Therapeutic Approach of Ayurveda in Pama Kusta: A Case Study

Human Scabies is a highly contagious parasitic skin infestation caused by Sarcoptes scabiei var. hominis. Globally, it affects over 200 million people at any given time, with cumulative annual cases exceeding 400 million. The condition is particularly prevalent in hot, tropical regions and densely populated resource-poor areas, where prevalence in children may range from 5% to 50%. Although sporadic in high-income countries, outbreaks in healthcare facilities and vulnerable communities impose a significant economic burden. Scabies mites burrow into the skin to lay eggs, leading to intense itching often worsens at night along with characteristic linear burrows and papules. In adults, lesions typically occur on the finger webs, wrists, limbs, and belt area, with inflamed bumps occasionally seen on the male genitalia and female breasts. Infants and young children may present with a more widespread rash involving the palms, soles, ankles, and scalp. Symptoms usually appear 4–6 weeks after infestation, and recurrent infections are common. Diagnosis is primarily clinical, based on recognition of itching, burrows, and papular eruptions. Treatment generally involves topical scabicides, with oral agents.¹ Resistance has increasingly been reported against frontline agents such as permethrin and ivermectin, while concerns regarding neurotoxicity with lindane and the potential adverse effects of repeated ivermectin use further restrict their safety profile.² Moreover, recurrence is frequently observed when close contacts and contaminated fomites, such as clothing and bedding, are not treated concurrently, thereby compromising long-term disease control.³ The clinical conditions can be correlated to Pama as described in Ayurveda Classics. Pama is one of the eleven types of Kshudra Kushta, which is caused by Kapha pitta dosha pathogenesis⁴. It is characterized by extreme itchy eruptions of white, reddish or black color seen over buttocks, hands and elbow joint. The main aim of treatment is to address the Kapha Pitta Dushti with sukshma Krimi. Personal hygiene and dietary regimen are a very necessary part of the treatment.

Case Description

Presenting complaints:

A 17 years old male patient reported to visha chikitsa Out-Patient Department (OPD) of Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan with complains of whitish papules over interdigital spaces of bilateral hands, fingers, wrist and scrotum. He also complains of blackish lesions over dorsal aspect of bilateral hands associated with severe itching all over the body in the past 3 months.

History of present illness:

Patient was apparently normal 3 months back. He initially noticed whitish papular eruptions over the fingers of left hand associated with itching. Subsequently, he mentioned similar complaints in his hostel mates with whom he had close contact. After about one week, the lesions gradually spread to the bilateral interdigital spaces, fingers, and wrists, later extending to the scrotal region. Initially, the lesions were associated with pus discharge secondary to scratching, which later turned blackish in colour. The itching was persistent, with marked aggravation during the night, disturbing sleep, and was partially relieved on washing the affected parts with warm water. He had taken allopathic medication for a month but did not find relief from the complains. So, he approached SDMCAHH for further management.

History of past illness:

Nothing significant

Family history:

Patients younger brother has itchy blackish lesions over body.

Personal History: -

Diet – Mixed (intake of curd, chicken, junk food frequently)

Appetite – Good

Bowel – Regular

Micturation – Regular

Sleep – sound

General Examination: -

There was no evidence of pallor, edema, icterus, cyanosis, clubbing or lymphadenopathy on observation.

Asta-Vidha Pareeksha:

Nadi: 74 bpm

Mala: Prakruta

Mutra: Prakruta

Jihwa: Lipta

Shabda: Spashta

Sparsha: Anushna-Sheeta

Drik: Prakruta

Akriti: Madhyama

Dashavidha pareeksha

Prakruti: Kapha vata

Vikruti: Pitta Kapha                                                   

Saara: Asthi

Samhanana: Madhyama 

Pramana- Madyama

Satva: Madhyama

Satmya: Madhura Katu rasa pradhana

Aharashakti: Madhyama

Vyayama shakti: Madhyama

Vaya: Youvana

Vital Signs

Temperature: - Afebrile

Heart Rate – 74 bpm

Respiratory Rate – 18 cpm

BP- 120/80mmhg

Anthropometry

Weight– 59kg

Height- 180cm

Systemic Examination:

The patient was fully conscious and well oriented. The heart sounds were normal, with S1 and S2 heard clearly and no extra sounds or murmurs. The lungs were clear on both sides with normal breath sounds. The abdomen was soft, without pain or swelling of any organs.

Local Examination:

Integumentary System

On Inspection:

Distribution- Localized and symmetrical

Site- B/L Interdigital spaces, B/L fingers, B/L wrist, B/L thigh region, scrotum

Number of lesions- Multiple

Type of lesions- Papule

Size of lesion- <1CM

Texture- dry

Colour- Whitish in interdigital spaces and scrotum, blackish over fingers

Discharge- present initially on excessive itching

Diagnostic Criteria⁵

Swetha aruna shyava pidaka (whitish/red/blackish popular eruptions)

Kandu(itching)

Srava (discharge)

TREATMENT PLAN

Initially amapachana and rookshana was done by giving bilwadi gulika and amahara kashaya twice a day. After proper amapachana and rookshana, snehapana (internal oleation) was administered with panchatiktaka guggulu ghrita (30ml, 60ml and 90ml) for 3 days respectively. Samyaksnigda lakshana (signs of adequate oleation) was attained with 90ml.Further patient was subjected to sarvanga abyanga (oil massage) with marichadi taila and followed by bashpa sweda(sudation) for 2 days. Last day virechana (purgation therapy) was done with avipathikara choorna 40gms with 100ml triphala kashaya. Total number of vegas (purgavtive bouts) observed were 7, hence avara shudhi (mild purification) was attained. Light diet (thin gruel and kichhdi) was given throughout the course of treatment and samsarjana karma (gradual dietary regimen) was adviced for 3 days.

Assessment criteria: Grading criteria

OBSERVATION

Assessment of patient was done by the grading criteria