Vd. Krishna H. Thanki. Deputed Assistant Professor. Dept. of Panchakarma. Govt. Ayurved College, Junagadh

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1 A DIETETIC APPROACH IN THE MANAGEMENT OF EKAKUSTHA(PSORIASIS) Vd. Krishna H. Thanki M.D., Ph.D.(Panchakarma) Deputed Assistant Professor Dept. of Panchakarma Govt. Ayurved College, Junagadh

2 INTRODUCTION Ayurved clearly state that there is a strong relationship between diet and dermatological disorder At various level of their etio-pathogenesis and treatment out come. Diet has long been associated with skin health, beauty, integrity And Aging through multiple pathways and co-factors implicated in skin biology. The onset and clinical course of various common skin diseases especially psoriasis have been suggested to be critically affected by nutrition patterns and habits.

3 IMPORTANCE OF AHARA Ahara Nidra Brahmacharya

4 AIMS & OBJECTS To study the etiological factors especially Aharaj Hetu in the manifestation of Eka kustha (Psoriasis) MATERIAL & METHOD A diagnosed cases of Eka kustha (Psoriasis) who were attended the OPD & IPD of Dept. of Panchakarma of Govt. Ayurved college, Junagadh, were selected for present study. Random sampling method was adopted for the selection of patients. Total 89 patients were screened for the present study.

5 DEMOGRAPHIC DATA Category Percentage AGE yrs yrs yrs yrs yrs SEX Male Female RELIGION Hindu Muslim others 8.98 OCCUPATION Housewife Service Business Labor Student 6.74 Retired 6.74

6 CONTI. CHIEF COMPLAINT n PERCENTAGE MAHAVASTU SWEDA MATSYASHAKLOPAMA KRISHNA ARUNA VARNA SRAVA VEDANA KANDU RUKSHATA DAHA MANDAL

7 CONTI. DIET VEGETARIAN MIXED DIETARY HABIT n PERCENTAGE SAMSHANA ADHYASHANA VISHAMASHANA

8 CONTI. DOMINANT RASA IN THE DIET n PERCENTAGE MADHURA AMLA LAVANA KATU TIKTA KASHAYA

9 CONTI. DOMINANT GUNA IN DIET n PERCENTAGE GURU LAGHU SHITA USHNA SNIGDHA RUKSHA

10 CONTI. AHARAJ NIDANA n PERCENTAGE VIRUDDHAHARA ADHYASHANA ATYASHANA ASATMYA AHARA

11 CONTI. VIRUDDHAHARA n PERCENTAGE SANYOGA & VIRYA KRAMA MATRA SANSKARA AVASTHA

12 CONTI. MITHYA AHARA n PERCENTAGE UDAD MULAK ATI DAHI SOUR FOOD PICKLE FAST FOOD COLD DRINKS USHNA & TIKSHNA VIDAHI ATI SNIGDHA

13 DISCUSSION Dietary Habit: Maximum patients were doing Adhyashana and Vishamashana which ultimately leads to Agnimandy and Ama formation Root cause of Kusthauttpati

14 Dominant Rasa in Diet: CONTI. Dominant Rasa in the diet of patients in this series was Amla, Lavan, Katu Provoke Pitta Vitiate Rakta

15 Dominant Guna in Diet: CONTI. Ushna Guna to lead Raktadusti Vitiation of Pitta, and in turn Guru & Snigdha Agnimandya, delayed Aharapaka Prakriya, Ama formation and Rasadusti

16 Aharaj Nidana: CONTI. In present study maximum number of patient were taking Viruddhahara followed by Adhyashana and Atyashana. Adhyashana: According to Astang Samgrah(Su) 4 Yaam is the time of food digestion. According to classical definition, eating before 12 hours of previous meal is Adhyashana. As defined by Hemadri, eating before 4 hours of previous meal is Adhyashana.

17 CONTI. Atyashana: taking excessive amount of diet is called Atyashana Acharya charak said that Atimatra Ashan is, Amapradoshahetu, Ahita bhojana when taking in excess (Atimatra) and at improper time leads to dusti of Annavaha Srotas and also disturb the Pakaprakriya.

18 CONTI. Viruddhahara: Agnimanya leading to Amavisha.(Ch. Su. 26/84) Utklesha of Tridosha but do not expel them out of the body.(ch.su.26/85) Deha Dhatubhi Virodhmapadhyante Chakrapani It causes Dusti of Dosha and Dhatu Gangadhara It causes Nash(destruction) of Dhatu Srotorodha in different Srotas of the body. (Ch. Su. 26/82)

19 FOOD INCOMPATIBILITIES IN TODAY'S PERSPECTIVE Green tea or black tea and milk Tea contains flavonoids called catechins, which have many beneficial effects on the heart. When milk is added to tea, then a group of proteins in milk, called caseins, interact with the tea to reduce the concentration of catechins. So avoid tea and milk together.[brown PJ, Wright WB. An Investigation of the interactions between milk proteins and tea polyphenols. J Chromatogr. 1963;11: [PubMed]] Milk and yoghurt interaction As you know consuming both together can precipitate milk inside the stomach that may irritate and induce vomiting. So avoid milk and yoghurt together. Tea and garlic Tea contains anticoagulant compounds called coumarins. When combined with garlic (that also has anticlotting properties), they may increase the risk of bleeding. So, better to avoid tea and garlic together.[engdal S, Nilsen OG. In vitro inhibition of CYP3A4 by herbal remedies frequently used by cancer patients. Phytother Res. 2009;23: [PubMed]]

20 CONTI. Pomegranate juice and grapefruit juice Pomegranate juice and grapefruit juice, are both known to block the cytochrome P450 3A4 enzyme systems in the intestines and increase blood levels of many medications you are taking. Taking these two juices together may synergize the above action.[7hidaka M, Okumura M, Fujita K, Ogikubo T, Yamasaki K, Iwakiri T, et al. Effects of pomegranate juice on human cytochrome p450 3A (CYP3A) and carbamazepine pharmacokinetics in rats. Drug Metab Dispos.2005;33: [PubMed]] Sanskara Viruddha Deep frying of potatoes can develop toxic substances, such as acrylamide, which can prove to be carcinogenic.[9tareke E, Rydberg P, Karlsson P, Eriksson S, Törnqvist M. Acrylamide: A cooking carcinogen? Chem Res Toxicol. 2000;13: [PubMed]] Eating potato chips regularly is Sanskara viruddha. It is also mentioned in Ayurved text that heating honey issanskar Viruddha. Honey that is available in the market is Agmark honey and this honey is strongly heated before packaging. It is very important to find the relevance about why we must not heat honey.

21 CONTI. Mithya Ahara Mithya Ahara means improper diet. According to Vijayrakshita, the diet opposite to Ashta Ahara Vidhi Visheshayatanani is designated as Mithya Ahara. Charaka has described eight factors determining the utility of food they are called as Aharvidhi Visheshayatanani. They are Prakruti, Karana, Samyoga, Rashi, Desha, Kala, Upyoga Samstha and Upayokta. These eight factors give rise to beneficial or harmful effects. Habitual intake of things in proper way may more useful but in improper way they are always harmful. So they should be avoided. Mitya Ahar deranged the digestive power of Jatharagni and cause Dushti of Grahani. Thus the food doesn t get digested properly leading to production of Ama. As grahani is also dushita, Ama undergoes purification, Amavisha is produced.(ch. Chi. 15/42-44). So along with Kustha other diseases which can be formed due to Ama, Amavisha and Grahanidusti etc. may coexist psoriasis, psoriatic arthritis, crohn disease, ulcerative collitis, dematological enteropathy have been reported.

22 AHARA WHICH IS ADVISED IN EKA KUSTHA Grains- Shali rice (Oriza sative Linn)/ Shastika rice/ Koradoosh (Paspalum serobiculatum Linn.)/ Shyamak (Echinochlova frumentacea Linn)/ uddalak (wild variety of Paspalum serobiculatum Linn).The above five varieties of grain should be old and matured, it may use individually or mixed form as per the patient inclination. Grain should be boiled Mixed as per the patient inclination with the soup or decoction of; mudga (Phaseolus radiatus Linn.) or Arahar (Canjanus cajan Linn.), Nimba (Azadirachta indica A. guss) Boiled Grain +Soup may mixed with sufficient quantity of medicated ghee prepared from Mandukaparni (Centella asiatica Linn or Hydrocotyle asiatica Linn.), Avagulga (Psoralea cordifolia Linn), Atarushak (Adhatoda vasika Neos) and flower of Arka (Calatropic procera). Or as per the patient inclination oil (mustered oil- Brassica compeastris Var.) of the above four medicines may use. Not only that, medicated Ghee with the grain like Chakramarda (Cassia tora Linn), vegetables like Patola (Trichosanthes dioica Roxb), Vartaku (Solanum melogena Linn.) or other which having the dominancy of Tikta Rasa (bitter taste) may use for this purpose. Similarly the fried Patola, Vartaku may place in the dish. Those are non-vegetarian they may be given -Flesh of Jangala (non aquatic) animals devoid of fatty matter from it. Khadir (Acassia catechu willed) decoction may be given for drink

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24 THANK YOU ALL