EFFICACY OF SEQUENTIAL SADYOVAMANA AND VIRECHANA KARMA IN THE MANAGEMENT OF VIPADIKA WITH REFERENCE TO PALMOPLANTAR PSORIASIS: A CASE REPORT

Introduction: The skin acts as the body's primary protective anatomical barrier. In Ayurveda, chronic dermatological conditions are broadly classified under Kushta, a Kleda Pradhana Vyadhi involving the Sapta Dravyas (Vata, Pitta, Kapha, Twak, Rakta, Mamsa, and Lasika). Vipadika, categorized under Kshudra Kushta, closely corresponds to the clinical presentation of palmoplantar psoriasis, characterized by severe dryness, Pani-Pada Sphutana (fissuring of palms and soles), scaling, and intense pruritus (Kandu). Aim of Study: To evaluate the clinical effectiveness of repeated Shodhana comprising Sadyovamana and Virechana Karma along with targeted Shamana Aushadhi in the management of Vipadika (palmoplantar psoriasis). Methodology: A 44-year-old female patient presenting with severe dry fissuring, white powdery scaling, and chronic itching on bilateral palms and soles persisting for 6 years was admitted and managed across three sequential inpatient admissions over a 12-month period. The therapeutic protocol comprised Sadyovamana, ascending Snehapana (Tiktaka, Mahatiktaka, and Guggulu Tiktaka Ghrita), classical Virechana Karma, Avagaha and internal Shamana medications. Clinical progression and symptomatic remission were documented across each phase. Result: The multi-course Shodhana approach resulted in complete healing of deep palmoplantar fissures, clearance of hyperkeratotic powdery scaling, and relief from pruritus, restoring functional skin texture without adverse events. Discussion: Sequential Sadyovamana effectively eliminated accumulated Kapha and Ama, facilitating enhanced absorption of internal Snehana. Subsequent Virechana purged deep-seated Pitta and Rakta morbidities, while targeted medicated Ghritas and Avagaha promoted cellular repair and local barrier restoration.