Also Bhavamishra has mentioned chakrakara (round) appearance of ekakushtha which is similar to drop-like lesion of the guttate psoriasis. Thus we can find striking similarity between plaque guttate psoriasis and ekakushtha in Ayurveda. N- number of samples, Df- Degrees of Freedom In kitibha (another variety of skin disease) the lesions are usually sukshma (small in size) and sravi (exudation) (R.K Sharma et al., 1988). But in psoriasis, the lesions are large and dry in nature. In sidhma (another variety of skin disease), the lesions are mostly found in urdhvakaya (upper portion of body) but in psoriasis the lesions are distributed all over the body. In sidhma, there will be scaling which is like raja (dust particles) &kandu (itching) is also present but in psoriasis there is scale formation andkanduis usually absent. Thus kitibha & sidhma cannot be exactly correlated with psoriasis. Description and characteristic features of ekakushtha very closely resemble the descriptions of psoriasis has been tabulated (Table 4): Probable mode of action of drug: As rightly said by all acharyas, some drugs may act through rasa (taste), some through guna (attributes), veerya (potency), vipaka (post-digestive effect) or prabhava (dominant function) or it may be the combined effect of all the ingredients (P.V.Sharma, 1998). Hence, to understand the mode of action of medicines, it is necessary to understand the pharmacodynamics by understanding dominant properties. Karanjabeeja is having katuvipaka (pungent- post digestive effect), katutikta rasa (pungent- bitter taste), laghurukshaguna (easily digestable and dry), ushnaveerya (hot potency), vatakaphashamaka (pacify vata and kapha humours) property and kushthaghna karma (skin disease curing property). Though kushtha (skin disease) is tridosha (involvement of three humours) dominant disease, the predominance of vata and kapha is found in psoriasis.

8 Table 5: Comparison of Ekakushta and Psoriasis Ekakushtha Aswedanam Mahavastum Matsyashakalopam Krishna Aruna Varna (black- red colour) Psoriasis The lesions of this disease are dry and rough Lesions are found all over body. The Un-involved skin is also abnormal. Well defined raised macules, papules & plaques of erythema found which are covered with silvery scales. The lesions are raised & erythematous, thick Non-indurated lesion becomes black in colour. Katu rasa (pungent taste)-one property of katu rasa described by acharyacharakais Marganvivrunoti which means it dilates the srotas (channels) and thus acts on cellular level and stops the uncontrolled production of cells which causes hyperkertanization. Other properties of katu rasa described by acharyacharaka are vishaghna (anti-toxic), kandughna (anti-itching) and vranaprasadana (improves skin complexion). Tikta rasa (bitter taste) has the property of raktaprasadana (blood purification), vishaghna, kushthaghna, kandughna (antiitching). It also has kaphaghna (pacifies kapha humour) property. Laghuguna (easy to digest) possess kaphashamaka (pacifies kapha humour) property. By its srotoshodhaka (clearing the channels) property, it acts on minute channels and removes the amavisha (indigested food). Acharyasushruta has described lekhana (scraping) and ropana (wound healing) properties of laghuguna. Lekhana property might help in management of hyperkertanization which leads to scaling. Acharya Hemadri has given shoshana (shrinking) property of ruksha (dry) guna. It also has kaphashamaka property. Acharya Hemadri has described shodhana (cleansing) property of tikshna (intense) guna. Acharya Madhava has described kaphavatahara (pacifies kapha and vata) and lekhana (scraping) property of tikshna (intense) guna. Ushnaveerya (hot potency)-according to Ashtangasangraha, ushnaveerya has vatakaphashamaka (pacifies vata and kapha) property and according to AshtangaHrudaya, it has ashupaka (sudden ation) property through which it acts quickly at minute channels. Looking to the karmas, it is clear that the drug is having kushthaghna, kandughna and vrunaghna (wound healing) properties which clearly explains its mode of action in kushta. DooshivishariAgada: It is indicated in all types of visha, i.e. Dooshivishari Agada is effective in sthavara, jangama (inanimate and animate) and also garavisha (poison). The properties of Dooshivishariagada are raktashodhaka (blood purifying) and vishaghna (antitoxic). Raktashodhaka property corrects the vitiated raktadhatu (blood) and helps in maintaining normal functions of raktadhatu. Vishaghna (anti toxic) property helps in detoxifying the garavisha, which is having alpavirya (mild potency) and is deep seated in raktadhatu. The drug profile shows that the general properties are predominant of madhurakashaya rasa, (sweet-astringent taste) laghurookshaguna (easy to digest and dry), sheethaveerya (cold potency) and katuvipaka(pungent post digestive effect). Being a combination of drugs bearing similar qualities, a synergistic drug action can be assumed. Due to the above-mentioned properties, Dooshivishariagada is tridoshahara (pacifies three humours), twakdoshahara (cures

9 skin diseases) and rakthasodhaka. Almost all the drugs of this yoga are seethaveerya (cold potency) in nature, capable of antagonizing the adverse effect of visha. Drugs of this yoga (recipe) are fairly met within many agada (antitoxic) preparations, some of these drugs are individually vishagna (anti-toxic) and again certain combination of drugs would bring about miraculous effects apart from their total effects (Yoga Samyogajam Phalam). The drugs are prominent in the rasas (tastes) which are said to beantitoxic ie madhura (sweet), tikta(bitter), katu (pungent) and kashaya (astringent). Almost all the drugs are laghu (easy to digest) and rooksha (dry). Thus the combination itself is highly potent and can cure Dooshivisha with signs and symptoms of kushta (skin disease) which is a kaphavata prominent disorder. Table no. 6: Properties of individual drugs of DooshivishariAgada Drug Rasa Guna Veerya Vipaka Karma Pippali Madhura, Katu, Tikta Laghu, Snigdha Dhyamaka Katu, Tikta Laghu, Rooksha, Teekshna Jatamansi Tikta, Kashaya Anushna Madhura Tridoshakara Ushna Katu Pittahara Laghu Sheeta Katu Tridoshahara Lodhra Kashaya Laghu Sheeta Katu Kaphapittanut Ela Madhura Laghu, Rooksha Gokshura Syonaka Tagara Kushta Madhura, Katu Tiktha, Kashaya Tikta, Katu, Kashaya Tikta, Katu, Madhura YashtiMadhu Madhura Chandana Gairika Madhura, Tikta Madhura, Kashaya Guru, Snigdha Laghu, Rooksha Laghu, Snigdha Laghu, Rooksha, Teekshna Guru, Snigdha Laghu, Rooksha Snigdha, Vishada Sheeta Madhura Kaphavatahara Sheeta Madhura Vatanut Sheeta Katu Kapha-pitta Shamaka Ushna Katu Kapha-vata Hara Ushna Katu Vata-kapha Hara Sheeta Madhura Vata-pittajit Sheeta Katu Kaphapittahara Sheeta Madhura Pittanasaka, Kaphajit CONCLUSION The present day polluted environment, unhealthy and unwholesome foods& stressful regimencan trigger accumulation of toxins in the body. Certain drugs, virudhahara (incompatible food), mental stress are aggravating factors in psoriasis. Virudhavihara (incompatible life style) will also contribute in the causation and exacerbation of kushta. Addiction to tobacco, non-vegetarian diet, virudhahara and even injudicious vegetarian diet has relationship with psoriasis

10 manifestations. The symptoms of psoriasis can be compared with features of ekakushta. Karanjabeejataila has got potent kushtagna properties. Karanjabeejataila for external application along with dooshivishariagada is effective in reducing the main symptoms of psoriasis. The combination is highly effective in reducing scaling upto 84% and thickness of lesions upto 57 %. It is also effective in reducing erythema upto 20 % & degree of involvement of lesions upto 30 %. Hence, agadayogas (anti-toxic formulations) can be effectively tried in kushta and other related complications of dooshivisha. REFERENCES August McLaughlin, (2013), Foods That Make Psoriasis Worse. [Online] Available from: foods-that-aggravate-psoriasis/ (accessedon 18/5/2015) Carlin CS, Feldman SR, Krueger JG, Menter A, Krueger GG. (2004) A 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis. J Am AcadDermatol. Jun; 50 (6): Dogra S, Yadav S. (2010) Psoriasis in India: Prevalence and pattern. Indian J DermatolVenereolLeprol;76: Government of India, (1999) Ministry Of Health And Family Welfare. Ayurvedic pharmacopoeia of India. part 1,vol.2 Department Of Indian Systems of Medicine publications. Pandey.G. (2001) DravyaGunaVijnan part2-1 st edition.varanasi: Krishnadas Academy publications. Roxanna Gunter (2011), The effect of a homeopathic complex in psoriasis andle/10210/7888/gunter.pdf?sequenc e=1 Sharma P.V. (1998) Charakasamhitha vol.1, 5 th edition.varanasi:chaukhambhaorien talia publications. Sharma P.V. (2000) Charakasamhitha vol.2, 5 th edition.varanasi:chaukhambhaorien talia publications. Sharma R.K (1988) Carakasamhita vol.3, first edition. Varanasi: Chowkhamba Sanskrit series office. Srikantamurthy K.R (1997), Ashtanga Hridaya of vagbhata vol.3.2 nd edition. Varanasi: Krishnadas Academy publications. Srikantamurthy K.R (2000), Ashtangasangrahavol.1.3 rd edition.vara nasi: Chaukhambhaorientalia publications. Srikantamurthy. K.R. (2004), Susruthasamhitha.vol.1.2 nd edition.vara nasi:chaukhambhaorientalia publications. Srikanthamurthy K.R (2005), Susruthasamhitha, vol.2,2 nd edition.varanasi:chaukhambh aorientalia publications. Tsankov N, Angelova I, Kazandjieva J. (2000), Drug-induced psoriasis. Recognition and management. [online] Available from: med/ (accessed on 13/3/2015) Source of Support: NIL Conflict of Interest: None Declared

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