Mandala Kushta in Ayurveda and Its Correlation with Plaque Psoriasis: A Conceptual Study

Abstract

Mandala Kushta, classified under Mahakushta by Acarya Charaka and Vagbhata, is  predominantly a Kapha-Dosha dominant disorder involving Tvak, Rakta, Maṃsa,  and Lasika as principal Duṣhya. Its etiopathogenesis begins with Nidana Sevana (Aharaja, Viharaja, Manasika, and Bijadoṣa), leading to Agnimandya, Ama formation,  Dosha Dushya Sammurchana, and Srotodushti of Rasavaha, Raktavaha, Maṃsavaha,  and Svedavaha Srotas, culminating in characteristic lesions such as Shvetarakta,  Utsannamandala, Sthira, Snigdha, and Anyonyasamsakta patches. Plaque psoriasis, the  most common form of psoriasis (80–90%), is a chronic immune-mediated inflammatory  disorder characterized by erythematous, well-demarcated plaques with silvery-white  scales. This study aims to explore the conceptual and pathophysiological correlation  between Mandala Kushtaand Plaque psoriasis. Methods: A classical textual review  of Charaka Samhita, Sushruta Samhita, and Aṣhtanga Hridaya was undertaken and  compared with contemporary biomedical literature on plaque psoriasis pathophysiology.  Results: The Nidana induced Agnimandya, Ama formation, and Dosha Dushya Sammurchana, as described in Mandala Kushta, correlate conceptually with immune  dysregulation involving the IL-23/IL-17 axis and TNF-α pathways in Psoriasis. Clinical  features such as raised, erythematous plaques correspond to Utsannamandala and  Shvetarakta lakshana. Srotodusti parallels vascular and inflammatory changes observed  in psoriasis. Discussion: The comparative analysis suggests a substantial conceptual  and clinicopathological overlap between Mandala Kushta and Plaque Psoriasis. The  immune keratinocyte inflammatory loop in Psoriasis can be interpreted through the  Ayurvedic framework of Dosha Dushya Srotas interplay initiated by Agnimandya and  Ama formation. This correlation strengthens the integrative understanding of Psoriasis  within the Ayurvedic paradigm and supports the rationale for applying Kushta chikitsa principles in its management.