Clinical Efficacy of Cow Urine Distillate with and without Therapeutic Purgation in the Management of Psoriasis: Two Case Reports


K.S. Girhepunje1*, Varsha Gupta3, V. K. Srivastava2, O.P. Singh1

1Dept. of Kayachikitsa, Faculty of Ayurveda, IMS, BHU, Varanasi, India.

2Dept. of Panchakarma, Faculty of Ayurveda, IMS, BHU, Varanasi, India.

3Dept. of Rachana Sharir, Faculty of Ayurveda, IMS, BHU, Varanasi, India.

*Corresponding Author E-mail:



Psoriasis is a chronic papulosquamous dermatosis with recurrent episodes of remission and relapse. Current available therapies are successful in managing clinical features at initial phases indeed; later found difficult in long term due to disruption of other systems.  In Ayurveda, skin disorders are categorized on the basis of their doshic imbalance and aim to correct the same to cure the pathological condition by the intervention of dietary restrictions and medicines. In the presented study, we discuss two cases of psoriasis; one 23 years old male patient treated with cow urine distillate (CUD) and other 72 years old male with CUD after therapeutic purgation (Virechana). Dietary restriction of milk products was advised during the treatment period. Both cases showed significant clinical improvement which were assessed on the basis of Psoriasis Area Severity Index (PASI). The management was done for short duration of 2 months and requires more follow ups for the strong conclusion about the therapy options. The alone use of CUD for treating psoriasis is not yet tested and hence the presented case reports seem to be unique after the use of the same. It would direct the futuristic clinical studies to strengthen the hypothesis of clinical efficacy of CUD in aforesaid condition.


KEYWORDS: Gomutra Arka; Virechana; Kushtha; Ayurvedic; Immunomodulation.




Psoriasis is a T- cell mediated autoimmune non contagious chronic dermatological ailment with significant physical as well as psychological consequences1,2. Approximately 125 million people worldwide and 10 million Indian people suffer from psoriasis every year3. Possible reason for its onset would be stress, various infections, intestinal dysbiosis and excess use of antibiotics and other chemotherapies4. Psoriasis affects patient’s social life leading them to emotional stress and lack of confidence5. Due to this, high expenditure on anxiety disorders along with psoriasis keep it underexplored and untreated properly6,7. Despite of the current inventories in the novel therapies for psoriasis, the prevalence of the cases is high worldwide8,9.


According to WHO, approximately 80% population of the developing countries use traditional medicines for the primary health issues and chronic diseases10. While dealing with the psoriasis with the Ayurvedic modalities, use of cow urine can also be used for the management of psoriasis11. Various topical herbal formulations are now being developed where cow urine can also be used for the management of psoriasis12.  we present the two case reports which were treated with cow urine distillate (CUD) also known as Gomutra arka in Ayurveda and therapeutic purgation (Virechana) which responded in short duration. The alone use of CUD for treating psoriasis is not yet tested. Also, its effect after therapeutic purgation is also a topic of research. The present study is a small footstep in the same direction. Though robust conclusion cannot be established through such limited data, the furthermore studies on large sample size are warranted.



The case report is designed according to the CARE case report guidelines.


2.1 Case 1

2.1.1 General information and past history:

23 years old male patient visited Out-Patient Department (OPD) of Kayachikitsa Department, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi on 12/6/2019 presenting with discoid erythematous scaly lesion below right knee anteriorly in the past 3 months. Also, he was suffering from multiple erythematous scaly lesions at occipital and bilateral temporal regions of head for 8 years. He had no history of psoriasis or major illness in family. He was diagnosed as a case of psoriasis by private dermatologist of Varanasi and was prescribed allopathic medication. Patient took oral prednisolone 5mg once a day along with topical corticosteroids for 5 years. Initially he got improved for about 2 years but later but didn’t get satisfactory improvement. Instead of relief, within one month of leaving medications, new lesion appeared below right knee for which he decided to try Ayurvedic treatment. He was frustrated with his disease and looking little depressed.


2.1.2 Clinical Findings:

On examination, his physique and general condition seemed fair with stable vitals. His appetite was normal and sleep was poor. He was afebrile (36.8ºC) with blood pressure-112/76mmHg, pulse rate-84/min, respiratory rate-20/min and weight-47kg. On systemic examination, central nervous system was normal. Cardio-respiratory system did not show significant findings. Gastrointestinal and urogenital systems were normal too.


2.1.3 Investigations:

Hematological investigation revealed hemoglobin - 13.1 gm/dL, platelets- 4.57lakhs/uL, total leukocyte count- 10020/uL. Renal function test and liver function test were normal. His C- reactive protein level was raised.


2.1.4 Diagnosis:

Clinical features and past history was suggesting presentation of Plaque Psoriasis. Also, Grattage test was positive at the lesions of leg region and head region. Patient was advised for skin biopsy but he refused and insisted for medication for initial. Thus, the final diagnosis was considered as a case of Plaque Psoriasis on the basis of clinical findings.


2.1.5 Treatment:

After proper counseling about disease, he was given oral cow urine distillate (Gomutra Arka) 10ml diluted in 1 glass of water twice a day for two months. Along with that, he was restricted for dairy and products in diet.

2.2 Case 2

2.2.1 General information and past history:

55 years old male patient visited same Kayachikitsa OPD on 27/9/2019. He was presenting with the multiple indurated discoid erythematous plaques on head, abdomen and back trunk region for about 12 years. Also, he was suffering from recurrent episodes of belching and heaviness in abdomen for last 6 months. He had no history of any other major past illness. He was diagnosed as a case of psoriasis from Dermatology OPD of Sir Sunderlal Hospital, Banaras Hindu University, Varanasi in 2012. He was thus taking treatment for about 8 years but despite of medication; he was going through episodic phases of remission and relapse of psoriatic lesions 3-4 times in a year. For last one years, he wasn’t getting relief and some new psoriatic plaques started appearing he added. Thus, he was referred to Kayachikitsa OPD of Sir Sunderlal Hospital on his personal request.


2.2.2 Clinical Findings:

On examination, he had moderate built with fair general condition. He had good appetite but sleep was disturbed. He was afebrile (36.2º C) with blood pressure - 128/86 mmHg, pulse rate - 92/min, respiratory rate - 22/min and weight - 72kg. On systemic examination, central nervous system, cardio-respiratory system and didn’t reveal any significant findings. On abdominal examination, it was distended with tympanic notes. No palpable organomegaly seen; no signs of ascites were observed. Urogenital system found normal too.


2.2.3 Investigations:

Routine hematological investigations were normal. Renal and liver function tests were normal. C reactive protein level was raised.


2.2.4 Diagnosis:

Patient was referred case of psoriasis and was diagnosed as plaque psoriasis on the basis of clinical features and skin biopsy.


2.2.5 Treatment:

He was given therapeutic purgation (Virechana therapy) as per scheduled below (Table 1) completed in 2 weeks. Virechana was done by giving Trivritta Avaleha (50gm) orally as main medicine and dried grapes’ decoction (1 litre) as Anupana. Patient was feeling light after Virechana. Total 16 Vegas (~episodes of motion) were observed during the therapy indicating moderate shuddhi. His vitals were stable with no sign of dehydration. His pulse rate was 92/min and blood pressure was 112/74mmHg. Later he was advised to take oral cow urine distillate (CUD) 10ml diluted in 1 glass of water twice a day for two months. He was also restricted for dairy and products in diet as above case.

Table 1: Procedure of Therapeutic purgation (Virechana)

Preparatory phase


Morning Schedule (melted Cow ghee with tolerable hot water at 6am)

Evening Schedule


30 ml CG PO with HW

Light diet (khichadi / dal-chawal / roti)


60 ml CG PO with HW

Light diet


90 ml CG PO with HW

Light diet


120 ml CG PO with HW

Light diet


150 ml CG PO with HW

Light diet


Snehana (Whole body Massage with luke warm mustard oil) followed by Sarvang Swedana (steaming).

Light diet


Whole body Massage with luke warm mustard oil followed by steaming

Hot liquid diet at evening (Kadhi / Dal / Tomato soup)

Main procedure


Whole body massage and steaming as above; followed by Therapeutic purgation.


Post-operative phase


Therapeutic purgation, No meal

Peya (thin gruel of rice)





Vilepi(thick gruel of rice)




Akrut yusha


Krut yusha (semi liquid preparation from lentils)

Krut yusha


Krut mansa rasa

Normal regular diet

CG- Cow ghee; PO- Per Oral; HW- Hot Water



Cow urine distillate (CUD) was given at each follow up. CUD was given for 2 months and assessment was done upto 3 months in both the cases. CUD was given after therapeutic purgation in case 2. Case 1 was given additional session of counselling for 15 min at each follow up. Both the cases were called for follow up every 15 days later. Both the cases showed improvement at each follow up. Assessment was done on the basis of Psoriasis Area Severity Index (Table 2) at one month interval of treatment. CBC, LFT and RFT were within normal range throughout the treatment period indicating the safety of medicine. CRP level was raised in both cases before treatment came to normal range within 2 months (Table 3).


Table 2: Psoriasis Area Severity Index (PASI) score both cases at each follow up

Hospital Visit and Follow up

Case 1 -PASI

Hospital Visit and Follow up

Case 2- PASI

12/6/2019 (BT)


27/9/2019 (BT)


11/7/2019 (F1)


28/10/2019 (F1)


12/8/2019 (F2)


28/11/2019 (F2)


13/9/2019 (F3)


27/12/2019 (F3)


BT Before Treatment, F1- Follow up 1, F2- Follow up 2, F3- Follow up 3



Figure 1 Psoriasis cases before and after treatment                


Figure 2 Assessment of PASI in both cases


Table 3: Timeline of the psoriasis cases

Case 1

Case 2


Clinical events and interventions


Clinical events and interventions


Onset of disease


Onset of disease


Diagnosed as Psoriasis


Diagnosed as Psoriasis

2014 to 2018

underwent allopathic medications for 5 years

2012 to 2019

underwent allopathic medications for about 8 years

March 2019

New lesion appeared on right lower limb

Early 2019

Onset of GI complaints

12/6/2019First visit

Severity of lesions:

Head-Erythema (+++), Scaling (++++), Induration (++++)

Lower limb- Erythema (+++), Scaling (+++), Induration (++++)

27/9/2019 First visit

Severity of lesions:

Head-Erythema (++++), Scaling (+++), Induration (++);

Trunk- Erythema (++++), Scaling (++++), Induration (++++);

Other complaints: Abdominal distension and heaviness, Belching

27/3/2019 Last visit

Severity of lesions: Head-Erythema (nil), Scaling (nil), Induration (+); Lower limb- Erythema (nil), Scaling (+), Induration (nil)

27/12/2019 Last visit

Severity of lesions: Head-Erythema (nil), Scaling (nil), Induration (nil); Lower limb- Erythema (+), Scaling (+), Induration (+)



Psoriasis is a chronic autoimmune dermatosis seeking long term therapy and which is very difficult to treat due to its recurrent relapsing behavior13. In Ayurveda, cow urine has been described to have anti dermatitis property14 and also it possesses Rasayana property which exhibit immunomodulator activity15. The presented cases were chosen to evaluate efficacy of CUD in the cases of Psoriasis due to their immunomodulator effect. One case was treated only with CUD and other was given CUD after therapeutic purgation. Both the cases showed significant changes in clinical features within 2 months of medication. Therapeutic purgation is commonly practiced by Ayurveda practitioners for the management of psoriasis which is indicated for the various skin disorders in Ayurvedic classics16. Thus, therapeutic purgation was expected to show the clinical efficacy in clinical features of psoriasis. But it is difficult to differentiate efficacy of CUD and therapeutic purgation separately. Besides this, first case showed its uniqueness due to its response with the use of CUD separately along with little dietary regulation.


Though both the cases showed improvement, they were observed for very short period of 3 months which is not enough to strengthen the hypothesis of anti-psoriatic property of CUD. Psoriasis is a disease of relapse and remission pattern and thus requires long term follow up for minimum 2 to 3 years. Moreover, the randomized clinical controlled trials are requisite for CUD and therapeutic purgation for long duration to evaluate the clinical efficacy and drawbacks of the therapeutic aspects if any.


Cow urine is the non-toxic waste material which contains 95% water, 2.5% urea and remaining 2.5% a mixture of minerals, salts, hormones and enzymes17. It exhibits the properties as pungent (katu rasa), easily digestible (laghu), penetrating easily through body channels (tikshna), improves intellect (medhya)18. It contains aurum hydroxide (swarna kshar) which mainly shows immunomodulator effect and allantoin that exhibits keratolytic activity9. Other compositions like urea, carbolic acid, phenol, etc show antimicrobial property and prevent psoriatic lesions from superadded infections. A vasodilator kallikrein and fibrinolytic enzyme urokinase improves circulation to affected part and help in maintaining vascular integrity along with the nitrogen, sulfur, sodium and calcium components which act as blood purifiers19. Thus, it possibly helps for immunomodulator effect of cow urine by enhancing purified blood which may alter the hyperkeratosis of the psoriatic lesion.


Here in the presented case reports, the intervention of CUD showed positive clinical efficacy (Fig 2). CUD is more effective than cow urine of which antimicrobial, antifungal and anticancer properties have been examined20,21. On the other hand, in Ayurveda, therapeutic purgation has been advocated for balancing and eliminating vitiated doshas prior starting of medication in skin disorders for better clinical results22. It mainly removes deeply accumulated vitiated doshas (especially pitta) and toxins from body through anal region. In Ayurveda, vitiated blood is also major contributing factor for skin disorders and hence it requires blood cleansing therapies during the management. Therapeutic purgation indirectly brings this blood cleansing effect by eliminating vitiated pitta dosha23. Skin disorders have been observed to aggravate due to dairy products and Ayurveda claims to restrict them during medication24,25. Excessive use of salt, meat, contradictory diet is some provoking factors for skin disorders and thus should be avoided. Scientific validation over dietary focus in the management of psoriasis is separately another matter of research and need further evaluation.



The use of CUD along with dietary restrictions of contradictory diet may exhibit good clinical results in the cases of psoriasis. The further clinical, exploratory and experimental studies are needed to unveil hidden facts of CUD.



The authors have no conflicts of interest regarding this investigation.



1.   Shivi Sondhi, Navdeep Singh, Shammy Jindal. Natural Remedies used in the Treatment of Psoriasis: A short Review. Asian J. Pharm. Res. 2021; 11(1):43-45.

2.   Mariam Mahmoud Taha, Zainab Thamer Shwait Al-Asady. Evaluation of the Effectiveness of Antioxidants and TNF-α in Iraqi Patients with Psoriasis treated with Etanercept. Research J. Pharm. and Tech 2019; 12(2):665-668. doi: 10.5958/0974-360X.2019.00118.5

3.   Navdeep Singh, Shivi Sondhi, Shammy Jindal, Vinay Pandit, Mahendra Singh Ashawat. Treatment and Management for patients with mild to severe Psoriasis: A Review. Asian J. Pharm. Res. 2020; 10(4):286-292. doi: 10.5958/2231-5691.2020.00049.0

4.   Shivi Sondhi, Navdeep Singh, Kamya Goyal, Shammy Jindal. Development of Topical Herbal Gel of Berberine Hydrochloride for the Treatment of Psoriasis. Res. J. Pharma. Dosage Forms and Tech.2021; 13(1):12-18.

5.   Geetha. P, Vaishnavi Raksha. R, Mohamed Ishak. J , Shanmugasundaram. P. A Review on Generalized Anxiety Disorder. Research J. Pharm. and Tech 2017; 10(11): 4043-4046. doi: 10.5958/0974-360X.2017.00733.8

6.   Sakthi Priyadarsini S, Vani PB, Kumar PR. A Comparative Review on Conventional and Traditional medicine in the Treatment of Psoriasis. Research J. Pharm. and Tech. 2020; 13(11):5642-5646. doi: 10.5958/0974-360X.2020.00983.X

7.   Vidya Raju, Jasmine Joy Bell, Merlin. N. J, Shaiju S. Dharan. Anxiety Disorders – A Review. Asian J. Pharm. Res. 2017; 7(4): 217-221. doi: 10.5958/2231-5691.2017.00033.8

8.   Strober, B.E., van der Walt, J.M., Armstrong, A.W. et al. Clinical Goals and Barriers to Effective Psoriasis Care. Dermatol Ther (Heidelb) 9, 5–18 (2019).

9.   Monson CA, Silva V, Andriolo RB, et al. Complementary therapies for chronic plaque psoriasis. Cochrane Database Syst Rev. 2019;2019(8):CD011243. Published 2019 Aug 14. doi: 10.1002/14651858.CD011243.pub2

10. Parag Sukare, Rupa Bhattacharya. Herbal plant used in Treatment of Psoriasis - A Systematic Review. Res. J. Pharmacognosy and Phytochem. 2020; 12(1):. 57-62. doi: 10.5958/0975-4385.2020.00011.4

11. Mr. Paresh A Patil, Mr. Vitthal. V. Bhosale, Ms. Varsha. P. Girase. Review on Gomutra (Cow Urine). Asian J. Pharm. Res. 2020; 10(2): 120-122. doi: 10.5958/2231-5691.2020.00023.4

12. Padmini Iriventi, N. Vishal Gupta. Formulation and Evaluation of Herbal Cream for Treating Psoriasis. Research J. Pharm. and Tech. 2021; 14(1):167-170. doi: 10.5958/0974-360X.2021.00029.9

13. Rendon A, Schäkel K. Psoriasis Pathogenesis and Treatment. Int J Mol Sci. 2019;20(6):1475. Published 2019 Mar 23. doi:10.3390/ijms20061475

14. Shukla V. & Tripathi R. Charak Samhita of Agnivesha. Vol. 1, Sutrasthan. Chaukhamba Sanskrit Pratisthan delhi 2009. p. 45

15. Banga, R. K., L. K. Singhal, and R. S. Chauhan. "Cow urine and immunomodulation: An update on cowpathy." International Journal of Cow Science 1.2 (2005): 26-29.

16. Chaganti S, Prasad BS. Analysis of Virechana karma with Danti avaleha: A retrospective study. J Ayurveda Integr Med. 2015;6(4):300-304. doi:10.4103/0975-9476.172420

17. Bhadauria H. Cow Urine- A Magical Therapy. Vishwa Ayurveda Parishad, 71-74. Int J Cow Sci. 2002;1: 32–6.

18. Review Article Benefits Of Cow Urine – A Review. Available from: [accessed Jun 26 2021].

19. Randhawa GK. Cow urine distillate as bioenhancer. J Ayurveda Integr Med. 2010;1(4):240-241. doi:10.4103/0975-9476.74089

20. Chauhan RS, Garg N. Banglore, Karnataka: Indian Science Congress; 2003. Cow Therapy as an alternative to antibiotics.

21. Chawla PC. Risorine - A Novel CSIR Drug Curtails TB Treatment, CSIR News. March. 2010:60–52.

22. Shukla V. & Tripathi R. Charak Samhita of Agnivesha. Vol. 2, Chikitsasthan. Chaukhamba Sanskrit Pratisthan delhi 2009.

23. Kaur M, Chandola H. Role of Virechana Karma in cure and prevention of recurrence of Vicharchika (Eczema). Ayu. 2012 Oct;33(4):505-510. DOI: 10.4103/0974-8520.110526.

24. Barrea L, Balato N, Di Somma C, et al. Nutrition and psoriasis: is there any association between the severity of the disease and adherence to the Mediterranean diet?. J Transl Med. 2015;13:18. Published 2015 Jan 27. doi:10.1186/s12967-014-0372-1

25. Katta R, Desai SP. Diet and dermatology: the role of dietary intervention in skin disease. J Clin Aesthet Dermatol. 2014; 7(7):46–51.




Received on 27.06.2021            Modified on 24.09.2021

Accepted on 03.11.2021           © RJPT All right reserved

Research J. Pharm.and Tech 2022; 15(9):4182-4186.

DOI: 10.52711/0974-360X.2022.00701