The physiological systems in the body are classified into two- the working systems and the controlling systems. The controlling systems namely the Central Nervous System and the Endocrine system mediates and regulates the functioning of the other systems, including respiratory, circulatory, digestive, reproductive etc, together known as the working systems. The controlling systems regulate the working systems under the influence of various stimuli from both external as well as the internal environments. On exposure to the stimuli, the CNS sends signals to stimulate or inhibit the endocrine secretions. Thus, this neuro-endocrine control decides the functioning of the working systems in the body. Psychological aetiology of diseases has been extensively studied and reported, especially so in dermatological disorders. In this regard, the fact that the endocrine system serves as a central gateway for psychological influences on health demands special attention while planning the management. Studies have reported that psychological disturbances like stress and depression can cause the release of pituitary and adrenal hormones that have multiple effects on immune function. For example, negative emotions have been observed to indirectly contribute to immune dysregulation by stimulating proinflammatory cytokine overproduction.
Role of Psycho-neuro-immunity in skin disorders
Psychoneuroimmunology (PNI) is the study of the interaction between psychological processes and the nervous and immune systems of the human body. Psychoneuroimmunology is an interdisciplinary field that specifically examines the biochemical cross-talk between the brain, behaviour, and the immune system.
Skin is the largest body organ. Skin has both metabolic and endocrine capabilities that facilitate homeostatic control between internal and external environments. The extensive cutaneous network of sensory fibers in the skin helps in the expression of many neurotransmitters and neuropeptide receptors similar to the central nervous system, including corticotropin-releasing hormone (CRH), serotonin, prolactin, and substance P (SP). Furthermore, skin is involved in the communication between immune, nervous, and endocrine systems through various biochemical mediators. Dysregulation of these mediators in both the central nervous system (CNS) and in the skin has been understood as contributing to the pathophysiology of diseases like Atopic Dermatitis and Psoriasis. There is a link between emotional stressors (acute or chronic), psychiatric diseases, and dermatoses (e.g., psoriasis, atopic dermatitis, urticaria, viral warts, herpes simplex, vitiligo, acne, alopecia, prurigo, etc.) and different cytokines and mediators produced in the skin are involved in their pathogenesis. A prominent role is played by those agents that belong to the hypothalamic-pituitaryadrenal axis.
Understanding Skin Disorders in Ayurveda
According to Ayurveda, Skin disorders are accommodated under the broad heading of Kushta. Generally, this clinical condition involves the skin, muscle tissue, blood, and lymph.
दूष्याश्च शरीरधातवस्त्वङ्मांसशोणितलसीकाश्चतुर्धा
(Ch. Sam.Sa. 5/3)
From different contexts, we can understand that twak (skin) is related to the Rasa dhatu. For example, in the context of Saara pareeksha, twak saara is mentioned among dhatu saara substituting the rasa saara.
सारतश्चेति साराण्यष्टौ पुरुषाणां
बलमानविशेषज्ञानार्थमुपदिश्यन्तेय त।
था- त्वग्रक्तमांसमेदोऽस्थिमज्जशुक्रसत्त्वानीति।।
Ch. Sam. Vim. 8/102||
Thus, it can be inferred that vitiation of Rasavaha strotas can lead to skin disorders. The factors mentioned to be causing Rasavaha sroto dushti includes:
गुरुशीतमतिस्निग्धमतिमात्रं समश्नताम्।
रसवाहीनि दुष्यन्ति चिन्त्यानां चातिचिन्तनात्।।
Ch.Sam.Vi. 5/13||
As mentioned in the sutra, chintyanaam cha ati chintanam (excessive worries or anxiety) can lead to rasavaha stroto dushti. Also, Ayurveda literature mentions that rasapradosha can lead to premature greying of hair and wrinkling of the skin. This hints towards the association between mental stress and skin disorders which have been studied and established in various studies.
नाशोऽग्नेरयथाकालं वलयः पलितानि च।।
रसप्रदोषजा रोगा…. | Ch.Sam.Su. 28/10-11|||
Role of psychotherapy in Skin disorders
The above discussions implies that therapies suggested for psychological disorders can help in controlling skin disorders to a good extent. Studies have reported faster symptomatic relief and relapse control in skin disorders with cognitive-behavioural therapies.
In Ayurveda, the chikitsa sutra for Manasika vyadhi suggests the use of the following:
- Jnana (creating awareness in the patient about the disease)
- Vijnana (educating the patient about the disease in detail including pathyaapathya)
- Dhairya (motivating the patient to follow a good diet and lifestyle compatible to his health issues)
- Smriti (unfolding and minimizing the deep-rooted impressions of the diseasetriggering factors)
- Samadhi (freedom from the disease)
Jnana & vijnana refers to the extensive patient education about the various aspects of the disease and helping the person to understand the etiological factors to be modified or avoided. Dhairya refers to continuous motivation given through counselling and self-help tasks to maintain the patient compliance to the advice given. Counselling and Yoga therapy can help to create the discipline to achieve this goal in treatment. Counselling should aim at helping the person recognize and accept the health issue and understand the various etiological and triggering factors and guiding to bring about the needed modifications. Yoga therapy helps in reducing stress and helps to bring about discipline in the patient which helps in coping with the disease.
Further, in some instances, a deep psychological involvement can be seen in terms of previous incidences or experiences which trigger the diseases. Meditation, especially the Smriti Meditation, has been observed to be yielding remarkable results in this regard. Smriti meditation helps the patient to explore the subconscious mind and to revoke the memory of previous incidents related to the disease stored therein and to get rid of those unfavourable stimuli. In this practice, the patient is guided to unfold such unfavourable memories and guided to overcome them completely. This helps in minimizing the disease recurrence. Pranayama helps in normalizing the endocrine functions in the body. Along with pharmacological interventions, a combination of Yoga, Pranayama, Counseling and Meditation, can bring about changes in the psychological status of the patient. These changes mediate a healthy neuro-endocrine response minimising the hyperimmune responses. This helps in attaining not only symptomatic relief but also reducing the chances of recurrence or relapse.
The role of Psycho-neuro-immunity is well-established in diseases, especially skin disorders. Ayurveda offers effective management of skin diseases through shodhana, samana and rasayana chikitsa. However, complementing the treatment with the psycho-therapeutical approaches as mentioned can speed up the recovery and minimize the recurrence of the disease.
