The Role of Pathya - Apathya in Psoriasis w. s. r to Kushtha – A literary review.

: Background: Psoriasis is a non-infectious chronic inflammatory disease of skin characterized by well-defined erythematous plaques with silvery scales having chronic fluctuatory course affecting both sex and different age groups. In India, its prevalence varies from 0.84% - 6%. Psoriasis can be correlated to different varieties of (Skin diseases) like or due to the resemblances of signs and symptoms. The etiological factors explained for can be classified as and. Each plays an important role in the manifestation of the disease. As Ayurveda emphasizes as the first line of treatment to treat a disease, so it is essential to prevent the manifestation of the disease and further to check the progression of the disease through and which the unique contributions of Ayurvedic science are. Aim & Obective: The objective of this review is to assess dietary factors which play a role in psoriasis. Discussion: The risk of dietary factors & their interactions in psoriasis is discussed. Conclusion: In this review, dietary factors which play a role in psoriasis are assessed and their potential benefit is evaluated.

etiological factors. It is a Chronic, genetically determined, inflammatory and proliferative disease characterized by dry, well circumscribed, silvery scaling papules and plaques, present over extensor surfaces and scalp of various sizes with spontaneous remission, relapse and seasonal variation [1]. Its prevalence in different population varies from 0.1%-11.8% [2]. The pathogenesis of Psoriasis involves both genetic factors including the influence of genes of the Human Leucocyte Antigen Complex and T-Cell mediated immunological mechanisms [3]. In Ayurveda, all skin diseases are included under the term Kushtha. The word Kushtha means that which makes skin look disgraceful. Due to Mithyaahara, Vihara and Karma, the Tridoshas get vitiated affecting the Twak, Rakta and Mansa Ambu Dushyas, thus producing Kushta. It is known as one of the 'Ashta Mahagada [4]. Though the modern science does not explain the specific cause for the manifestation of psoriasis, but Ayurveda has clearly described the causes leading to Kushta [5] as Aharaja, Viharaja Nidanas, Sadvritta Apalana and following the Pathya could help the future generations to avoid Kushta and also to check its progression and remission for those already afflicted with. An objective of this review article is to critically analyze the various in bringing the disease psoriasis. 2. Mithya Ahara: Improper food is also a major cause of Kushtha. There are certain a code of conducts of eating and when it is not followed called Mithya ahara. These codes of conduct of eating are termed as "Ashtaaharavidhi Visheshayatani" [8] 3. Virrudha Ahara: "Viruddha" is the term for incompatible or antagonistic. Substances which act as antagonist to normal Dhatu (tissues) of the body are to be called as 'Viruddha in Ayurveda [9]. Ahara can sometimes become poisonous and in some case it may become Gara Visha (artificial poisoning) if consumed for long time [10]. As per the classics type of food combination which directly produce the disease Kushtha are described here. Fish with Milk: It is the example of Samvoga and Veerya Viruddha. Codes of conduct must be followed everyday [19]. Dinacharya is a daily routine to be followed regularly without the interruption.
Mukha Prakshalana (face cleaning): Cleaning face with water, this to be practiced possibly at least twice a day.

Aims_and_Objects:
To assess dietary factors which play a role in psoriasis.

Materials_and_Methods
Here all the references from classical books related to causation of Kitibha/eka kushta (psoriasis) are elaborated in detail.  [24]. Intake of Viruddh ahara also vitiates Srotasa (micro channels). In general, food substances and activities (Vihara) which are similar in quality to body humors and deleterious to the body elements vitiate the body channels [25]. Samyoga Viruddha (Fish with Milk) is more harmful than others. Both milk and fish are Madhura, having Madhura Vipaka and are Maha Abhishyandi. Though, milk is Sheeta (cold) in Virya (potency) while fish is Ushna (hot) in Veerya (potency). Due to incompatibility when these are taken together it causes Rakta dushti and due to Maha Abhishyandi (blocks micro channels) property it may obstruct the Srotas [26]. It may produce Kleda and Amavisha.

Discussion
Mithya Ahara (Improper Diet) upsets the jatharagni (digestive power) and also cause Dushti (Vitiation) of Grahani (Site of the Digestive power). Thus the food doesn't get digested properly leading to production of Ama (undigested food). As Grahani is also Dushita, Ama undergoes purification and Amavisha (poison) is produced [27].
Hence Mithya Ahara (Improper Diet) must be avoided to avoid further complications. Ahara Drvyas which increases Jatharagni and Pachankriya (Digestive Process) should be included in Diet.
Vishama Ashana (food taken with the ingredients of the diet mixed in undesired and odd proportions) is best known to produce Vishama Agni (imbalanced Agni) [28]. According to Acharya Charaka, taking food in state of indigestion is best known to cause Grahani (Site of the Agnidigestive enzymes) Dushti [29]. Ajirna Adhaysahana (taking food while having indigestion and consumption of food even before the previously taken food is digested) causes Agnimandya (indigestion) and Dushti (Vitiation) in Malavaha Srotas (channels carrying wate products of body) [30]. Both are the causes Agnimandya (indigestion) so ultimately produces disease. Both of them also vitiate Rakta [31]. If this pathology continues for long time, Kushtha may be produced. Rasavaha Srotas Dushti occurs when taking excessive Guru, Snidgha Ahara [32]. Acharya Charak has also described "Gurubhojana Durvipakakaranam" (Ahara Guru in guna and in quantity too) [33]. Guru Ahara also causes Dushti of Mamsavaha Srotas [34]. Excessive Drava cause Dusti in Raktavaha Srotas (Channels of blood circulation through body) [35].
Hence these Aharaja Nidanas has to be avoided and the Pathya Ahara which consists of Laghu Anna (light food articles), Hence these Viharaja Hetu which vitiates the normalcy of body humors and manifest the disease has to be avoided and Pathya Vihara has to be practised which helps to keep the Tridoshas in normalcy.
The Achara Nidanas explained bring about psychogenic stress which is of prime importance in the pathogenesis of Psoriasis.
Due to Raja and Tama Doshas (mental humors) the Mana (mind) is always in search of materialistic pleasures and to satisfy this greed, it is always doing good and bad deeds (Papakarma). And by the after effects of such bad deeds one suffers from diseases like Kushta. Hence these Hetus has to be investigated and Sadvritta has to be followed to bring the normalcy in Raja and Tama the Mano Doshas, thus soothing the stress by improving the Satvika Dosha.

Conclusion:
Psoriasis is one of the most common chronic inflammatory skin disorders, affecting about 2% of the general population. Psoriasis is considered as a Tcell-mediated inflammatory skin disease which is characterized by hyper proliferation and poor differentiation of epidermal keratinocytes. While susceptibility to psoriasis is inherited, the disease is influenced by environmental factors such as infections and stress. Psoriasis may substantially affect quality of life. Diet plays a crucial role in the aetiology and pathogenesis of psoriasis.
It has been observed that psoriasis has been improved in 60% of the patients who changed their role in the aetiology and pathogenesis of psoriasis. Diet has been equally linked with the treatment of psoriasis. It has been observed that psoriasis has been improved in 60% of the patients who changed their dietary habits. Today's food has lots of more refined & processed ingredients. It produces more toxins & our body unable to handle them. With the use of a specific psoriasis diet, the body gets help to self-cleanse & eliminate toxins effectively. Once a person gets into a routine of eating Hitakara Ahara (healthy diet) in psoriasis, he/she will feel better & finally be able to control psoriasis for the whole life.