PSYCHOCUTANEOUS DISORDERS IN AYURVEDA-AN APPRAISAL

Abstract

Psychodermatology is a new discipline which deals with the interaction between skin and mind.Skin diseases are considered to be major cause of chronic suffering as they affect both body as well as mind.Psychodermatological disorders significantly affect the emotional sphere and psychosocial functioning of patients.Physiological and pathological association of these two entities is well established in ayurveda.Treatment of psychocutaneous disorders in ayurveda is acombined approach including both pharmacological and nonpharmacological interventions. A better understanding of psychocutaneous disorders help in an effective management and improving the quality of life of patients. The article is a narrative review with references collected from authoritative texts, hand searches and computerized databases.

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REVIEW ARTICLE
PSYCHOCUTANEOUS DISORDERS IN AYURVEDA- AN APPRAISAL
KAVYASHREE K1 SAVITHA H P2 SHRILATA3 SUHAS KUMAR SHETTY4
ABSTRACT
Psychodermatology is a new discipline which deals with the interaction between skin and mind.Skin diseases
are considered to be major cause of chronic suffering as they affect both body as well as
mind.Psychodermatological disorders significantly affect the emotional sphere and psychosocial functioning of
patients.Physiological and pathological association of these two entities is well established in
ayurveda.Treatment of psychocutaneous disorders in ayurveda is acombined approach including both
pharmacological and nonpharmacological interventions. A better understanding of psychocutaneous disorders
help in an effective management and improving the quality of life of patients. The article is a narrative review
with references collected from authoritative texts, hand searches and computerized databases.
Keywords: Psychodermatology, Psychosomatism, Kustha.
1PG Scholar, 2Associate Professor, 3PG Scholar, 4Professor and HOD, Department of Mano Vigyan Avum Manasa Roga, Shri
Dharmashala Manjunatheshwara College of Ayurveda and Hopsital, Hassan, Karnataka, India
Corresponding Email id: kavya.klm@gmail.com Access this article online: www.jahm.in
Published by Atreya Ayurveda Publications under the license CC-by-NC.

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INTRODUCTION
Ayu (life) is an amalgamation of
shareera(body), indriya (senses), sattwa
(psyche) and Aatma (soul) which signifies the
concept of psychosomatism in ayurveda[1]. All
ancient text books of Ayurveda have explained
the interrelationship between mind and body
through various analogies. The disease is not
only biological but also a social phenomenon.
There will be both somatic and psychic
sufferings. The word disease is composed of
Dis-Ease which means feeling of uneasiness.
The sense of pain is experienced by mind,
body as well as senses [2].
Psychodermatology is a new branch
which addresses the interaction between skin
and mind. The complex interplay between
neuro-immuno-cutaneous system (NICS)
connects the two disciplines of psychiatry and
dermatology, where psychiatry is more
focused on the ͚internal͛ invisible disease and
dermatology deals with the ͚external͛ visible
disease. The interaction between nervous
system, skin and immunity has been explained
by release of mediators from NICS[3]. This
system gets disturbed in several inflammatory
skin diseases.Skin diseases are considered to
be major cause of chronic suffering as they
affect both body as well as mind. In more than
one third of dermatological patients, an
effective management of the skin condition
involves consideration of associated
psychological factors [4].
In Ayurveda ͚Kushta͛ is considered as a
group of skin diseases. It is one of the oldest
diseases of mankind with mythological
importance. Skin and mind share an
inseparable relationship with each other
[5].Skin diseases develop deformity and make
the entire body obnoxious [6].This leads to
deterioration in quality of life and causes
cosmetic nuisance, anxiety, depression and
other psychological problems. Patients having
skin disorders always experience physical,
emotional and socio-economic
embarrassment in the society, further leading
to aggravation of already existing disease.
Physiological relation between skin and mind:
Skin and mind grossly differ with each
other but share some similar characteristics.
Vata (humour which governs all movements of
mind and body) being the controller and
stimulator of mind has an inseparable relation
with the skin, which is responsible for tactile
sensation [7,8]. Hridaya (heart) and the entire
body are considered to be abode of
manas(mind)[9,10]. Among the five varieties of
vata, vyana vata (humour which has
multidirectional movement and responsible
for all types of bodily functions) has a greater
influence on mind due to its existence in both
twak(skin) and hridaya[11,12]. The functions of
pitta dosha (humour responsible for digestion

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and metabolism) and kapha dosha (humour
responsible for stability and unctuousness)
depend on vata dosha [13]. Hence they are also
involved in the functions of skin. Gross part of
digested food nourishes the body while subtle
part nourishes mind [14]. Hence the source of
sustenance is same for both skin and mind.
Skin is the major sense organ among
five, which covers the entire body. Likewise
manovaha srotas (channels of mind) resides all
over the body [15]. The tactile cognition is
perceived through an association of skin and
mind leading to all pleasurable and painful
sensations [16]. Skin is closely connected with
the nervous system and it is acutely sensitive
to emotional events as well. It turns pale and
clammy during fear, it blushes when
embarrassed and it glows due to happiness.
Anger, depression and elation cause subtle
and measurable changes to the skin [17].
Pathological relation between skin and mind:
The etiological factors of kushta are divided as
dietary, lifestyle and psychological factors. The
skin diseases are also mentioned to be a
resultant of previous sinful acts like
disrespecting or abusing teachers, dieties etc.
These antiritualistic behaviours impose a
greater psychogenic stress. Fear, excessive
mental and physical exhaustion are also
important contributing factors of kushta[18].
Rasavaha (channels carrying rasa dhatu),
ambuvaha(channels carrying lymph)and
swedavaha srotas(channels carrying sweat)
are the three major channels involved in
kushta. Certain psychological factors are
responsible for vitiation of these channels.
Table no.1: Psychological causes ofSrotodushti (vitiation of channels)
Psychological causes
Vitiated channels
Excessive thinking
rasavaha srotodushti (vitiation of
channels carrying rasa dhatu) [19]
Fear
ambuvaha srotodushti (vitiation of
channels carrying lymph) [20]
Anger, sadness and fear
swedavaha srotodushti (vitiation of
channels carrying sweat) [21]
Skin and mind derive their nutrients from
rasa dhatu (the fluids of body- first result of
metabolism). So consumption of food and
drinks which are mutually contradictory,
unclean and unwholesome have a greater
impact on either entities [22,23].Bhagavadgeeta
explains about the close relationship between
food and psyche. Intake of sour, hot, spicy and

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fried food leads to vitiated rajo guna(attribute
of psyche) which in turn disturbs the mind [24].
This kind of food is also responsible for rakta
dushti (vitiation of blood) which is a key factor
in developing kushta[25]. Consumption of half
cooked, stale, foul smelling and left over food
vitiates tamas(attribute of psyche)[26].
Intake of excessive sour, hot, spicy and
fried food leads to vitiation of rajo guna
(attribute of psyche)which inturn disturbs the
mind [24]. This kind of food is also responsible
for rakta dushti (vitiation of blood) which is a
key factor in developing kustha [25].
Consumption of half cooked, stale, foul
smelling and left over food vitiates
tamas(attribute of psyche)[26]. These are the
main dietary causes of kustha. Psychological
factors either newly manifest skin disorders or
aggravate previously existing skin conditions.
Both come under the umbrella term ͚stress
related skin disorders͛. These are of three
types,
 Psychophysiological disorders due to
stress or other emotional states.
 Psychiatric disorders with
dermatological symptoms
 Dermatologic disorders with
psychiatric symptoms [27].
Stress represents an internal or external
force that threatens to disrupt the
homeostasis of an organism. It activates 2
major neuronal pathways; the hypothalamic-
pituitary-adrenal axis and the sympathetic
nervous system. When an external stress is
being identified, these two systems get
activated. Chronicity of this stress disturbs the
ability of an organism to balance acute
homeostatic challenges resulting in
exhaustion, distress and disease or flare-up of
pre-existing dermatoses [28]. Commonly
occurring Psychodermatological disorders are
psoriasis, dermatitis artifacta, urticaria,
neurotic excoriations, atopic dermatitis and
acneetc[29].
Pathological relation between skin, Agni and
mind:
Psychological stress is associated with
impairment of jatharagni (digestive fire)
further producing dhatvagnimandya(impaired
tissue metabolism). This hampers the process
of digestion and metabolism starting from
rasa dhatu producing ama(undigested food
material)[30].The nourishment of skin is derived
through rasadi dhatu(consecutive body tissues
starting from rasa). Hence vitiation of these
contributes to the manifestation of various
skin diseases.

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Pathogenesis of Psychodermatological disorders
Ayurvedic management
A combined approach including
pharmacotherapy and psychotherapies are
administered in the management of
psychocutaneous disorders. Modern science
considers skin and mind as two separate
entities. Hence symptomatic treatments are
practiced considering psychological and skin
manifestations. Some of the modern
medicines used in treating chronic skin
diseases can manifest psychological symptoms
and somepsychotropic medicines also show
their adverse drug reaction on skin.
Ayurveda being a holistic science
establishes the relation between skin and
mind. Various treatment approaches in
ayurveda focus on eliminating disease from its
root and providing a sense of well-being.
Management of psychocutaneous disorders in
ayurveda aims at a multidimensional approach
through daivavyapashraya (Psychospiritual
therapy), yuktivyapashraya
(pharmacotherapy) and Sattwavajaya (Psychic
intervention).
Daivavapashraya Chikitsa:

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This is the psychospiritual mode of
treatment. Following spiritual practices like
vrita, seva (service), tyaga (renunciation),
daana (offering) worship of deities, friendly
behaviour with everyone etc are advised in
treatment of kustha caused due to papa
karma (sinful activities)[31]. When practiced for
longer duration these spiritual activities tend
to decrease the stress level, improve
confidence in cure and enhances mental
wellbeing [32]. This idea has been upheld by
recent researches also. There is a custom of
offering prayers for the cure of chronic
debilitating skin disorders exists in certain
temples of southern India. This is specially
practiced when other treatments fail and the
disease is believed to be due to sinful
activities. The faith of patient on god, clinically
translates into a psychological coping
mechanism due to which patients may rely on
to proceed with their lives.
Antarparimarjana (Internal treatments):
The main line of treatment in
psychodermatological diseases is shodhana
chikitsa (Purificatory procedures) which
removes the disease from its root, provides
excellent complexion and clarity of mind,
senses and intellect [33]. Oral administration of
ghee (clarified butter) is a chief line of
treatment in both kushta and unmada (group
of psychiatric disorders)[34,35]. Ghee is known
to pacify the vitiated vata dosha which is the
first humour to be affected.
Shamana (Palliative therapy) follows
shodhana chikitsa. This includes
administration of various drugs which have
their combined effect on both mind as well as
skin. Ghee preparations such as brahmi ghrita,
kalyanaka ghrita and mahatiktaka ghrita are
indicated in both unmada and kushta[36,37,38].
Brahmi churna is indicated where there is
altered sensation in kushta which is a potent
medhya drug [39]. Medhya rasayana like
brahmi (Bocopa monnier), yashtimadhu
(Glyceriza glabra), shankhapushpi (Convolvulus
pluricaulis) etc. are used for an effective
management of psychocutaneous disorders.
According to recent researches some of the
single drugs useful in skin disorders also
exhibit anxiolytic and antidepressant property
and drugs acting on brain also have an effect
on the skin.
Table 2: List of single drugs acting on skin and mind
Sl.No
Name of the herb
(sanskrit)
Botanical name
1
Mandukaparni
Centella asiatica
2
Brahmi
Bacopa monnieri

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3
Shankhapushpi
Convolvulus pluricaulis
4
Yashtimadhu
Glycerizzha glabra
5
Jyothishmati
Celastrus paniculatus
6
Haridra
Curcuma longa
7
Jatiphala
Myristica fragrans
8
Shatavari
Asperagus recemosa
9
Vacha
Acorus calamus
10
Jatamamsi
Nardostachys jatamansi
11
Amalaki
Phyllanthus emblica
12
Bhallataka
Semicarpus anacardium
13
Nagabala
Grewia hirsute
14
Madayantika
Lawsonia inermis
Table 3: List of polyherbal formulations acting
on skin and mind mentioned in classics
Sl. No
Name of the formulation
1
Kalyanaka ghrita
2
Mahatiktaka ghrita
3
Tiktaka ghrita
4
Brahmi ghrita
5
Siddhartaka ghrita
6
Mahabhutarava ghrita
7
Brahmi churna
8
Haritaki rasayana
9
Amalaka ghrita
10
Shilajitu rasayana
11
Bhallataka rasayana
12
Triphala rasayana
Bahirparimarjana(External treatments):
Experimental studies have shown that
massage and other touch treatment
modalities soothes or stimulate the nerves
there by modulate psychosomatic arousal.
External treatments like abhyanga(oil
massage), udvartana(powder massage),
parisheka(pouring medicated liquid) are
practiced in psychodermatological disorders.
Vata being situated in skin gets pacified with
the administration of these external therapies.
Physical pressure of massage induces
softness in the external skin and soothes
internal viscera and tissues. At motor end
plates acetylcholine acts as transmitter in the
presence of calcium ion and facilitates
synaptic action potential. Na and K ions are
responsible for repolarization in the nerve

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fibre. This action with the association of
melatonin a by-product of serotonin
(synthesized from tryptophan) and a
neurochemical causes pleasantness and
calming effects by the process of massage [40].
Practicing of shirodhara, shiropichu and
shirobasti based on doshic predominance are
also helpful in reducing the associated anxiety
and insomnia.
Satwavajaya Chikitsa (Psychic intervention):
Satwavajaya chikitsa potentiates sattva
(psychological threshold)by modifying
maladaptive characteristics caused by rajas
and tamas (mental factors). Mind is trained to
restrain from unwholesome objects by means
of jnana(insight, orientation), vijnana(scientific
awareness about the disease),
dhairya(building confidence) etc[41]. These help
in removing pessimism and fear associated
with psychocutaneous disorders by providing
emotional support and boosting up
confidence. Psychological measures are
especially beneficial in chronic skin diseases
like psoriasis associated with anxiety and
depression. Apart from these practicing self-
relaxation techniques, yoga, pranayama and
meditation also play a role in bringing down
the stress associated with the skin diseases
and help in improving coping abilities.
CONCLUSION:
Psychodermatology is a relatively new
discipline in dermatology which deals with the
diseases affecting mind and skin. Psychological
factors responsible for skin diseases and vice
versa is demonstrated in the classics of
ayurveda. Psychological stress is one of the
major factors which hampers the immune
system thereby making a person susceptible to
various skin disorders. Associated anxiety,
depression or other psychological problems
worsen the previously existing skin condition
and affect the quality of life. The management
of psychodermatological disorders in ayurveda
involves various therapies and life style
modifications that preserve the mental
balance and healthy skin.
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Cite this article as: Kavyashree K, Savitha H P,
Shrilata, Suhas Kumar Shetty. Psychocutaneous
disorders in ayurveda- an appraisal, J of Ayurveda
and Hol Med (JAHM).2017;5(4):61-70
Source of support: Nil
Conflict of interest: None Declared