Ayurveda-Yoga Integrated Approach in Sidhma Kushta (~Psoriasis) with Co-existing Alcohol Withdrawal (Dhwamsaka~Alcohol Withdrawal Syndrome) – A Clinical Case Report

Abstract

The management of chronic Sidhma Kushta (~Psoriasis) becomes particularly challenging when accompanied by Dhwamsaka (~Alcohol Withdrawal Syndrome), which manifests with neuropsychological and systemic disturbances. This case report highlights the therapeutic potential of a sequential Ayurvedic protocol integrated with Yoga in addressing both conditions holistically. A 39-year-old male presented with widespread Sidhma Kushta (Psoriasis Area and Severity Index [PASI] score: 17.3) and acute Dhwamsaka symptoms, including tremors, hyperhidrosis, and severe insomnia following alcohol cessation. Treatment was planned in two phases. The initial phase focused on Shamana Chikitsa (~pacifying therapy) for Dhwamsaka with Drakshadi Kashayam (90 mL BD) and Kharjuradi Mandam (200 mL OD), complemented by a daily Yoga regimen involving Sithali, Sitkari, and Anuloma Viloma Pranayama. Yoga played a central role in calming autonomic hyperactivity, improving sleep, and promoting mental stability, thereby facilitating faster withdrawal recovery. After stabilization, Shodhana Chikitsa (~purificatory therapy) was undertaken for Sidhma Kushta through Snehapana with Aragwadha Maha Tikta Ghrita (50–250 mL over 7 days) followed by Virechana Karma (~therapeutic purgation). Withdrawal symptoms resolved within a week, and the PASI score reduced from 17.3 to 0 at discharge, remaining stable at the one-month follow-up. Subjective sleep quality and overall well-being also improved. This case demonstrates that a Yoga-centered, sequential Ayurvedic management can effectively address complex comorbidities such as Sidhma Kushta and Dhwamsaka, ensuring both neuropsychological balance and sustained dermatological remission.