Background: Ekakustha, characterized by aswedana (absent sweating), mahavastu (large lesions), and matsya-shakalopama (fish-scale appearance), correlates with plaque psoriasis. Classical Shodhana-Shamana remains underexplored in modern clinical practice. Objective: Evaluate integrated Shodhana-Shamana protocol efficacy in treatment-resistant Ekakustha. Case Presentation: A 33-year-old male with 12-month widespread psoriasis resistant to antihistamines, steroids, and vitamin D analogues presented with bilateral erythematous plaques, severe pruritus, and alopecia. Treatment: Nidana parivarjana, Deepana-Pachana (Days 1-3), Snehapana with Mahatiktaka Ghrita (Days 4-8), Abhyanga-Swedana with Dashamoola (Days 8-10), Virechana with Trivrit-Triphala (Day 11), followed by 30-day Shamana with Potala Katuruhinyadi Kashaya, Arogyavardhini Vati, Dusivishari Gutika, Gandhaka Rasayana, and topical Brihat Dantapala Taila. Results: Psoriasis Area and Severity Index (PASI) score declined from severe (>20) to absent (0) at Day 45. Complete resolution of erythema, induration, scaling, and pruritus with significant hair regrowth. No relapse at follow-up. Conclusion: Integrated Shodhana-Shamana chikitsa effectively addresses Samprapti through sequential Ama pachana, Kleda soshana, and Raktashodhana, providing sustainable Ekakustha management. Multicentric trials recommended.