Yavanipidika vamana-pk

“COMPARATIVE CLINICAL STUDY ON EFFECT OF VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN

YOUVANA PIDAKA (ACNE VULGARIS)” – By –

Anil S. Managuli

Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

In partial fulfillment of the requirement for the degree of

Ayurveda Vachaspati (Doctor of Medicine)

In

Panchakarma

Under the guidance of

Dr. Sanghamitra Patnaik M.D. (Ayu)

Associate Professor & H. O. D. Department of P.G. Studies in Panchakarma

Under the Co-guidance of

Dr. Anilkumar Baccha M.D. (Ayu)

Asst. Professor Department of Kayachikitsa

DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA

N.K.J. AYURVEDIC MEDICAL COLLEGE & P. G. RESEARCH CENTER, GUMPA, BIDAR – 585 403.

2009.

Ayurmitra

TAyComprehended

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled

“COMPARATIVE CLINICAL STUDY ON EFFECT OF

VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN

YOUVANA PIDAKA (ACNE VULGARIS)” is a bonafide and

genuine research work carried out by me under the guidance of

Dr. Sanghamitra Patnaik M.D. (Ayu) Associate Professor Department of

P.G. Studies in Panchakarma and under the co-guidance of

Dr. Anilkumar Baccha M.D.(Ayu). Asst. Professor, Department of

Kayachikitsa N.K.J. Ayurvedic Medical College & P. G. Research

Center, Gumpa, Bidar.

Date : Signature of the Candidate

Place: BIDAR. (Anil S. Managuli)

DEPARTMENT OF POSTGRADUATE STUDIES IN

PANCHAKARMA

N.K.J.A.M.C., P.G. RESEARCH CENTER, BIDAR.

(Affiliated to Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka)

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled



YOUVANA PIDAKA (ACNE VULGARIS)” is a bonafide

research work done by the “Anil S. Managuli” in partial fulfillment of

the requirement for the degree of Ayurveda Vachaspati M. D. (Ayu)

Signature of the Guide Dr. Sanghamitra Patnaik

M.D. (Ayu)

Associate Professor

Dept. of P.G. Studies in Panchakarma

N.K.J.A.M.C., P.G. Research Center, Bidar.

Date :

Place: BIDAR.


PANCHAKARMA




CERTIFICATE BY THE CO-GUIDE





research work done by the “Anil S. Managuli” in partial fulfillment of

the requirement for the degree of Ayurveda Vachaspati M. D. (Ayu)

Signature of the Co-Guide

Dr. Anilkumar Baccha M.D. (Ayu)

Asst. Professor,

Department of Kayachikitsa

N.K.J.A.M.C., P.G. Research Center, Bidar.

Date :

Place: BIDAR.


PANCHAKARMA




ENDORSEMENT BY THE H.O.D. & PRINCIPAL





research work done by the “Anil S. Managuli” under the guidance of

Dr. Sanghamitra Patnaik M.D. (Ayu) Associate Professor & H. O. D.

Department of P.G. Studies in Panchakarma N. K. J. Ayurvedic

Medical College & P. G. Research Center, Gumpa, Bidar.

H. O. D. PRINCIPAL

Dr. Sanghamitra Patnaik Dr. K. V. L. N. Acharyulu M.D. (Ayu) M.D. (Ayu)

Department of P.G. Studies Principal & Dean

in Panchakarma

N. K. J. Ayurvedic Medical College & P. G. Research Center, Bidar.

Date : Place: BIDAR.

COPY RIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of

Health Sciences, Bangalore, Karnataka shall have the rights to

preserve, use and disseminate this dissertation in print or electronic

format for academic / research purpose.

Date : Signature of the Candidate

Place: BIDAR.

(Anil S. Managuli)

© Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka.

ACKNOWLEDGEMENT “Love is the only inspiration.” Along with the divine blessings of

Lord Manjunatheshwar and Lord Dhanwantari, this work carries some

memories to express gratitude and record some distinguished

personalities with whom I had inspired during the course of this thesis.

It is an inexplicable pleasure, sincere and respectful regards to

Pujya Shri. Shri. Siddharudha Mahaswamiji, Siddharudha Math,

Gumpa, Bidar.

My vocabulary falls short of suitable words to express my recondite

sense of indebtedness –

� Dr. K. V. L. N. Acharuyulu M.D. (Ayu) Principal & Dean

� Dr. P. V. Sauvnur M.D. (Ayu) Vice-Principal

� Dr. V. S. Patil M.D. (Ayu) Medical Advisor

� Dr. Sanghamitra Patnaik, M.D. (Ayu) Guide & H. O. D.

� Dr. Anilkumar Bacha M.D. (Ayu)

N. K. J. A. M. C., P. G. Research Center, Bidar.

It is beyond the reach of my language to inscribe the profound

respect and devotion towards affectionate to

� Dr. Harini C. M.D.(Ayu), Asst. Prof. PG Dept. Of Panchakarma

� Dr. Manikrao Kulkarni M.D.(Ayu), Lecturer, PG Dept. Of Panchakarma

� Dr. Nagesh Gandagi, M.D. (Ayu) Lecturer, Dept. of Kayachikitsa

� Dr. Deepali Sherikar M.D.(Ayu), Lecturer, Dept. Of Kayachikitsa

� Dr. Sanjeev Kadalewad M.D.(Ayu), Lecturer, Dept. Of Kayachikitsa

� Dr. Ratnakar L. V. M.S.(Ayu), Prof. & HOD PG Dept. Of Prasutitantra

� Dr. Bandeppa Sangolagi, M.D. (Ayu) Asst. Prof. Dept. of Rasashastra

� Dr. Praveen Shimpi M.D. (Ayu) Asst. Prof. Dept. of Rasashastra

� Dr. Chandrakant Halli M.D. (Ayu) Asst. Prof, PG Dept. of Shalyatantra

� Dr. Divyadarshan Shelly M.D. (Ayu) RMO & Lecturer Dept. of

Shareera Rachana

N.K.J.A.M.C., & P.G. Research Center, Bidar.

I express my obligation and heartfelt thanks to my teachers � Dr. Anand Jabshetty M.S. (Ortho) Asst. Prof. BIMS, Bidar. � Dr. Vijaykumar Kote M.D.DVD Dermatologist, Asst. Prof. BIMS, Bidar. � Dr. Sipra Sasmal M.D. (Ayu) C.C.R.A.S., Bhuvaneshwar. � Dr. Mallikarjun Malipatil M.Pharma., Ph. D. Professor Dept. Of

Pharmacognosy, Karnataka College of Pharmacy I acknowledge technical and non-technical staff members of our

institute who have helped me – Shri. Rajakumar Kadam, (Lib.) Smt. Sakubai, Shri. Rajkumar, Shri. Kanteppa, Shri. Basavaraj, Smt. Parvathi, Smt. Guramma, Smt. Padmavati, Mr. Jagadish, Mr. Santosh, Shri. Mohan Reddy, at N. K. J. A. M. C., P. G. Research Center, Bidar.

I wish to express thanks to my friends, seniors, juniors & colleagues. Special thanks to Dr. K.P. Namboothiri, Dr. Girish, Dr. Pradeep, Dr. Gourish, Dr. Mahesh, Dr. Vivek, Dr. Prashant, Dr. Omprakash, Dr. Siddharam, Dr. Santosh, Dr. Shankar, Dr. Satish, Dr. Jyoti Dr. Raju, and Dr. Muralikrishna As I recall my parents Shri. Shivaputra B. Managuli and Smt. Sushila who advised me to enter in this noble profession. The truth dawns on me that the language of words suffers very stringent limitation. I have not been able to find words enough to express my sentiments, love, respect and gratitude for them.

I must record the occasion to show love and gratitude towards my younger brother Mr. Sunil & Shri. Umesh Patil & Smt. Sunita who inspired and blessed me to achieve this milestone in my life along with their timely help in many ways like moral support, financial assistance, etc.

I acknowledge my patients for their wholehearted consent to participate in this clinical trial. I thank my patients who exhibited high level of patience and subjected themselves for cooperating with me in every stage of my clinical work.

Lastly I express my thanks to all the persons who have helped me directly and indirectly with apologies for my inability to specify them individually. I did this work as a partial fulfillment of Post graduation degree, but dedicate to forthcoming researchers of Ayurveda.

DATE : (Anil S. Managuli) PLACE : BIDAR.

ABBREVIATIONS

� AH – Ashtanga Hridaya

� AS – Ashtanga Sangraha

� CS – Charaka Samhita

� BV – Bhavaprakasha

� MN – Madhava Nidana

� ShS – Sharangadhara Samhita

� SS – Sushruta Samhita

� YR – Yoga Ratnakara

� AD – Arundatta

� Gr – Group

� BT – Before Treatment (Day 0)

� AT – After treatment (Day 7)

� FU1 – 1st Follow up (45 Days after treatment)

� FU2 – 2nd Follow up (75 Days after treatment)

� FU3 – 3rd Follow up (105 Days after treatment)

� NI – No improvement

� MiR – Mild relief

� MoR – Moderate relief

� MrR – Marked relief

� CR – Complete relief

ABSTRACT

Background and Objectives

Acne vulgaris is a chronic inflammatory disease of the

pilosebaceous units of the skin of certain body parts with formation of a

papules / pustules eruption commonly known as pimples. The classical

description of Youvana Pidaka resembles with this.

Objective of the present study was to evaluate and compare the

effect of Vamana with Lepa and only Lepa in Youvana Pidaka (Acne

vulgaris).

Methods

30 patients filling the inclusion criteria of Youvana Pidaka were

randomly selected and divided into 2 groups. In Gr. A the patients were

subjected for Vamana with Kritavedhana followed by Manjishta Madhu

Lepa. In Gr. B the patients were subjected for Manjishta Madhu Lepa.

Source of the data – Patients were selected from OPD and IPD of

PG Department of Panchakarma, N.K.J.A.M.C., P. G. Research Center,

Bidar.

Clinical signs and symptoms were given suitable self formulated

scores according to its severity. Patients were assessed based on pre and

post data gathered through pre-designed research proforma.

The results having ‘p’ value less than <0.05 was considered to be

statistically significant in this study.

Results

Overall effect of the treatment in Gr. A was –

� Moderate improvement was found in 05 patients (33.33%)

� Marked improvement was found in 08 patients (53.33%)

� Complete relief was found in 02 patients (13.33%)

Overall effect of the treatment in Gr. B was –

� Moderate relief was found in 09 patients (60%)

� Marked improvement was found in 06 patients (40%)

Interpretation and conclusion

� Manjishtha-Madhu Lepa was found effective in the management of

Youvana Pidaka

� All the patients were responded to the given treatment without any

complications

� In most of the cases complete relief was found in pain, burning

sensation, number of Pidaka, dryness of the face, score of the

Pidaka on the basis of affected place and global acne grading

system after the treatment

� Manjistha-Madhu Lepa is an efficacious, cost effective, safe and

better drug in the management of Youvana Pidaka (Acne vulgaris)

� The effect of Lepa followed by Vamana was better than only Lepa

prescribed to the patient

� The result obtained in Gr. A were better than in Gr. B after treatment

as well as during subsequent follow ups with minimal recurrence

KEY WORDS –

Youvana Pidaka, Vamana, Lepa, Kritavedhana, Majishtha, Madhu.

CONTENTS

Chapters Page No.

01) Introduction 01 – 03

02) Objectives 04

03) Review of literature 05 – 72

� Ayurvedic review 05 – 39

� Modern review – Shareera and Disease review 40 – 72

� Drug review 73 – 00

04) Methodology 00 – 86

05) Observations & Results 87 – 140

06) Discussion 141 – 173

07) Conclusion 174 – 175

08) Summary 176 – 178

09) Bibliography i – xviii

10) Annexure xix – xxxiv

LIST OF TABLES

SL. TABLE Pg. 01. Layers of the skin according to various authors 07 02. Explanation of Twacha According to Sushruta 08 03. Aharaja Nidana of Youvana Pidaka 13 04. Viharaja Nidana of Youvana Pidaka 14 05. Manasika Nidana of Youvana Pidaka 14 06. Anya Karana of Youvana Pidaka 14 07. Sign & Symptoms of Youvana Pidaka according to various

authors 18

08. Quantity of Sneha Dravya in Lepa formulation 31 09. Types of Lepa according to various seasons 32 10. Process of Vamana and effect of Vamaka Dravya 37 11. The criteria for the evaluation of Shuddhi 38 12. Samsarjana Krama on Various days 39 13. Differential Diagnosis on Acne Vulgaris 68

13a. Prescription guidelines for systemic antibiotics 70 13b. Adverse reactions associated with oral antibiotic usage 70 14. Drugs used during clinical study 73 15. Properties of Drugs used during clinical study 74 16. Karma & indication of Drugs used during clinical study 75 17. Preparation of Peyadi Samsarjana Krama 78

17a. Procedure of Conducting the Vamana 79 18. Distribution of patients registered in trial Groups 87 19. Distribution of patients according to Age 88 20. Distribution of patients according to Sex 88 21. Distribution of patients according to Religion 88 22. Distribution of patients according to Education 90 23. Distribution of patients according to Occupation 90 24. Distribution of patients according to Socio-Economic Status 90 25. Distribution of patients according to Habitat 92

26. Distribution of patients according to Marital Status 92 27. Distribution of patients according to Dietary Habits 92 28. Distribution of patients according to Prakriti 94 29. Distribution of patients according to Satwa 94 30. Distribution of patients according to Desha 94 31. Distribution of patients according to Vyayama Shakti 96 32. Distribution of patients according to Satmya 96 33. Distribution of patients according to Divaswapna 96 34. Distribution of patients according to Agni 97 35. Distribution of patients according to Ahara Nidana Specification 99 36. Distribution of patients according to Vihara Nidana Specification 100 37. Distribution of patients according to Site of Pidaka 101 38. Distribution of patients according to Chronicity 101 39. Distribution of patients according to Varna of Patient 103 40. Distribution of patients according to Shotha of Pidaka 103 41. Distribution of patients according to Onset of Pidaka 103 42. Distribution of patients according to aggravation of Pidaka

in Season

105

43. Distribution of patients according to Family history of acne 106 44. Distribution of patients according to Relation with

Rajopravrutti 106

45. Distribution of patients according to Type of Vedana 108 46. Distribution of patients according to Number of Pidaka 108 47. Distribution of patients according to Density of Pidaka 108 48. Distribution of patients according to Nature of Pidaka 110 49. Distribution of patients according to Area Affected 110 50. Distribution of patients according to Size of Pidaka 111 51. Distribution of patients according to Number of scars 111 52. Distribution of patients according to Pain 112 53. Distribution of patients according to Burning Sensation 112 54. Distribution of patients according to Use of cosmetics 115 55. Distribution of patients according to Dosha Pradhanata 115

56. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of pain in both the groups

117

57. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of burning sensation in both the groups

119

58. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of number of Pidaka in both the groups

121

59. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of size of Pidaka in both the groups

124

60. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of number of scar in both the groups.

126

61. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of oiliness of the face in both the groups

128

62. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of dryness of the face in both the groups

131

63. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of score of the Pidaka on the basis of affected place in both the groups

133

64. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of score of the Pidaka on the basis of Global Acne Grading System place in both the groups

135

65. The % of improvement in Individual Symptoms of Youvana Pidaka After treatment & 3rd Follow up

138

66. The over all Response of the Therapy 139

66a. The percentage of improvement in individual parameters of Youvana pidika after the treatment and Third follow up

66b. The over all improvement in both groups after treatment in all the parameters

67. Master Chart Showing Demographic Data of patients in group B.

–

68. Master Chart Showing Demographic Data of patients in group B

–

69. The assessment of Pain before & after the treatment and in all three follow ups

xxx

70. The assessment of burning sensation before & after the treatment and in all three follow ups

xxx

71. The assessment of number of Pidaka before & after the treatment and in all three follow ups

xxxi

72. The assessment of size of Pidaka before & after the treatment and in all three follow ups

xxxi

73. The assessment of number of scars before & after the treatment and in all three follow ups

xxxii

74. The assessment of oiliness of the face before & after the treatment and in all three follow ups

xxxii

75. The assessment of dryness of face before & after the treatment and in all three follow ups

xxxiii

76. The assessment of score of Pidaka on the basis of affected place before & after the treatment and in all three follow ups

xxxiii

77. The assessment of global acne grading system before & after the treatment and in all three follow ups

xxxiv

LIST OF GRAPHS

SL. TABLE Pg.

01. Age-wise distribution of the patients 89

02. Sex-wise distribution of the patients 89

03. Religion-wise distribution of patients 89

04. Educational status-wise distribution of the patients 91

05. Occupation-wise distribution of the patients 91

06. Socio-Economic status-wise distribution of the patients 91

07. Habitat-wise distribution of the patients 93

08. Marital status-wise distribution of the patients 93

09. Dietary habits-wise distribution of the patients 93

10. Prakriti-wise distribution of the patients 95

11. Satwa-wise distribution of the patients 95

12. Desha-wise distribution of the patients 95

13. Vyayama Shakti-wise distribution of the patients 97

14. Satmya-wise distribution of the patients 97

15. Divaswapna-wise distribution of the patients 98

16. Agni-wise distribution of the patients 98

17. Ahara specific Nidana wise distribution of the patients 102 18. Vihara specific Nidana wise distribution of the patients 102

19. Site of Pidaka-wise distribution of the patients 102

20. Chronicity-wise distribution of the patients 104

21. Varna of patient-wise distribution of the patients 104

22. Shotha of Pidaka-wise distribution of the patients 104

23. Onset of Pidaka-wise distribution of the patients 105

24. Aggravation of Pidaka in Season-wise distribution of the patients

107

25. Family history of Pidaka-wise distribution of the patients 107

26. Relation with menses-wise distribution of the patients 107

27. Type of Vedana-wise distribution of the patients 109

28. Number of Pidaka-wise distribution of the patients 109

29. Density of Pidaka-wise distribution of the patients 109

30. Nature of Pidaka-wise distribution of the patients 113

31. Area of Pidaka involved-wise distribution of the patients 113

32. Size of Pidaka-wise distribution of the patients 113

33. Number of scars-wise distribution of the patients 114

34. Pain-wise distribution of the patients 114

35. Burning Sensation-wise distribution of the patients 114

36. Use of Cosmetics-wise distribution of the patients 116

37. Dosha Pradhanata-wise distribution of the patients 116

38. % of Reduction in mean score in Pain of Pidaka 123

39. % of Reduction in mean score in Burning sensation 123

40. % of Reduction in mean score in Number of Pidakas 123

41. % of Reduction in mean score in Size of Pidakas 130

42. % of Reduction in mean score in Number of Scars 130

43. % of Reduction in mean score in Oiliness of the face 130

44. % of Reduction in mean score in Dryness of the face 137

45. % of Reduction in mean score in Score of Pidaka on the basis of Affected area

137

46. % of Reduction in mean score in Acne Global Grading Sysem

137

47. Results obtained After treatment & 3rd Follow up in Group A 139

48. Results obtained After treatment & 3rd Follow up in Group B 140

49. Over All improvement in Group A 140

50. Over All improvement in Group B 140

LIST OF FLOW CHARTS, FIGURES & PHOTOGRAPHS

Sl. Table Pg. FLOW CHARTS

01. Samprapti of Youvana Pidaka according to Sharangadhara

16

02. Samprapti of Youvana Pidaka according to Vagbhata & Sushruta

16

03. Summerized Samprapti of Youvana Pidaka 17 04. The Procedure of Lepa in detail 30 05. Pathological Consequences in Acne Vulgaris 53

PHOTOGRAPHS 05. Ghrita, Tila Taila, Yashtimadhu Kwatha Churna 06. Madhu, Ksheera, Yashtimadhu Phanta 07. Kritavedhana and Kritavedhana Churna 08. Dried Kritavedhana, Kritavedhana soaked in Yashtimadhu Phanta,

Kritavedhana ready for usage during Vaman 09. Saindhava Lavana, Manjishta, Manjishta-Madhu Paste ready for

application 10. Saindhava Jala, Trikatu Churna, Snehapana with Moorcchita Ghrita 11. Sarvanga Abhyanga with Moorcchita Tila Taila 12. Sarvanga Bashpaswedana, Aakantha Pana, Patient during Vamana

procedure 13. Mukha Prakshalana, Dhoomapana, Containts of the vomitus 14. Anatomy of Skin and Pathogenesis of Acne vulgaris 15. Pathogenesis and Clinical presentation of Acne vulgaris 16. Group – A – Vamana followed with Manjishta Madhu Lepa – Before,

During and After the treatment 17. Group – A – Vamana followed with Manjishta Madhu Lepa – Before

and After the treatment 18. Group – B – Only Manjishta Madhu Lepa – Before, During and After

the treatment

INTRODUCTION

Ayurveda, the holistic healing Shastra, deals with the concept of

individual approach. The preventive and curative aspects1 of individual life

related entities are summed up in eight branches of Ayurveda.2

Panchakarma is developing as an emerging individual specialty field

of research in Ayurveda. It has become the sole attraction of the Ayurvedic

treatment. All most all specialties require the Panchakarma procedures,

hence gained much popularity.

It is the natural instinct of mankind to have a healthy and glamorous

skin with attractive personality. But very few are blessed with naturally

perfect skin. People always have great concern about their health and

beauty (i.e. good looking). Thus, health and beauty are the two faces of

single coin.3

Face is the index of body & mind. Youvana Pidika is a most common

anomaly, usually self limiting, found in teenagers and young adults.4 This

results in disfigurement of facial skin leads to feeling of inferiority complex

and sometimes depression, isolation from society, suicidal tendency, etc.5

It is produced due to combine association of vitiated of Vata, Pitta, Kapha

Doshas along with Rakta as dushya.6 It is explained under the concept of

Kshudraroga.7


pilosebaceous units of the skin in certain body parts with formation of a

papules / pustular eruption commonly known as pimples.8 The classical

description of Youvana Pidaka resembles with this.

It commonly affects the skin of face involving forehead, cheeks,

nose, and chin. It rarely affects neck, chest, shoulder, back. It is closely

related to the hormonal changes at puberty.9 Nearly 8 out of 10

adolescents suffers from acne vulgaris. Majority of patients recovers with

20-25 years, although 10-20% of adults may experience its severe forms.10

In women, it rarely lasts beyond the early 30’s and normally it is worse

before each menstrual period.11

Various systems of medicines come up with various remedies and

therapeutic procedures stating from simple topical applications till the

extensive management like use of X-ray, antibiotics, multivitamins,

hormones, corticosteroids, etc. In spite of their therapeutic values, these

procedures posses temporary relief, limitation and several health hazards

on body.12

Cosmetology is branch of medicine which is coming up with the

various methods to preserve and to restoring bodily beauty. Various

chemical and cosmetic agents are taken into practice which has got

temporary effect. Some of the chemicals used in the practice of

Cosmetology produces severe allergic reactions in few people.

Looking into above facts there is a need of treatment which can

prevent complications of the disease as well as reduces the recurrence

effectively.

In classics dozens of topical applications are explained for this

condition. Among that Manjishta-Madhu13 external application was

selected for the present clinical study.

Vamana is the treatment of choice for Kustha’s which produces in

Urdhvanganga Shareera. Sushruta14 praised utility of Vamana as a best

remedy, capable of alleviating the pathogenesis of Youvana Pidika

efficiently.

So an effort was made to study the comparative efficacy of Vamana

followed by Manjishtha Lepa & only Manjishtha-Madhu Lepa in the

management of Youvana Pidika.

30 patients were randomly selected and subjected into 2 groups.

� Group A – 15 patients were subjected for Classical Vamana

followed with Manjishta-Madhu Lepa.

� Group B – 15 patients were subjected for Manjishta-Madhu Lepa

alone.

During the duration of study the patients were assessed on the basis

of pre and post treatment with pre-designed research profile and self

designed severity grading. The data was collected as pre treatment (Day 0

– BT), after treatment (Day 30 – AT), first follow up (Day 45 – FU1 from

AT), second follow up (Day 75 – FU2 from AT), third follow up (Day 105 –

FU3 from AT).

OBJECTIVES OF THE STUDY

Vamana is one of the major procedures in Panchakarma. This is

a Shodhana procedure which has got effect all over the body with long

term results.

Lepa is local treatment procedure in which the medication is

made into a paste form and applied over the desired site with particular

thickness and removed after specified time.

The present study was undertaken in 2 groups with a course of

Vamana followed by Lepa and Lepa alone in cases of Youvana Pidaka

(Acne vulgaris). The samples were collected from OPD and IPD of

Department of P.G. Studies in Panchakarma, N. K. J. A. M. C. & P. G.

Research Center, Bidar with following objectives –

� Evaluate the effect of Manjishta-Madhu Lepa in Youvana Pidaka

� Evaluate the additional effect of Vamana with Kritavedhana followed

by Manjishtha-Madhu Lepa in Youvana Pidaka

� Compare the effect of only Lepa over the Vamana followed by Lepa

in Youvana Pidaka

HISTORICAL REVIEW

Youvana Pidaka is a common condition observed in day to day

life. But, detail explanation about its aetiopathogenesis is not mentioned in

classics. Numbers of remedies are explained in all most all treatises and

even in traditional practice.

PRE-VEDIC AND VEDIK ERA

The Vedik literature was the treasure of knowledge in those days. It

has briefed all the life related sciences in it. But the word Youvana Pidaka

or Youvana Pidaka and its independent explanation is not found in pre

Vedic or Vedic period.

Reference of the term Youvana Pidaka is found in Purana Kala,

Bhauddha Kala and Adhunika Kala.

SAMHITA PERIOD (BRIHAT TRAYEES)

Though the Samhita period was the important period for the

documentation of the clinical experiences of the sages, Sushruta was the

first to describe about Youvana Pidaka in the context of Kshudraroga.

Explanation about the condition is not found in Charaka.

LAGHU TRAYEES

After Sushruta, later texts have included the Youvana Pidaka in their

literature. The texts like Madhava Nidana, Sharangdhara, Vangasena,

Gadanigraha, Chakradatta, Basavarajeeyam, etc have briefed the aetio-

pathology of the disease and explained several treatment modalities for

the same.

ADHUNIKA KALA

Youvan Pidika described in later texts like Rasakamdhenu,

Yogaratnakara, Bhaishajya Ratnavali, Arkaprakasha, Brihat Rasaraja

Sundara, etc.

TWAK SHAREERA

Youvana Pidaka is a skin disease. For better understanding of

etiopathogenesis, normal structure of the skin should be considered.

FORMATION OF TWACHA

According to Sushruta, Twak has developed after the fertilization of

the ovum. At the time of fertilization Shukra, Shonita and Soul become

united for the manifestation of Garbha. Its growth is rapid and nourished by

Tridosha. Seven folds of the layers of the skin are formed in the embryo

during the first and second trimester of pregnancy, similar to as milk gets

its cream over the surface during boiling.01

Twacha is derived out of Panchamahabhoota. Vayu Mahabhuta

predominance creates tactile sensation. Bhrajaka Pitta helps in absorption

and metabolism. Topical medicaments give luster and complexion to the

body.

Sweda is the Mala of Meda Dhatu. Charaka says, that 10 Anjali of

Sweda is formed in a healthy individual. Twak is included under Bahya

Rogamarga.

Twak is formed by the Paka of Rakta Dhatu by its Dhatvagni thus;

Twak is also called as “Rakta Santanika”. Vagbhata mentions that the skin

is fully developed during 6th month of intrauterine life.

Table No. 01. Layers of the skin according to various authors.

SL. SS CS AD ShS Bh

01. Avabhasini Udakadhara Bhasini Avabhasini Udakdhara

02. Lohita Asrukdhara Lohita Lohita Asrikdhara

03. Shweta 3rd Shweta Shweta 3rd

04. Tamra 4th Tamra Tamra 4th

05. Vedini 5th Vedini Vedini 5th

06. Rohini 6th Rohini Rohini 6th

07. Mamsadhara – – Mamsadhara Sthula

According to Sushruta and Vagbhata02 there are 7 layers of Twak

whereas, Charaka considered only 6 layers in Twak.

Sushruta has given specific name for each layer. Whereas, Charaka

has mentioned only the first two layers and numbered the others referring

them by the disease to which they are prone.

Vagbhata has given specific names to the first two layers and the

last one and the rest were numbered according to the diseases afflicting

them.

Ashtanga Sangraha follows the verse of Sushruta but used different

names for some layers. e.g. Avabhasini and Lohita have been replaced

with Bhasini and Lohini respectively. The names for the other four layers

are same as that of Sushruta.

The first layer Avabhasini is mentioned as Udakadhara both in

Charaka Samhita and Astanga Sangraha. This layer is so named because

it provides protection against the loss of fluids.

The total thickness of the skin is 3½ Vreehi (approximately 0.7 to

0.12mm). This varies in palm, sole and other Mamsala Pradesha but not in

Lalata Pradhesha.

Skin layers according to Sushruta03

Table No. 02. Explanation of Twacha according to Sushruta.

Sl. NAME FUNCTION Thickness in Vreehi

DISEASES

01. Avabhasini Reflects Varna Elucidate Chhaya & Prabha

1/18th Sidhma, Padmini, Kantaka

02. Lohita – 1/16th Tilakalaka, Nyaccha, Vyanga

03. Shweta – 1/12th Charmadala, Ajagallika, Mashaka

04. Tamra – 1/8th Kilasa & Kushta

05. Vedini – 1/5th Kushta & Visarpa

06. Rohini – 1 Granthi, Apachi, Arbda, Shleepada & Galaganda

07. Mamsadara – 2 Bhagandara, Vidradhi & Arshas

NIRUKTI

The word Youvana Pidaka contains two terms. Viz.

Youvana + Pidaka = Youvana Pidaka.

Where, Youvana referes to the incidence of the condition typically

during adulthood.

Pidaka refers to the formation of eruptions.

Combinely, it can be taken as the condition which typically observed

during adulthood in the form of eruptions over the face.

The word Mukhadooshika contains two terms. Viz.

Mukha + Dooshika = Mukhadooshika.

Where, Mukha refers to face

Dooshika refers to spoiler

Combinely, it can be taken as the condition which disfigures or spoils

the face.01

VYUTPATTI

It is a feminine gender and derived as

Youvano Vyutpatti: Youvanam (�� )

Pidika Vyutpatti: | – (��) = or circular swelling.

From the above two it is clear that the circular swelling like Pinda

(papule, pustule, nodule, etc) occurring on the face in youth is Youvana

Pidika.

“�� ”��

It means that, which disfigures the face along with discoloration is

known as Mukhadooshika.

Mukhadooshika = Mukhagata Kshudraroga Bhede.02

� ��

The Mukha Twak undergo Paka.03

The term “Youvana” is derived from04 “Youvanavasthayam” |

“Tachcha Panchadashadoordhwamuchyate” |

“Kaishoram Panchadashat Youvanantu Tataha Param”|

Pidaka is derived from

“Peedayati Iti Pidakaha”|

“Yasya Pittam Prakupitam Twachi Rakte Avatishtate |

“Shotham Saragam Janayet Pidaka Tasya Jayate” ||05

The aggravated Pitta located in the Tvaka and Rakta causes red

swelling which is known as Pidaka.

“Pidakayam Cha Sthiro Jneya Ata Eva Pidaka Sampraptau”|

The lesion, which is neither spreading nor stable in nature, is called

Pidaka.06

“Youvana” means Youth, Youthfulness, Puberty and Manhood.07

Pidaka means Kantaka that which occurs on the face of youth (Yuva

Kali Mukhajata Pidakayam).08

SYNONYMS

The synonyms were used to describe the nature of the condition and

highlight various facts of Youvana Pidaka.

1. Mukhadooshika09

2. Tarunya Pidaka10

3. Youvana Pidaka11

4. Varandaka12

5. Ananadooshika13

6. Vayasphoda14

Meanings of the above mentioned synonyms are as follows –

� Mukhadooshika – The condition which spoils the face of an

individual.

� Tarunya Pidaka – The condition which disturbs in adulthood.

� Youvana Pidaka – The condition which disturbs in early adulthood.

� Varandaka – The condition which appears along with the

growing age.

� Ananadooshika – The condition which disturbs the face.

� Vayasphoda – The eruption of the follicles or papule with the

growing age.

NIDANA

Youvana Pidaka is explained in the context of Kshudra Roga.

Hence, direct reference regarding detail etiopathological factors is not

found. Following are some of the Nidana that are explained during the

explanation of the condition as well as some of the cross references

mentioned in the context of Kushta and other skin diseases.

� Mala of Shukra Dhatu is Youvana Pidaka. So Shukra Vriddhi can be

taken a cause for Youvana Pidaka.15

� Youvana Pidaka occurs because of its Swabhava.16

� All three Doshas are involved in the manifestation of Youvana

Pidaka and even it occurs due to its Swabhava.17

� Youvana Pidaka is having Kapha, Vata and Rakta as Dooshya.

Hence we consider general causes of vitiation of Vata, Kapha and

Rakta as Nidana factors for Youvana Pidaka.18,19, 20,21,22,23

� Pidaka is one of the Raktaja Vikara. The causes of Raktaprakopa

are Krodha, Shoka, Bhaya, Aayasa, Vidagda Ahara Sevana,

Maithuna, excessive intake of Katurasa, Amlarasa, Lavanarasa,

Teekshna, Ushna, Laghu, Vidahi Ahara, excess intake of Tila Taila,

Pinyaka, Kulatta, Sarshapa, Atasibeeja, Haritashaka, Mamsa of

Godha Matsya, Aja, Avika, Dadhi, Takra, Sura and Amlaphala.24

Apart from these, intake of Drava, Snigdha, Guru Ahara,

Divasvapna, Krodha, excess Atapa Sevana, intake of

Viruddhashana and excess Parishrama causes Rakta Prakopa.25

� Excess intake of Teekshna, Ushna, Madya, Lavana, Kshara, Amla,

Katu Rasa, Kulattha, Tilataila, Moolaka, Harita Shaka, Jalaja and

Anupa Mamsa, Dadhi, Amlamastu, Sura, Souvira, indulgence in

incompetent food (Viruddha Ahara), Paryushita Ahara, consumption

of excess food, day sleep immediately after consumption of Snigdha,

Drava and Guru Ahara, excess exposure to sunlight, fire, excess of

anger, suppression of Chhardi and if non implementation of

Raktamookshana during Sharad ritu causes Pidaka in general.26

� According to Charaka foods and activities, which have similar

property to that of Dooshya causes Srotodushti, so here Rakta

Prakopaka Aahara and viharas causes the Youvana Pidaka.27

� Svabhava is bound to human body by invisible factors, is also

another factor for Youvana Pidaka.28,29

Brief description of Youvana Pidaka is available in all the Samhitas,

and they have mentioned Kapha, Vata, Rakta, as the causative factors of

the disease. Here the causes are summarized as follows –

All the Nidana can be divided in following categories. Viz.

1. Ahara

2. Vihara

3. Manasika and

4. Anya Karana

Table No. 03. Aharaja Nidana of Youvana Pidaka

DOSHA AHARAJA NIDANA

Vataja Excess intake of Katu, Tikta and Kashaya Rasas, Rooksha,

Laghu Guna Aharas,Varaka(Kudhanya), Uddhalaka,

Koradoosha, Shyamaka, Neevara, Mudga, Masoora, Shushka

Shaka Ahara Sevana

Kaphaja Excess intake of Madhura, Amla & Lavana Rasas, Sheeta,

Snigdha, Guru, Picchila, and Abhishyandhi Ahara Sevana.

Dadhi, Dugdha, Krishara, Payasa & Ikshu Vikara, Anupa

Udaka, Vasabisa, Mrunala, Kaseruka and Srungata mamsa,

Madhura Valli

Raktaja Excess intake of Lavana, Kshara, Katu, Amla Rasas, Jalaja,

Anupa, prasaha, Bileya, Aja, Avika mamsa, Kulatta and

Masha Dhanyas, Dadhi, Takra, Amlamatsu. Pradusta, Ushna,

Tikshna, Madya Sura & Souviraka. Tilataila, and Atasitailas,

Lashuna, Harita Shaka, Moolaka

Table No. 04. Viharaja Nidana of Youvana Pidaka

DOSHA VIHARAJA NIDANA

Vataja Anashana, Vishamashana and AdhyashanaVata, Mootra,

Pureesha, Shukra, Chardi etc.

Vega Vidharana, Balavat Vigraha, Ativyayama and Vyavaya,

Parapatana, Pradhavana, Prapeedana, Abhighata

Langhana, Plavana, Tarana, Ratri Jagarana, Bharaharana.

Dhatu Kshaya, Rogatikarshana, Dukha, Shyyasana,

Divaswapna, Marma Bhadha, Vishamad Upachara, etc.

Kaphaja Adhyashana, Prabhruti, Divaswapna, Avyayama, Alasya.

Raktaja Adhika Bhojana, Ati Atapa Sevana, Chardivega Dharana.

Not undergoing Raktamokshana during sharadritu, Excess

exhaustion, Adyashana

Table No. 05. Manasika Nidana of Youvana Pidaka

DOSHA MANASIKA NIDANA

Vataja Ati-Shoka, Bhaya, Chinta, Krodha and Udvega

Raktaja Ati-Shoka, Bhaya, Chinta, Krodha and Udvega

Table No. 06. Anya Karana of Youvana Pidaka

DOSHA ANYA NIDANA

Vataja Varsha, Vata Prakriti

Kaphaja Vasanta, Kapha Prakriti

Raktaja Sharad Ritu, Pitta Prakriti

SAMPRAPTI OF YOUVANA PIDAKA

Detail Samprapti of Youvana Pidaka is not mentioned in classics.

Here an attempt has been made to construct its step-wise Samprapti

based on available classical references and symptomatology.

Sharangdhara has accepted Mukha Snigdhata and Youvana Pidaka

as Mala of Shukra Dhatu. As mentioned earlier most of the classics have

mentioned the vitiation of Kapha and Vata Dosha and Rakta Dooshya

leading to Youvana Pidaka. Thus when Kapha and Vata get vitiated and by

involving Rakta produce Youvana Pidaka. As Youvana Pidaka is related

with Shukra therefore it occurs in young person during their adult hood.

SAMPRAPTI GHATAKA

1 Dosha – Kapha and Vata

2 Dooshya – Rasa, Rakta, Meda, Shukra

3 Upadhatu – Twacha

4 Mala – Sweda, Tvaksneha

5 Srotasa – Swedavaha, Raktavaha.

6 Srotodushti – Sanga

7 Agni – Dhatwagni Mandya

8 Sthana – Twak

9 Samutthana – Amashaya

10 Roga Marga – Bahya Marga

11 Udbhava sthaana – Ama-Pakvashaya

12 Sanchaara sthana – Urdhwa Shareera

13 Vyakta Sthana – Mukha

On the basis of the above Samprapti Ghataka following sketch of

Samprapti of Youvana Pidaka may be constructed.

Flow chart No. 01. Samprapti of Youvana Pidaka according to

Sharangadhara.

Nidana

� Kapha, Vata, Rakta Prakopaka

� Later involvement of Shukradhatvagni

� Excess of Shukradhatu Mala

� Vaktra-Snigdhata leads to YOUVANA PIDAKA

Flow chart No. 02. Samprapti of Youvana Pidaka according to Vagbhata &

Sushruta.

Nidana sevana �

Kapha, Vata, Rakta, Meda Prakaopa �

Rasa-Raktadi Dhatvagni Vaishamya (Mainly Medo Dhatvagni Mandhya)

� Excess Sweda Utpatti as Mala

(Sweda is Mala of Meda) �

Meda Sangha in Roma Kupa (Swedavaha Srotas Moola) �

YOUVANA PIDAKA

Flow chart No. 03. Summarized Samprapti of Mookhadooshika

Nidana

Dosha Prakopaka Dushya Dourbalyakara Agnimandyakara

Vata Pitta Kapha Rakta Meda Twak Sweda Ama

Kha Vaigunya in Swedavaha & Raktavaha Srotas

Kaphadhikya (Sebum �)

Sang In Swedavaha & Raktavaha Srotas

Shushakata in Kapha & meda

Dosha Samurchana

Pidika with Medogarbhi (Poorvaroopa)

Pittaja Vataja Kaphaja (Rupavastha)

Paka, Daha, Srava, Vedana,Rukshata Kandu, Snigdhata,

Vaivarnya, Ushnata Krishnata Kathinata

MUKHA DUSHANA VAIVARNYA VRANA VASTU (Nodule Cyst Comedon etc) (Perme of discoloration) (Scars)

PURVA RUPA (PREMONITORY SYMPTOMS)

The Poorvaroopa of Kshudra Rogas is not mentioned in classics.

While commenting on Charaka Chikitsa Vaatavyadhi Adhyaya,

Chakrapaani commented that, if Poorva Roopa is not mentioned, one

should consider the Laghu Roopa of the disease as Poorva Roopa. 30

ROOPA (SIGNS AND SYMPTOMS)

Signs and symptoms of Youvana Pidaka is summarized according to

various authors as follows –

Table No. 07. Signs and Symptoms of Youvana Pidaka according to

various authors.

SL. LAKSHANA SUSHRUTA VAGBHATA OTHERS

01. Shalmali Kantaka

Sadrusha Pidaka + + +

02. Ruja – + –

03. Contains Meda

In its core

– +

–

04. Ghana Shotha – + –

05. Involved Doshas Kapha, Vata

and Rakta

Kapha, Vata,

and Rakta

Vata, Pitta

Kapha (SKD)

06. Site of affliction Face Face Face

07. Age of occurrence Yauvana Yauvana Yauvana

The references of the above mentioned signs and symptoms are as

follow –

1. Shalmali Kantaka Sadrusha Pidaka31,32,33,34,35,36,37,38,39,40

2. Contains Meda 41,42

3. In its core Ghana Shotha43,44

4. Involved Doshas – Kapha, Vata and Rakta 45,46,47,48,49,50,51,52,53

Vata, Pitta, Kapha54

5. Site of affliction – Mukha (Face)55,56,57,58,59,60,61,62,63,64

6. Age of occurrence – Youvana65,66,67,68,69,70,71,72,73,74

7. Ruja75,76

DEFINITION OF YOUVANA PIDAKA

The painful eruptions enclosed with Meda, similar to the thorns of

Shalmali on the face during adulthood known as Youvana Pidaka. The

details of individual signs and symptoms are being elaborated as follows –

01. Resembles with Shalmali Kantaka

The eruptions are conical in shape, similar to the thorn of Shalmali

tree. Shalmali Kantaka is with broad base on the trunk of the tree and with

triangular projection. Similarly, the Mookhadooshika is having broad base

inside the skin and a small triangular eruption over the skin. Here this

simily is being used to demonstrate the shape of eruption.

Some believes that, Shalmali Kantaka simily is being given for the

pain in Mookhadooshika. Pain experiences the pain like pricking of the

thorns of Shalmali.

02. Pidaka

Pidaka means eruption. This disease is characterized by the

presence of multiple eruptions over the face.

03. Saruja

Saruja means with pain. The eruptions are painful and the pain may

be mild or sub-acute in nature. It may associate with burning sensation.

04. Ghana

Ghana word refers to the thick or turbid discharge. It also indicates

the hard in appearance of Pidaka before Paka. Ghana word also can be

taken as the deeply indurated eruptions over the skin. This particular

feature appears by the aggravated Kapha.

05. Medogarbhata

It means the eruptions are enclosed with the thick whitish cheesy

material which is also having the qualities resembling Meda. It occurs due

to the blockage of openings of pilosebacious gland.

When a gentle pressure is applied over the eruptions, it comes out

with some discharge, which is usually whitish, cheesy in appearance. This

discharge may vary in colour according to the dominant Dosha.

06. Yuna Mukhe

This condition typically observed in adulthood and with equal

incidence in both sexes. The most predominant site of this disease is

Mukha. Here, Mukha refers to the outer parts of the face except the mouth

such as checks, forehead, nose and chin are affected.

COMPLICATIONS OF MOOKHADOOSHIKA

As such there is no direct reference in classics regarding the

complications of Youvana Pidaka except disfigurement of the face.

TREATMENT OF YOUVANA PIDAKA

Dozens of remedies are mentioned in classics for this condition. The

management of Youvana Pidaka can be done in 3 ways.

� Medicinal management

� Para-surgical management

� Surgical management

MEDICINAL MANAGEMENT

It includes two types of therapies. Viz. –

� Systemic therapies – This includes the utility of Panchakarma

and other para-surgical procedures.

� Local therapies – This includes the utility of various types of

procedures like Lepa, Gharshana, Swedana, etc.

Systemic Management

01. Vamana : It is the best procedure to subside the Kaphaja

abnormalities and even in Youvana Pidaka. It is also indicated in classics

that, when all the therapeutic management is not giving satisfactory

results, then go for Shodhana therapies, typically Vamana. 77,78,79,80,81,82,83

02. Nasya : The mediciitons are administered through nostril for

the Urdhvajatrugata Dosha Shamana which may also its influence over the

Youvana Pidaka.84,85

03. Virechana : This therapy is specific for Pitta Dosha, or Pitta

Samsarga Doshas. This procedure removes excessive Pitta through

Adhomarga. Thus, helps in Samprapti Vighatana of Youvana Pidaka.

Local Management

As per the disease pathology concern local therapies like facial

massage, application of various medications, etc got an immediate impact

on the Youvan Pidika. Various formulations are prescribed in classics for

the topical usage in the form of powder, past, oil, ghee, gel, etc. The

method advised for the application of medication includes special regimens

like Prakshalana, Snehana, Swedana, Lepana and Gharshana.

Lepa

Rational combination of Varnya dravyas used in the form of external

application in Youvana Pidaka. It is found very efficacious when used

simultaneously with internal administration of the Raktashodhaka,

Pittarechaka drugs.86

� In Youvana Pidaka use Lepa prepared out of drugs like Vacha,

Lodhra, Saindhava and Sarshapa87,88,89,90,91,92,93

� Dhanyaka, Vacha, Lodhra and Kusta applied over the face is also

useful.94

� Application of the Lepa prepared out of Lodhra, Tuvaraka95

� Vatapatra, Narikelapushpa, and Shukti are useful96,97

� Lepa of Lodhra, Dhanyaka, Vacha over Mukha is

useful.98,99,100,101,102,103,104,105

� The Lepa prepared out of Gorochana and Maricha.106,107,108,109,110

� Matulungajata, Ghrita, Manashila and cow dung these formulation

should be applied over the face it improves the complexion and

cures the Youvana Pidaka and Nyaccha.111

� Milk and Shalmali thorn. If fails then Vamana is to be done.112,113,114

� Lepa prepared out of Jatipala, Chandana, Maricha115,116

� Bark of Arjuna tree and milk117,118,119

� Manjishta Churna with Madhu120,121,122

� Washing the face with Varunadi Kwata and Lepa prepared out to

Vatapatra, Malathi, Raktachandana, Kusta, and Lodhra, or

Matulungajata, ghee, Manashila, Lodhra are applied over the

face.123

� Kumkumadi Taila Abyanga can also be done. 124

� In all Kshudrarogas Sarpi, Nimbachurna and Parpati is to be given

internaly.125

� Sahacharaghrita126

� Parada Bhasma can be used along with other suitable drugs or with

any other Yogavahi formulations can be used to treat Kshudra

Rogas.127

� Haridradi Lepa can be applied for face. Manjishtadi Taila to be over

the face.128

� Masuradal fried with milk and applied over the face or Kaliyaka,

Neelakamala, Kushta, Priyangu Pushpa with milk or Tusharahita

Masoora, Yashtimadhu, Yava, Lodhra with milk or Haridra Churna

with Arka Ksheera.129

PARASURGICAL MANAGEMENT

If the medical treatment does not give better results Raktamokshana

/ Siravyadha is advised as a parasurgical procedures are advised in

Youvana Pidaka.130, 131,132,133,134

SURGICAL MANAGEMENT

Even after para-surgical procedures, if the patient has not got

satisfactory relief, following surgical procedures are indicated.

� Chhedana

� Agni Karma

� Kshara Karma

Line of treatment prescribed by various Acharyas can be

summarized as follows –

� Sushruta Samhita : Vamana, Lepana

� Ashtanga Hridaya : Vamana, Lepana, Nasya, Siravedha

� Ashtanga Sangraha : Vamana, Lepana, Siravedha

� Chakradatta : Vamana, Lepana, Siravyadha &

Abhyanjana.

PATHYA AND APATHYA

By considering the involved Dosha, Dooshya and Avastha

Patyaapathya have to be employed. 135,136

PREVENTIVE MEASURES

� Mukha Prakshalana – The healthy person should wash his face

and eyes with the decoction of Ksheeriya Vriksha (lactiferous trees)

mixed with milk or that of Amalaka or with simple water. It alleviates

shortly blue spots, dryness of face, boils, freckles and other diseases

caused by Rakta and Pitta. It also makes the vision strong, light and

easy.137

� Abhyanga – Relieves Kapha and Vata. Restores the proper color

and complexion and acts as a nutrient to Dhatu. It prevents the

ageing tiredness and eyes become clear, increases the life of the

person, person will get the proper sleep and skin become healthy

wrinkle free.138

� Udhvartana – Relieves Kapha and Medas. It stabilizes Twak and

gives complexion to the skin.139

� One should under go Rakta Mokshana in Sharad Ritu.140

LEPA

The external application of a paste prepared from the drugs is

known as Lepa. It is used to improve the skin health as well as to relieve

the diseases.

ETYMOLOGY AND DERIVATION OF LEPA

The word Lepa is derived from its root “Lip” affixed by “Vang”

Pratyaya.1

� Lepanam – “Lipyati, Anena iti Lepanam”

It means, the one which is used for anointing is Lepa.2

� Pradeha – (Pradeha + Gung) Lepa.

� Lepa – (Lip + Gung) smearing plastering, anointing.

� Lip – Smearing, anointing, plastering.

� Lepa – The act of smearing - anointing + plastering.

DEFINITION

Medicines in the form of paste used for external application are

known as Lepa.

Synonyms : Lipta, Lepa or Lepana.3

TYPES OF LEPA

� Pralepa – The paste which is cold, thin and non-drying or drying i.e.

with absorbing or non-absorbing property.

� Pradeha – The paste which is warm or cold, thick or thin acts as

non-absorbent and which is Vata and Kapha Shamaka. It cleanses,

heals, and alleviates inflammatory swelling and pain.

� Alepa – Midway between Pralepa and Pradeha is Alepa. It is of

medium character and it normalizes the Rakta and Pitta. 4

Charaka has classified Lepa as follows –

� Kaathinyakara Pralepa – It is used in Vrana Shaithilyata and in

Sukumara. It also have the property of Prasadana.5

� Maardavakara Pralepa – It is used in Saruja, Kathina, Stabdha

and Nirasrava Vrana.6

� Ropana Pralepa – It is used as Twak Grahnanti (binding of torn

skin).7

� Shodhana Pralepa – It is Twak Shuddhikara.8

� Twak Kaarshnyakara Lepa – It is used for Krishna Karma in the

discolored skin caused by a Vrana. 9

� Savarneekarana Lepa – This Lepa is used for enhancing color

and complexion.10

� Varnakara Lepa – To get the normal color of skin from healed

Vrana this Lepa can be used.11

� Roma Sanjanana Lepa – It is used for the reproduction of Roma

which got destroyed by the Vrana. 12

Vagbhata13 has mentioned 10 types of Lepa based on their different

actions are as follows –

� Snaihika Lepa (Oliating or Lubricatory) – This is meant for Vata

Dosha and is prepared with Snighda Dravya or Dravya added with

more of fats.

� Nirvaapana Lepa – This is meant for Pitta Dosha, Pittaja and

Vishaja Shotha, burning caused by Agni and Ksharadagdha. In this

Sheeta Dravya are used.

� Prasaadana Lepa – This is similar to Nirvaapana Lepa and it is

meant for cleansing the vitiated blood present inside.

� Stambhana Lepa – Apart from having Nirvaapana Lepa property it

has the additional property of Rakta Stambhana in Raktaatipravrutti.

� Vilayana Lepa – It is meant for Shleshma and Medas predominant

Shotha which does not undergo Paka because of its Sheetata,

Grathita and Rookshata.

� Paachana Lepa – It does the Paachana of Apakva Shotha, by using

Rooksha and Ushna Dravya.

� Peedana Lepa – This can be made use in Sookshma Vrana by

application of Rooksha and Picchila Dravya.

� Shodhana Lepa – It is indicated in Ashuddha Vrana where using

Shodhana Dravya can do Shodhana.

� Ropana Lepa – As the name indicates it is used for Ropana of

Shuddha Vrana.

� Savarneekarana Lepa – It is meant for bring back the normal skin

color after the ulcer has healed.

Apart from these, 3 more types of Lepa are explained by Vagbhata

and Sharngdhara are as follows –

� Doshaghna – The Lepa, which alleviates the impure Doshas called

as Doshaghna Lepa. Due to Prakopa of Dosha following features

may appear i.e. Shotha, Shoola etc. To reduce vitiated Dosha this

Lepa is useful. Its thickness is 1/4th Angula.14 for Vata and Kapha

vitiation Ushna Lepa is advised. Similarly for Pitta, Sheetala Lepa is

advised.15

� Vishaghna – That which nullifies the poisonous effect is Vishaghna

Lepa. Vitiation of Dosha may occur either due to Sthaavara or

Jangama Visha Oushadhi. Lepa can be applied to suppress the

effect of such Visha or there fore it is called Vishghna Lepa. Its

thickness is 1/3rd Angula. 14 Vishaghna Lepa is said to be Sheetala in

nature.15

� Varnya – That which increases the skin color is Varnya Lepa.Many

diseases like Vyanga, Pitika, etc lose normal color and complexion

of the face. The Lepa used for its correction is called Varnya Lepa. It

is ½ Angula in thickness.14 For Varnya purpose Sheetala Lepa is

used.15

GENERAL RULES AND REGULATIONS OF LEPA16

� Always Lepa should be applied in the opposite direction of hair

follicles.

� The Lepa should not be left in situ after drying. It must be removed

as soon as it dries up, until the Lepa is wet, it helps to cure the

disease but, as soon as they are dried they lose their potency and

irritate the skin. Except in Pralepa, this is kept even after drying for

Peedana action in Vrana Shotha.

� Lepa should be prepared freshly and used.

� Lepa drug should not be reused.

� Fresh Lepa should not be applied over previous one.

� Lepa should not be applied at night, if applied it causes skin

diseases by suppressing local temperature and also enhances the

Roga Lakshana.

� Do not cover the Lepa with cloth because it causes retention of

sweat, which in turn leads to Pidaka, Kandu etc. complications.

� Lepa should neither be too Snighda nor too Rooksha. Neither solid

nor liquid (It should be of medium consistency.)

� The thickness of Pradeha should be Ardra Maheesha Charmavat

like that of wet skin of the buffelow17 or 1/3rd of angula.18

� Ratri Lepa is indicated in Vrana associated with Apaka shopha, Vata

and Shleshma, Kshata, Raktaja Vikara and which is Ati Gambheera.

If in Pittaja Shopha Vata Pitta Lakshanas are present then

Shatadhouta Ghrita application is advised.19

GENERAL METHOD OF LEPA FORMULATIONS

� Lepa can be prepared from both dry and wet drugs.

� The dry drugs are powdered fine individually in a Khalvayantra and

mixed well if compound formulation is advised.

� Add required or advised liquids to prepare paste. Some of the

liquids advised in classics are Goghrita, Goksheera, Gomutra,

Divyajala, Madhu, Taila, Swarasa, Kashaya, etc.

LEPA KARMA PROCEDURE

This can be subdivided into 3 types. Viz. –

� Poorvakarma

� Pradhanakarma

� Paschyata Karma

Poorvakarma for Mukha Lepa

There is no specific reference for the Poorvaroopa of Lepa. But,

Mukha Prakshalana with Luke warm water can be done as a part of

Poorvaroopa in Lepa procedure.

Pradhanakarma for Mukha Lepa

The procedure for Lepa application is mentioned individually in

respective contexts. The Lepa Karma used in this context is as follows –

Flow chart No. 04. The procedure of Lepa in detail.

Patient is advised to wash the face with luke warm water

Apply the Lepa in the opposite direction of hair follicles.

Apply the medicine with gentle pressure and massage.

Allow the medicine to be applied for specific period, like till it gets dried.

Then the applied medicine is to be removed.

PASCHAT KARMA OF LEPA20

� Mukha Prakshalana with Jala after wetting the lepa with water.

� Abhyanga to face

UTILITY OF SNEHA DRAVYA IN LEPA FORMULATION

The utility of Sneha Dravya in Lepa formulation according to Dosha

is mentioned as follows –

Table No. 08. Quantity of Sneha Dravya in Lepa formulation.

SL. DOSHA QUANTITY OF SNEHA DRAVYA

01. Vataja Vyadhi 1/4th part of Senha Dravya

02. Pittaja Vyadhi 1/6th part of Sneha Dravya

03. Kaphaja Vyadhi 1/8th part of Sneha Dravya

MUKHA LEPA ACCORDING TO VARIOUS KALA

� In Ushna Kala Lepa is applied for soothing effect and Lepa drugs

should be Parama Sugandhi and Sheeta in Veerya.21

� In Sheeta Kala Lepa is producing Ushnata and it will be Vata Kapha

Nashaka effects.22

� Vagbhata has mentioned different Dravya to be used for Mukha

Lepa according to different Ritu.23

MUKHA LEPA ACCORDING TO SEASON

In classics, various Lepa are advised according to various seasons.

Table No. 09. Types of Lepa according to various seasons.

SL. SEASON SPECIFIC LEPA

01. Hemanta Kola Majja, Vrishanamoola and Goura Sarshapa.

02. Shishira Simhimoola, Tila, Krishna, Darvi twak, Nistusha and Yava.

03. Vasanta Darbhamoola, Hima Usheera, Shireesha, Mishiba and Tandula.

04. Greeshma Kumuda, Utpala, Kalhara, Doorvi, Maduka and Chandana.

05. Varsha Kaleeyaka, Tila. Usheera, Mamsi, Tagara and Padmaka.

06. Sharad Taleesa, Gundra, Pundra, Yasti, Kashanata and Agaru.

BENEFITS OF LEPA24

Mukhalepa helps to overcome the diseases like Akaala Palita

(Gryaying of hair), Vyanga (Discoloured patches over face), Vali

(Wrinkles), Timira and Neelika (Blur vision and Bluish discolouration),

Relieves burning sensation, Itching and Pain, Makes Tvak,Mamsa and

Rakta Prasadana, etc.

Other benefits of regular Mukha Lepa application are as follows25

� Stability of the eye sight vision become clear

� Pleasant facial appearance

� Good complexion with smoothness (soft)

� Resembles like a fresh Lotus flower.

CONTRA-INDICATIONS OF MUKHA LEPA26

� Peenasa

� Ajeerna

� Hanugraha

� Arochaka

� Datta Nasya

� Awaken at night

Those for whome Snana is contraindicated are also considered as

Ayogya for Mukha Lepa.27 Such as –

� Jwara

� Atisara

� Netra Roga

� Karna Roga

� Vata Vikara

� Adhmana

� Peenasa

� Vishakta

RESTRICTIONS AFTER MUKHA LEPA28

The person who has underwent Mukhalepa should not involving in

� Divasvapna

� Ati Bhashana

� Agni Sevana

� Atapa Sevana

� Ati-Shoka

� Krodha

VAMANA

This is one of prime procedure in Panchakarma. It occupies the first

place among Panchkarma. It is the best Shodhana therapy and requires

special care. It must be conducted under the supervision of trained

physician. It is indicated for Kapha Shamana in Sharad Ritu for healthy

persons as well as in several acute conditions of Kapha and Pitta Vikara.

ETYMOLOGY OF VAMANA

"Vama Udgare, Yak Set | Vamati Avamit |

The root word “Vama” means “Udgare.” It is derived from the root

verb “Udgru,” conveys the exact interpretation through the meanings like –

ejecting, giving out, oozing, stream, eruptations, echo & hissing sound. But

according to Monnier William, “Vama” refers to ejecting, spitting out,

vomiting, giving out, emitting, saliva, belching, sound, etc.

DEFINITION1

It is a process in which waste products i.e. vitiated Doshas are

eliminated out through the upper channels i.e. through the mouth1.

Chakrapani mentions that Urdhvabhaga should be considered as

Urdhvamukha.

Sharangadhara defines Vamana as “A process in which Apakwa

Pitta and Kapha are eliminated out forcefully through upper channel by the

act of vomiting.”

Vamana is the best treatment to eliminate out the vitiated Kapha

from the body, thus removes all sorts of derangements regarding Kapha.

SYNONYMS

Vama, Vamana, Vami, Vamathu, Virechana, Vireka, Chardi,

Chardana, Ullekhana, Lekhana, Shodhana, Samshodhana, Udgirana &

Urdhvamukha Doshaharana.

INDICATIONS OF VAMANA

� When Doshas are accumulated in large quantity (Bahu), Vamana is

advised.2

� More specifically Vamana may assist the body in the following

conditions.

� Aggravation of Kapha in its own sites or place.

� Kapha combined with Pitta, which is present in a small proportion.

� Vata or Pitta invading the sites of Kapha.

� Excessive increase in the levels of Kapha.

� Apart from these there are several diseases in which Vamana is

indicated are – Peenasa, Navajwara, Kushtha, Shwasa, Kasa,

Rajayakshma, Galagraha, Shleepada, Mandagni, etc.3

CONTRAINDICATIONS OF VAMANA4

There are certain contra-indications for Vamana such as – Atibaala,

Atividdha, Atisthula, Atikrisha, Durbala, Shranta, Pipasita, Kshudhita, etc.

VAMANA INDICATED IN URDVABHAGAGATA KUSHTA5

Charaka explained that, when Doshas are in Utklishta Avastha in

Hridaya and Kushta is present in Urdvabhaga of Shareera then Vamana

should be advised.

VAMANA AND RITU

Vamana is advised in Vasanta Ritu to combat with the exaggerated

Kapha.6 Vasanta Ritu comprises of two months viz. Phalguna and Chaitra.

VAMANAKARMA PROCEDURE

The whole process in Vamana Karma can be divided into three

categories. Viz. –

� Poorvakarma

� Pradhanakarma

� Paschyatakarma

VAMANA POORVAKARMA

In this category, one has to fulfill the prerequisites required for

conducting the Vamana procedure. This includes –

� Examination of patient in terms of Vamya / Avamya

� Analysis of Ashtavidha and Dashavidha Bhava

� Examination of the disease and status of Tridosha

� General physical, biochemical and instrumental examinations

� Collection of drugs and utensils required for Vamana7

� Vamaka Drug selection and dosage fixation

� Preparation of Vamanopaga Dravya and set up in treatment room

� Preparation of the patient like – Proper concealing, Detail

information Informed written and oral consent, Proper pre-

medication like Deepana-Pachana, Abhyantara and Bahya

Snehana, Swedana, Vishramakala, Maanasopachara, etc.

VAMANA PRADHANAKARMA

This is the actual act of the Vamanakarma. This includes following

procedure, which are to be done carefully and with caution.8 Viz. –

� Examination and monitoring of vitals

� Guiding and monitoring the procedure of Vamanakarma

� Administration of Yavagu

� Administration of Aakanthapana Dravya like milk / Ilkshu Rasa

� Administration of suitable Vamaka Dravya and in required quantity

� Waiting for Swa-pravrita Vega for 1 Muhurta (48 minutes)

Table No. 10. Process of Vamana & effect of Vamaka Dravya on the body9

SL. SYMPTOMS

APPEARED

CHANGES

IN DOSHA

MECHANISM OF VAMANA

01. Appearance

of Sweating

on Forehead

Doshas are

liquefied

Due to Ushna, Teekshna and Vyavayi

properties, the Doshas are starts

melting from their site of adherence

(i.e. Doshadooshya Sammurcchana)

and start moving them through major

and minor channels.

02. Pilling of

hairs

Doshas

moving

towards

Amashaya

Due to Ushna, Teekshna and Vyavayi

property of Vamaka Dravya, the

vitiated Doshas start moving towards

Kostha.

Doshas moves through Srotas just

like water moving through polished

vessel without sticking to it.

03. Discomfort in

abdomen

Enters the

Amashaya

The moving Dosha enter the

Amasaya by Anupravana Bhava.

04. Nausea,

Salivation,

Pain in chest

region.

Doshas

moves in

upward

direction.

Due to excitement of Udana Vayu,

Agni, Vata predominance and self

tendency Vikrita Dosha to move

upwards, they start to move in

upward direction.

� Observation regarding extend of results obtained

Table No. 11. The criteria for the evaluation of Shuddhi. 10

VAMANA AVARA SUDDHI

MADHYAMA SUDDHI

PRAVARA SUDDHI

Vaigiki 4 Vega 6 Vega 8 Vega Maniki 1 Prastha 1 ½ Prastha 2 Prastha Antiki PITTANTAM Laingiki Signs of symptoms of Samyak Vamana

YOGA-AYOGATA OF VAMANA11

Vamana is complicated procedure. The attending physician must be keen enough to have a look on Yoga-Ayogata of the Vamana procedure. This is an important part in obtaining result through the procedure. The patient with Samyaka Yoga of Vamana will have – Kaale Pravritti, elimination of Kapha, Pitta and Vata respectively, Swayam Cha Avasthanam, Hridaya Shuddhi, Parshwa Shuddhi, Srotodushti, Indriya Dushti, Laghutwa, etc.

VAMANA ATIYOGA LAKSHANA

Trishna, Moha, Moorccha, Vata Prakopa, Nidranasha, Balahaani.

VAMANA AYOGA LAKSHANA

Kotha, Kandu, heaviness of body, Hridaya and Srotas Ashuddhi.

VAMANA VYAPAT12

It is the prime duty of attending physician check the Vamana vyapat and treats them accordingly. The patient suffer from the complications like – Adhmana, Parikartika, Parisrava, Gatragraha, Hridgraha, Jeevadana, Alpa Dosha Harana, Vata Shoola, Atiyoga, Pravahika, Vibandha, etc.

VAMANA PASCHYATA KARMA13

After conducting Vamana, one should look after the patient carefully. The immediate things to be done by the patients are –

� After Samyaka Vamana, patient is advised to wash mouth, hands & feet, then to rest for a Muhurtta

� Then the patient is subjected for Dhoomapana. � Then Kavala is advised with Saindhava Jala.

� Due to Dosha elimination, Agni becomes weak. So to restore the strength of Agni and Prana, Peyadi Samsarjana Krama should be followed.14

SAMSARJANA KRAMA

After Vamana, the diet regimen should be planned according to the

type of Shuddhi obtained.

Table No. 12. Samsarjana Krama on various days15

DAYS Annakala Pravara Suddhi (3Days)

Madhyama Suddhi (5 Days)

Avara Suddhi (7 Days)

1 Morning – – – I day 2 Evening Peya Peya Peya 1 Morning Peya Peya Vilepi II day 2 Evening Peya Vilepi Kritakrita

Yusa 1 Morning Vilepi Vilepi Kritakrita

Mamsarasa III day

2 Evening Vilepi Akrita Yusa Normal diet 1 Morning Vilepi Krita Yusa –

IV day 2 Evening Akrita Yusa Akrita Mamsarasa – 1 Morning Krita Yusa Krita Mamsarasa – V day 2 Evening Krita Yusa Normal diet – 1 Morning Akrita

Mamsarasa – –

VI day 2 Evening Krita

Mamsarasa – –

1 Morning Krita Mamsarasa

– – VII day

2 Evening Normal diet – – SPECIAL PRECAUTIONS AFTER VAMANA16

The who has underwent Vamana should specially avoid the

activities like – Loud speeches, sitting in one position for long duration,

standing in one position for long duration, long walks and riding vehicles

should avoided, exposure to excessive cold or heat or dew, exposure

directly to flowing winds, long journey, sleeplessness in the nights,

sleeping in day time, should also be prohibited.

ANATOMY OF SKIN

Introduction

The skin is the largest organ of the body covering all living tissues in

the body. It is made up of multiple layers of epithelial tissues and guards

the underlying muscles, bones, ligaments and internal organs.01

Skin interfaces with the environment and protects against

pathogens. Its other functions are insulation, temperature regulation,

sensation, synthesis of vitamin D, and the protection of vitamin B.

Severely damaged skin tries to heal by forming scar tissue which is

often discoloured and depigmented. In humans, skin pigmentation varies

among populations, and skin type can range from dry to oily skin.

Skin Components

Skin has melanin, provided by melanocytes, which absorb some of

the potentially dangerous ultraviolet radiation (UV) in sunlight. It also

contains DNA repair enzymes which help to reverse UV damage.

The skin has the largest surface area of all the organs. For the

average adult human, the skin has a surface area of between 1.5 to 2.0

square meters (16.1 to 21.5 sq ft.)

1 square centimeter of skin holds 650 sweat glands, 20 blood

vessels, 60,000 melanocytes, and more than a thousand nerve endings.

Layers of the Skin

Skin is composed of three primary layers –

� Epidermis – It provides waterproofing and serves as a barrier to

infection.

� Dermis – It serves as a location for the appendages of skin; and

� Hypodermis

Epidermis

In the word epidermis, "epi" comes from the Greek meaning "over"

or "upon," is the outermost layer of the skin.

The epidermis contains no blood vessels. Cells in the deepest layers

of skin are nourished by diffusion from blood capillaries extending to the

upper layers of the dermis.

The major constitutes of epidermis are Merkel cells, Keratinocytes,

Melanocytes and Langerhans cells.

Layers of the Epidermis

Epidermis is divided into five layers. These cells are formed by

mitosis at the innermost layers. They move up the strata changing shape

and composition as they differentiate and become filled with keratin. They

eventually reach the top layer called stratum cornium and become

sloughed off, or desquamated. This process is called keratinization and

takes place within weeks. The outermost layer of Epidermis consists of 25

to 30 layers of dead cells.

Sub-layers of Epidermis

Epidermis is divided into the following 5 sub layers or strata. Viz. –

� Stratum cornium

� Stratum lucidum

� Stratum granulosum

� Stratum spinosum

� Stratum germinativum (also called "stratum basale")

DERMIS

The dermis is the layer of skin beneath the epidermis that consists of

connective tissue. It cushions the body from stress and strain. The dermis

is tightly connected to the epidermis by a basement membrane.

Dermis also harbors many mechanoreceptors (nerve endings) that

provide the sense of touch and heat. It contains hair follicles, sweat glands,

sebaceous glands, apocrine glands, lymphatic vessels and blood vessels.

The blood vessels in the dermis provide nourishment and waste removal to

its own cells as well as the Stratum basale of the epidermis.

Dermis is divided into the following two sub layers or strata. Viz. –

� Papillary Region – Area adjacent to the epidermis.

� Reticular Region – Deep thicker area below papillary region.

Hypodermis

The hypodermis is not part of the skin. Its purpose is to attach the

skin to underlying bone and muscle as well as supplying it with blood

vessels and nerves. It consists of loose connective tissue and fibroblasts,

macrophages and adiposities (the hypodermis contains 50% of body fat).

Fat serves as padding and insulation for the body.

Physiology of Skin

� Protection – Skin is an anatomical barrier from pathogens and

damage between the internal and external environment in bodily

defense. Langerhans cells in the skin are part of the adaptive

immune system.

� Sensation – It contains a variety of nerve endings that react to heat

and cold, touch, pressure, vibration, and tissue injury.

� Thermo-regulation – The skin contains a blood supply far greater

than its requirements which allows precise control of energy loss by

radiation, convection and conduction. Dilated blood vessels increase

perfusion and heat loss while constricted vessels greatly reduce

cutaneous blood flow and conserve heat.

� Control of evaporation – The skin provides a relatively dry and

impermeable barrier to fluid loss. Loss of this function contributes to

the massive fluid loss in burns.

� Storage & Synthesis – It acts as a storage center for lipids and

water, as well as a means of synthesis of vitamin D by action of UV

on certain parts of the skin.

� Excretion – Sweat contains urea. However, its concentration is

1/130th that of urine. Hence excretion by sweating is at most a

secondary function to temperature regulation.

� Absorption – Oxygen, nitrogen and carbon dioxide can diffuse into

the epidermis in small amounts. In addition, medicine can be

administered through the skin, by ointments or by means of

adhesive patch.

� Water Resistance – The skin acts as a water resistant barrier so

essential nutrients aren't washed out of the body.

� Hygiene – Unclean skin favors the development of pathogenic

organisms. The dead cells that continually slough off the epidermis

mix with the secretions of the sweat and sebaceous glands.

Along with this dust form the environment forms a thick layer on its

surface. If it is not washed away it forms decomposed by bacterial

flora and produces foul smell.

� Cosmetics should be used carefully because these may cause

allergic reactions. Each season requires suitable clothing in order to

facilitate the evaporation of the sweat. Sunlight, water and air play

an important role in keeping the skin healthy.

� The skin supports its own ecosystems of microorganisms, including

yeasts and bacteria, which cannot be removed by any amount of

cleaning. The skin is continuous with the inner epithelial lining of the

body at the orifices, each of which supports its own complement of

microbes.

� Oily skin is caused by overactive glands that produce sebum, a

naturally healthy skin lubricant. When the skin produces excessive

sebum, it becomes heavy and thick in texture. Oily skin is typified by

shininess, blemishes and pimples.

� The oily skin type is not necessarily bad, since such skin is less

prone to wrinkling, or other signs of aging, because the oil helps to

keep needed moisture locked into the epidermis. The negative

aspect of the oily skin type is that oily complexions are especially

susceptible to clogged pores, blackheads, and buildup of dead skin

cells on the surface of the skin.

� Oily skin can be sallow and rough in texture and tends to have large,

clearly visible pores everywhere, except around the eyes and neck.

SEBACEOUS GLAND02

The skin contains sebaceous glands and the sweat glands.

Sebaceous glands are ovoid or spherical in shape and situated at the site

of the hair follicle .these glands develop from hair follicles .so, the

sebaceous glands are absent over the thick skin. Each gland is covered by

a connective tissue capsule. The alveoli of the gland are lined by stratified

epithelial cells.

The sebaceous glands open into the neck of the hair follicle by

means of a duct. In some areas like face, lips, nipple, glans penis and labia

minora the sebaceous glands open directly into exterior.

Secretion of Sebaceous Gland

The sebaceous gland secretes an oily substance called sebum.

Sebum is formed by the liquefaction of the alveolar cells, and poured out

through the ducts either via the hair follicle or directly into exterior.

Composition of sebum

Sebum contains free fatty acids, triglycerides, squalene, sterols,

waxes and paraffin.

Functions of sebaceous glands

� The free fatty acid content of the sebum has antibacterial and anti

fungal actions. Thus, it prevents the infection of skin by bacteria or

fungi.

� The lipid nature of sebum, keeps the skin smooth and oily. It protects

the skin from unnecessary desquamation and injury caused by

dryness.

� The lipids of the sebum prevent heat loss from the body. This is

particularly useful in cold climate.

Sebaceous glands at puberty

The sebaceous glands are stimulated by sex hormones in both male

and females. At the time of puberty particularly in males, due to the

increased secretion of sex hormones especially dehydro-epiendrosteron,

the sebaceous glands are stimulated suddenly leading to the development

of acne over face at the time of puberty. The acne disappears within few

years when the sebaceous glands become adapted to the sex hormones.

ACNE VULGARIS

Acne is commonly known as Acne vulgaris. It is a chronic

inflammatory dermatological condition affects nearly all people during

adulthood with formation of comedone, papules or pustule eruptions,

commonly known as Pimple.01

DEFINITION

Acne is an inflammation of the pilosebaceous units of certain body

area (face, trunk, rarely buttocks) due to obstructed with plugs of sebum

and desquamated keratinocytes that occurs most frequently in

adolescence.02

NATURAL HISTORY

It is one of the commonest skin disorders, and popularly known as

acne or pimple. It is a disorder of adolescence and is more common

amongst male than in females.03

It has been estimated that 70% of the total population have some

clinically evident acne at some stage during adolescence.04 It develops at

puberty when sebaceous glands are most active. In twenties, it gradually

decreases and again seen especially in women after the age of 28 or so

(post adolescent acne), since they usually adopt family planning. It occurs

both in girls and boys in the later in a some what sever form.05

EPIDEMIOLOGY

About 70% of the population develops some clinically evident acne

at some point during adolescence and early adult life, but only 10-20%

request medical attention for the problem.

Acne develops earlier in female than in males. This may reflect the

earlier onset of puberty in females. However, some subjects may show

small non-inflamed lesions by the age 8-9 years. The age of greatest

severity and incidence is 16-18 years for females and 18-19 years for

males. The incidence of acne in females at 17 years is 40% and in males

at 18 years is 35%.06

After the age of 35 years acne resolves very slowly. At 40 years of

age lesions are found in 1% of males and 5% of females. Acnes are more

predominant and persistent in females and why they resolve by

themselves is obscure. Duration of lesions takes weeks to months for

recovery and condition worsens in winter season.07,08

AETIOLOGY09a

The etiology of the acne is not fully understood. Certain factors

responsible for the occurrence of acne includes –

� Basic or primary causes

� Predisposing or aggravating factors

BASIC / PRIMARY CAUSES

� The basic seborrhoeic state & the tendency to acne itself may cause

� Androgenic stimulation of pilosebaceous follicles & thickening of

horny layer take place at puberty. In older patients, the ratio of

androgenic to estrogenic substance may be abnormal.

Due to these probabilities acnes are directly affecting the skin or the

pilosebaceous unit and produces excess amount of sebum. Accumulated

sebum in ducts may have allergic manifestation and bacillary interference.

01. Hormones – This disease is closely linked with the sex hormones. At

puberty either of the sexes is affected. In females during the phase of

premenstrual congestion the condition is often worse. The increased

productions of sex hormones make the sebaceous glands hyperactive.

Androgen and progesterone are responsible for the hyperplasia of oil

glands.

The main hormones associated with the acne are is as follows –

02. Androgens – These are male and female sex hormones. In males it is

produced in the testes. In females these are produced in adrenal gland

and ovaries.

The most important androgen is testosterone, which affects the face,

pubic area and armpits. The excessive secretion of testosterone stimulates

sebaceous glands, which produces excess sebum, may leads to formation

of acne lesions.

This fact was studied in 139 women afflicted with acne. 90% were

observed to have above average plasma testosterone levels and only 10%

of individuals were had normal or below normal testosterone.

03. Estrogens – These are female hormones, produced by the ovaries. It

reduces the secretion of sebum and thus helps in remission of acne

lesions. The estrogen benefits the skin by retarding the wrinkling process

and gives it a clear and moistures look.

04. Steroids – These are produced by the adrenal glands. Excess

production of steroids cause skin atrophy, prone for skin infections and

poor healing. Thus stimulates the sebaceous glands which may cause

acne. Lack of steroids causes loss of body hair and pigmentation of the

skin.

05. Bacillary Interference – Although acne is not primarily a bacterial

disease but exudates may show presence bacilli like cornye bacterium

acne, propioni bactrium acne, staphylococcus epidermis albus which may

alter the characters of oily secretions. The acne bacillus belongs to

diptheriod group. Bacteria enter in the orifice of sebaceous gland, forms

comedone and large lumpy deep lesions. Microscopically, the deep-seated

indurate lesions show a granulomatus structure with many giant cells.

06. Allergic Manifestation – Allergy also plays a role in the formation of

acne up to some extent. The persons working in the manufacturing

industries, catering works and those dealing with oils may have acne.

Excessive intake of Bromides and iodides in the form of tonic,

medicines or diet causes acne. When these salts are discontinued, lesions

are subsided.

PREDISPOSING FACTORS

Certain factors which do not produce acne but may predispose in

acne lesion are enlisted as follows –

01. Diet – Certain diets and regimens may precipitates in acne like butter,

cream, ice cream, chocolates, fried foods, fats, excess starches, sweets,

delicious greasy dishes, overeating, chilies, alcohol, aerated drinks, tea

etc. These foods may aggravate acne.

Acne appears less frequently in Zambia, Nigeria and Japan as their

diet differ from West Europe. The incidence is said to be low in Eskimo’s

eating a diet rich in fish.

02. Climate – The disease is commonest in moist temperate climate, while

it is uncommon in Eskimos of the hemisphere. A dry sunny produces

marked improvement. Exposure to sun and wind increases desquamation

of the exposed skin, diminishes hyperkeratosis of the hair follicles, thus

reduces comedone formation.

03. Use of cosmetics – Excess use of greasy cosmetics may cause acne.

It blocks the pores of sebaceous and sweat glands. Natural cosmetic

agents do not have any hazardous effect but artificial cosmetics may

produce or aggravates the lesions. The habit of squeezing the lesions and

lack of hygiene of face also makes the condition worse.

04. Mental stress – Mental stress can aggravate acne lesions. For

example, acne lesions may become more in adolescence with epilepsy is

also notable. About 70% of ladies complain exacerbation of 2-7 days

premenstrual. Possibly, it is related to a premenstrual change in the

hydration of the pilosebaceous epithelium.

Acne may relate to severe increased anger or anxiety. The stresses

causes excess secretion of androgens and subsequently lead to acne.

05. Occupation – The persons working in the industries of heavy metals,

oils may have tendency of developing acne.

06. Constipation – A common predisposing cause to produce acne is

intestinal stasis, especially the constipation.

07. Season – The condition predominantly seen in winter than in summer.

The condition of the disease is worse in the winter and spring months.

PATHOLOGICAL CAUSES

01. Increased Sebum Secretion

Sebaceous glands activity is controlled by androgens. Increased

production of sex hormones makes the sebaceous glands hyperactive.

Normally both men and women have androgen hormones circulating

through blood.

02. Microbial Colonization

Bacterias such as P acnes is an anaerobic organism predominantly

found on the surface of the skin. It can contaminate the pilosebaceous unit

and start reproducing themselves. This process is further promoted by the

increased temperature in the infected area. The presence of P acnes

promotes inflammation through a variety of mechanisms.

P acnes stimulate inflammation by producing proinflammatory

mediators that diffuses through the follicle wall. Studies have shown that P

acnes activate the toll-like receptor 2 on monocytes and neutrophils.9b

Activation of the toll-like receptor 2 then leads to the production of

multiple proinflammatory cytokines, including interleukins 12 and 8 and

tumor necrosis factor. Hypersensitivity to P acnes may also explain why

some individuals develop inflammatory acne vulgaris while others do not.9c

Inflammation may be a primary phenomenon or a secondary

phenomenon. Most of the evidence to date suggests a secondary

inflammatory response to P acnes. However, interleukin 1-alpha

expression has been identified in microcomedones, and it may play a role

in the development of acne.9d

Meanwhile, the swelling caused by the inflammation leads to

complete obstruction of the opening and more sebum stagnates inside the

pilosebaceous unit. Thus, Propionibacterium acnes are a normal

commensal of the pilosebacious apparatus plays an important role in the

pathogenesis of acne.

It has lypolytic enzymes capable of altering the local lipid

constituents. Other organisms implicated in pathogenesis of acne are P.

granulosum, pityrosporum ovale and coagulase negative micrococci.

These organisms act by –

� Breaking down triglycerides (from the sebum) into free fatty acids,

which induce hyperkeratosis in the ductal epithelium.

� Producing extra cellular enzymes which attract inflammatory cells.

OCCLUSION OF PILOSEBACIOUS DUCT

In the acne pelosebacious orifice is occluded by a keratinous plug

which is induced by –

� Chemicals (present as ingredients of cosmetics)

� Fatty acids (produced by lypolysis of sebum by micro-organisms)

Thus, results in retention of sebum. Further encouraging growth of

micro-organisms, which act on the lipids of sebum, liberating free fatty

acids which intern enhance follicular occlusion, triggering a vicious cycle.

The distended follicle eventually ruptures, releasing pro-

inflammatory chemicals into the dermis, stimulating intense inflammation.

The ductal epithelium also produces cytokines and an inflammatory

cascade is triggered.

PATHOGENESIS10

Acne vulgaris is follicular disease. In the pre-adolescent period

seborrhea oleosa and some comedones frequently appear as fore runners

of the disease.

For its development beside seborrhea, the hyper keratosis of the

pelosebacious ostea is an important pathogenic factor. A keratinous cum

sebaceous plug is formed in follicular neck resulting in the narrowing and

some time blocking of the canal. In general a well developed growing hair

interferes with the collection of keratinous and sebaceous material.

The primary lesion of acne is the comedone it signifies the plug

composed of dried sebum, epithelial cells and keratinous scales; it fills the

pilosebacious canal on the surface of the skin, it appears as a slightly

elevated white head.

When the same passage is occluded by the sulphur constituents,

sebum soon gets converted into sulphide and turning the white head into

black dot, called a black head.

With the comedone extractor, the entire comedones can be readily

squeezed out as a yellowish, cheesy looking worm like mass. Some

comedons may persist and remain unchanged, but often an inflammatory

reaction occurs.

The first stage of acne is erythema which surrounds or engulfs the

comedone is transformed into moderately firm hemispheric, lentil to bean

sized papule of red rose color.

Most of these papules gradually disappear leaving no trace. Others

suppurate to form pustules resulting from the acting of secondary invading

micro-organisms, chiefly staphylococci-acne pustulosa.

The suppuration may be superficial or deep seated; the deep seated

pustules take time to resolve. Acne indurate is characterized by rather firm,

perifollicular nodules of bluish-red color. They persist for long time. Many

of them eventually become completely or partially absorbed. Others

transform into cysts-acne cystica.

They however tend to persist, discharging from time to time thin,

purulent fluid. In the severest variety of acne, numerous such pseudo cysts

draining sinuses and hypertrophic scars are seen.

Reaction of etiological factors and pathogenesis and sequence of

events can be represented diagrammatically as11

Flow Chart No. 05. Pathological consequences in Acne.

Etiological factors

Action on sebaceous gland

Keratin plug

Blocks secretion of sebum

Comedons

Increase in the bacterial flora

Proinflammatory mediators

Inflammation

Papules Pustule Nodule Cyst

COURSE OF ACNE12

In majority of the individuals, troublesome acne subsides by the age

of 25 years. Unfortunatly for few, the condition is a disaster as it is

disfiguring and persistent with wave after wave of new lesions.

In some young women tend to have lesions for longer period and in

some there is premenstrual acne about 7-10 days before menses. Some

experiences acne during winter and sun expose seems to be beneficial in

many patients.

SKIN LESIONS IN ACNE13,14,15,16

� COMEDONS – It is primary lesion of acne & of two types.

� Open Comedons (black heads) – Due to plugging of

pelosebaceous orifice by keratin and sebum on the skin surface.

� Closed comedones (white heads) – Due to keratin and sebum

accretions plugging the sebaceous ducts below the skin surface.

� Intermediated noninflammed lesions – This shows both

features of black heads and white heads. Inflammatory lesions

may be superficial or deep and some arise from noninflammed

lesions.

� PAPULES – These are superficial lesions, the first

stage is erythema which surrounds or engulfs the comedone and a

papule develops from blocked follicle.

� PAPULOPUSTULE – Papule topped by a pustule. It results

from the action of the secondary invading micro-organisms, chiefly

staphylococci.

� NODULES / CYSTS – These are 1-4 cm in diameter. Repeated

rupture leads to inflammation, abscess and foreign body reaction. In

few patients some of the papules become quite large and persists

for long periods they are often referred to as nodules.

� CYSTS – In severely affected patients the nodules liquefy centrally

so that fluctuant cysts are formed. In reality the lesions are

psuedocysts as they have no epithelial lining. (This type of severe

acne is known as cystic or nodulo-cystic acne). Pseudo cysts as

they are representing abscess.

DIAGNOSIS

There is no specific diagnostic test for acne vulgaris. Diagnosis is

confirmed on the basis of history and course of the illness. However, the

lesions of acne vulgaris need differentiated from acne from dermatosis.

CLINICAL TYPES OF ACNE

Commonly there are 6 types of acne found. Viz. –

01. Acne Punctata – If the eruption is made up entirely of small

comedones or black heads and is located upon the forehead or cheeks.

The comedones are generally asymptomatic, and proceed not to the

pustular forms. There are not markable swellings in these types of lesions.

02. Acne Papulosa – Small papular acne is frequently associated

with profuse no of large comedones which have become inflamed probably

from the acne bacillus. This type of acne is most common in males with

oily skin. It yields redial to x-ray treatment combined with local medicinal

measures.

03. Acne Pustulosa – This is a type of small superficial pustular acne

which is principally staphylococcus dermatitis, occurring infrequently in

young girls with delicate skin. There are practically no comedones

associated with eruption.

04. Acne Indurata – Papular acne often progresses into indurata

type due to secondary staphylococcus infection. The lesions are deep

seated, destructive and may be popular and mixed. This type is

characterized by rather firm peri-follicular nodules of bluish red color. Many

of them eventually become completely or partially absorbed other

transform into cysts. If the eruption has been present for some length of

time scarring is often severe.

05. Acne Cystica – Uncommonly acne indurata may develop into

cysts. The cysts are a form of tissue reaction about small, hard deposits of

sebum; which acts like foreign body. The contents are jelly like of granular

and serosanguineous fluid and the cysts are of a sebaceous origins and

apparently identical with sebaceous cyst, either because of their different

types of contents, being rarely cheesy. The cysts also tend to persist,

discharging from time to time a thin purulent fluid.

06. Acne Keloidal – This is a type of acne with hypertrophic

scarring. Hypertrophic scars are rarely encountered on the face they are

more frequent on the chest and back or neck. Occasionally these scars

become keloidal. The condition is known as keloidal acne.

GRADING THE ACNE

Severity of acne can be graded in 4 varieties. Viz. –

Grade I: Mild Acne (Papulopustular acne)

Comedones, occasional skin colored and erythematous papules 1 to

2 mm in diameter with central whitish dot, black heads or open

comedones.

Grade II: Moderte Acne (Papulopustular acne)

Comedones, multiple erythematous conical follicular papules 2 to 4

mm in diameter few topped by pustules.

Grade III: Severe Acne (Papulonodular acne)

A few larger more than 5 mm indurated erythematous papules and

nodules are present. Larger and deeper pustules with abscesses.

Grade IV: Nodulo-Cystic Acne

Large skin coloured and erythematous indurated nodules and their

sequelae characterize in this stage. Painless cystic swelling which rupture

and heal with scars, scarring may be hypertrophic and can be associated

with discharging sinuses which interconnecting sinus tracts.

OTHER CLINICAL PRESENTATIONS OF ACNE

A. Neonatal acne 17,18,19

It occurs on nose and cheeks in newborns or infants, related to

glandular development, due to the presence of maternal hormones in the

child. It is more common in males may last for up to three years. Lesions

are similar to those of adolescent acne.

The main lesions are comedones with only a few papules and

pustules. But oily substances applied to the face and scalp can also

produce grouped comedones in children.

B. Acne excoriee 20,21,22,23

Mild acne, usually in young women, associated with extensive

excoriations and scarring due to emotional and psychological problems

(obsessive compulsive disorder) but the primary lesions (comedones and

papules) of acne are not visible.

Small acne spots around the chin, forehead and on the jaw line are

picked, squeezed and otherwise altered by manual interference. The

resulting papules are crusted and often more inflamed than routine acne

spots. Often the patients have little true acne and the main cosmetic

problem is the results of the labor of their fingers.

C. Tropical acne 24,25,26

Flare of acne, usually with severe folliculitis, inflammatory nodules,

and draining cysts on trunk and buttocks in tropical climates secondary

infection with staphylococcus aureus. This may leads to frequent keloidal

scarring and the eruption subsidies dramatically when the patient leaves

the tropics.

D. Acne fulminan 27,28

Teenage boys (Ages13-17), acute onset, severe cystic acne with

concomitant suppuration and always ulceration, also present are malaise,

fatigue, fever, generalized arthralgias, leukocytosis and elevated

erythrocyte sedimentation rate.

E. Drug induced acne 29,30,31,32,33

Certain drugs particularly Corticosteroids, androgens, anabolic

steroids, oral contraceptives, anti-tubercular drugs iodides, bromides and

anti-convulsants can cause an acneiform eruption. The eruption is

frequently associated with mild pruritus. Bromides and iodides may

sometimes aggravate the withdrawal of drugs.

Lesions are monomorphic, consisting of papules and sometimes

pustules. Comedones and scarring are unusual, especially when lesions

are induced by steroids.

For example –

� When androgen is given therapeutically for any reason, they can

also cause an eruption of acne spots.

� Glucocorticoids, such as prednisolone, when given to suppress the

signs of rheumatoid arthritis or some other chronic inflammation can

also induce troublesome acne, why this should be so has never

been adequately explained.

F. Occupational Acne 34,35

Certain chemical substances plug, irritate and block the pilo-

sebaceous apparatus causing acne like lesion. Workers handling chlorine,

oils, greases and due to exposure to tar derivatives, cutting oils,

chlorinated hydrocarbons are particularly prone to this condition, The

lesions like comedones, inflammatory papules and cysts occur on the

exposed and less so on the covered areas of the body through

impregnation of the cloth.

G. Acne in Aged36,37,38

Single or grouped comedones are frequently seen in the elderly

people. The main seat of involvement is the temporal and the peri-ocular

regions. They usually persist unaltered, only occasionally showing a

tendency to become inflamed. This is mainly seen in an hursute female

with or without irregular menses needs an evaluation for hyper secretion of

adrenal and ovarian androgens, total testosterone, free testosterone, and

/or de hydro epiandrosterone sulfate (DHEAS) (e.g. in the Polycystic ovary

syndrome).

H. Premenstrual Acne39

Many women with acne note a premenstrual exacerbation of

papulopustular lesions. Usually 5-10 lesions will appear a week before

menstruation. These some evidence that progesterone mediated

premenstrual contraceptive pills will diminish or prevent premenstrual flare

of acne.

I. Acne Cosmetic 40, 41

Due to comedogenic cosmetics eruptions frequently seen in women

using cosmetics especially oil based ones. Almost always comedonal

lesions are seen on the chin.

J. Acne Detergence 42

This type may develop in acne patients who over wash with soap

that contain comedogenic substances. These patients wash the face at

least four times per day. Closed Comedones have principle reasons seen.

Few soaps which has unsaturated fatty acids bacteriostatic substances

and friction probably contribute the comedogenicity of soap.

K. Acne Aetivalis (Mollarca acne)43

This is rare which starts at spring, progress to summer and resolves

completely in full. This affects women between age 25 years and 40 years.

Dull red, dome shaped had small papule usually not more than 3 to 4 mm.

develop on cheeks and commonly extend is to the sides of neck, chest,

shoulders, and characteristically the upper arms.

L. Acne Mechanica44

Mechanical forces induced by various pressures, frictions,

stretching, rubbing, pinching, can aggravate existing acne. The key feature

is an unusual distributive pattern of acne. Provocative factors include

chinstraps, hats, collars, surgical tape orthopedic cents, chair, seats,

because of leaning face on hands, or on fore head, from pressure of

football helmet etc.

M. Chloracne45,46,47,48

Caused by due to exposure to industrial chemical like tar derivatives,

cutting oils, chlorinated hydrocarbons, Large comedones, inflammatory

papules and cysts; not restricted to predilection sites of acne but can

appear on other (covered) body sites.

N. Acne conglobata 49, 50

In this mainly we can see severe cystic acne with more involvement

of the trunk than the face. It is characterized by coalescing nodules, Cysts,

abscesses, and ulceration. Spontaneous remission is long delayed. Rarely

acne conglobata seen in XYY genotype (i.e., in tall males, slightly mentally

retarded, with aggressive behavior) or in the polycystic ovary syndrome.

The lesions take months to heal and on healing leave behind deep pitted

or hyper tropic scars, joined by keloidal bridges.

O. Acne after facial massage 51

Facial massage, a popular form of beauty treatment, may be

followed (3-6 weeks later) by an acneiform eruption in about 30 % of

patients, Indolent, deep seated nodules with very few (or no) comedones,

Take long to heal and heal with hyper pigmentation, lesions dominantly

seen on cheeks, less on chin.

P. Pomade acne 52

Usually in Africans they apply pomade to hair, which leads to acne

on the fore head.

Q. Acne with facial edema 53

This is associated with recalcitrant, disfiguring midline facial edema

and woody indurations with or without erythema.

R. Recalcitrant acne 54

This can be related to congenital adrenal hyperplasia

Other rare causes are

� Adenoma sebaceum

� Androgen excess

� Actinic Comedones

� Pyoderma facile etc.

There are certain myths about acne aggravating & relieving factors

01. Diet and Acne 55

There is no adequate evidence to suggest that diet plays very little, if

any role in the pathogenesis and aggravation of acne. There is no need to

restrict items of diet like nuts, oily foods, chocolates and aerated drinks in

patients with acne.

Considerably folklore medicine has blamed the cause as certain

foods in particular, chocolate and pork fat. Excessive dietary restriction

resulting in weight loss reduces seborrhea. But no physiological or

pharmacological benefit is seen. A link between diet and acne has recently

been suggested again and it is true that acne occurs less frequently in

Zambia Nigeria and Japan, where dietary habits differ marked from those

in Western Europe.

02. Premenstrual flare 56

About 70% of women complain of premenstrual aggravation of acne,

i.e. 2 to 7 days in the menstrual period probably related to premenstrual

edema of the pilosebacious duct, during each cycle and this observation

has been confirmed objectively. It is unlikely that variations in sebum

secretion during menstrual cycle even it is substantial, could explain the

flare. Possibly, it is related to the effect of well-recognized premenstrual

fluid changes on the epidermal hydration of the Pilo sebaceous duct.

Progesterone and estrogen also have both pro and anti-

inflammatory effect. Severity of acne, ethnicity and contraceptive use did

not affect the premenstrual flare rate. Women older than 33years had a

higher rate of premenstrual flares. Conclusion is that almost half of all

women expensive premenstrual flares of their acne. Premenstrual flares

may be more common in older women.

03. Sweating57

About 15% of acne patients notice that sweating causes

deterioration in their acne especially if they live or work in humid

environment (e.g. cooks) ductal hydration may be responsible factor.

04. UV Radiation58

Patients and doctors alike accept that natural UV radiation often

improves acne but objective evidence is relatively lacking. Artificial

irradiation seems to be less effective than natural radiation. PUVA has

been reported actually to induce acne lesions. Further more UV radiation

may enhance the comedogenicity of sebum.

05. Seasonal variation of skin59

The severity of the acne, improvement of acne in summer time or

aggravation of acne in winter is a traditional dermatologic opinion. Ultra

violet rays are proved to be beneficial in the treatment of acne. Conclusion

here, being drawn that Sun bathing may be beneficial for psychological

reasons and may produce euphoric effects, U-V rays as here negative

effects to our skin better to not expose for U-V-irradiation.

06. Psychological status60,61

Although primary induction has occasionally been observed, it is

unlikely that stress in general induces the formation of acne lesions.

However, acne itself produces stress and pricking the spots and thus will

aggravate this condition. This is particularly important in young female who

present with acne exocrine. Severe acne related to increased anger and

anxiety. Emotional stress can defiantly cause exacerbations. Occlusion

and pressure on the skin, such as by leaning face on hands, very

important and often unrecognized exacerbating factor.

07. Occupation62

Hydration of ductal stratum cornium may induce acne in such

occupation as catering. Patients using mere oil foods undoubtedly develop

an oil folliculitis, particularly on their trunk and limbs. By the accidental

release of halogenated hydrocarbons or other chemicals induces

chloracne.

CLINICAL APPEARANCES

Acne is a polymorphic disease occurring dominantly on the face

(99%) and less so on back (60%) and the chest (15%). In young males, it

predominantly affects the face and the older males the back.

Seborrhea is an almost universal feature. Non inflamed lesions are

more frequent in younger patients and consist of blackheads (The black

color is due to melanin, not dirt) White heads and so called intermediate

non inflamed lesions which show both features of black heads and white

heads. Inflammatory lesions may be superficial or deep and some arise

from non-inflamed lesions. Superficial lesions are usually papules and

pustules and the deep lesions are deep pustules and nodules and cysts.

Often forgotten is macule, a lesion well on the way to regression, but

one, which can last for many weeks and contribute markedly to general

inflammatory appearance. Classification of lesions is conventional and the

many types merge. Nodules and Cysts are particularly disfiguring. They

may extend over one as of a few to many centimeters and the nodules

may be remarkably deep with very little surface involvement the deeper

inflammatory lesions are often associated with scaring. Rarely do they

develop into pyogenic granuloma.

Scars may be atrophic macules, ice pick scars, or keloids. Keloids

are least common and most prevalent in trunk region. Atrophic macules

normally retain a purple color for many months before becoming white and

less conscious. Ice pick scars probably change very little but except for

keloids, scarring tends to improve even in the absence for treatment. A

further common type of scarring on the back and chest is small

perifollicular atrophic lesions the so called perifollicular elastolysis.

As the lesions resolve, a post inflammatory erythema and ever

pigmentation can last several months before they resolve. The deeper the

inflammatory process more likely it will tend to produce permanent

scarring. It may vary from small pits to deep furrows or ever-hypertrophic

keloidal scars. The process augmented by self-induced trauma to

superficial lesions by some patients who spend much time in front of mirror

working at their lesions.

Complication of scarring is calcification. A common feature of darkly

pigmented skin is relatively persistent of post inflammatory pigmentation.

Hydradentits suppuration may be associated.

Sites Affected 63

Any hair bearing skin can develop acne but certain acnes areas

much more prone than others. These acne prone areas are tending to

have hair follicles with terminal hairs and larger sebaceous glands. The

face and particularly skin of cheeks, lower jaw, chin, and nose and fore

head are usually affected. Scalp is not involved but back of neck is often

involved. In front of chest, the shoulders and upper back area “favored

area” for the development of lesions.

They usually affected together with the face, but occasionally they

are involved in isolation. Other rare acne affected is outer aspect of upper

aim, buttocks and found and side of thigh are such areas. In patients with

severe acne, it is quite common for other areas to be affected, including

the outer aspects of the upper arms, the buttocks and thighs.

COMPLICATIONS OF ACNE

� Residual hyperactive pigmentation especially causes problem in

dark skinned people

� Pyogenic granuloma formation is another complication.

� Osteoma cutis – which is small firm papules, results from long

standing acne vulgaris.

� Solid facial edema – the latter is a persistent firm facial swelling that

is uncommon.

� Psychological impact of acne on the personality development of an

adolescent or job performance of a young adult is tremendous.64

� Large painful nodules are uncomfortable enough, but their

progression to abscesses, cysts and discharging sinuses cysts and

discharging sinuses can be disabling.

� Facial scarring due to acne vulgaris is an important complication

because of its cosmetic importance and psychological sequelae.

Several types of scars seen in patients with acne include pitted

scars, varioliform scars, atrophic & hypertrophic scars, keloidal

scars, bridge like scars etc.

� Carcinoma rarely supervenes in the sinus tracts of acne conglobata

� Systemic symptoms rarely accompany severe acne (acne fulminans)

fever, myalgia, arthralgia have been described. 64

� Embarrassment, Shame and lack of confidence are important

sequelae of acne.65

DIFFERENTIAL DIAGNOSIS

Acne is rarely misdiagnosed. Following are some of the conditions

which mimic like acne are as follows –

� Acne Rosacea – This occurs in older age groups. There are no

comedones, nodules or cysts and scarring does not occur.

� Peri-oral Eczema – These patients are usually females and a lesion

usually causes itching; the skin is dry and there will be lacking of

non-flamed lesions.

� Milia – Predominantly occur in the infra arbitrary region and are

whiter and can occur in a way that is unrelated to acne also.

� Folliculitis – It Is due to gram-negative organisms can complicate

acne therapy and rare folliculitis due to Candida may also present as

multiple pustular eruptions.

� Zinc deficiency – Can be mistaken associated with severe acne.

� Drug induced acne – Androgens, Halogens, corticosteroids, lithium

causes acne like lesions, which are easily misdiagnosed as acne

vulgaris.

GENERAL MEASURES

Patient with acne are often depressed and may need sympathetic

counseling and support. Particularly, those subjects need the explanation

of inevitability of this condition and this should be stressed.

There is no evidence that particular foodstuffs have any deleterious

effect and washing vigorously will help to remove lesions. Along with other

myths should be dispelled with straightforward explanation of the nature of

disease, its natural history and treatment.

Educating patient on the nature of the disease and daily skin care is

important. Expensive soap or strong detergents are not necessary. Oily

cosmetics and hair griseous causes Comedones and acne, hence should

not be used.

Table No. 13. Differential diagnosis of Acne.

SL. DIAGNOSIS Age of onset

Clinical feature

Location Clinical appearacne

01. Acne rosacea

30-50 Slow onset aggravated by cold, ethyl alcohol, hot foods, stress; unknown etiology

Central face Erythema, telangiectasias, papules/ pustules; can present with rhinophyma or chronic eye inflammation

02. Perioral dermatitis

Primarily adult women

Sometimes associated with prolonged use of high potency topical steroids

Chin, perioral and nasolabial folds

Erythramatous, sometimes scaly 1-2mm papules; may progress to diffuse, scaly, yellow-red plaques

03. Gram-negative, folliculitis

Any age Can be seen with longterm antibiotic therapy

Nose and mouth areas (common) Neck (uncommon)

Superficial pustules & Large nodules

04. Steroid acne

Teenage to adult years

Associated with oral corticosteroid therapy

Chest, upper arms, and scalp

Small, Monomorphic papules, Pustules, or closed comedoes

05. Milia – – Infra-arbitrary

White in Colour, similar to acne

MODERN LINE OF MANAGEMENT

Local application of antibiotics is most of the time preferred. If the

condition is not controlled then use of oral antibiotics, corticosteroids

ritinoids and hormonal therapy is advocated. But recurrent attack and

incomplete management makes the disease chronic even with the

complications.

Commonly used topical anti-bacterial drugs are –

� Benzyl Peroxide – 2.5%

� Erythromycin – 1.5 to 2 %

� Clindamycin – 1%

Commonly used topical comodolytic and exfoliant are –

� Tretinoin – 0.025% to 0.1%

� Tazarotene – 0.05%

� Adapalene – 0.1%

� Azelaic acid – 20%

� Glycolic acid – 10%

Commonly used oral antibiotics are –

� Tetracycline – 500mg BD

� Doxycycline – 100mg BD

� Minocycline – 50-100mg BD

� Erythromycin – 500mg BD

Commonly used oral retinoids are –

� Iso-tretinoin – 1 to 2mg/Kg

Commonly used drugs in hormonal therapy are –

� Progestin Norgestimate

� Ortho Tri-Cyclen

� Combination of Norgestimate, ethinyl estradiol,

� Norgestimate, Desogestrel, Spironolactone.

Table No. 13a. Prescription guidelines for systemic antibiotics.

SL. ANTIBIOTICS INITIAL DOSAGE

MAINTENANCE DOSAGE

COMMENTS

01. Tetracycline 500 mg twice daily

250 to 500 mg daily

Take on an empty stomach to avoid chelation with calcium, iron and other polyvalent cautions. Take with a large glass of water to decrease dyspepsia.

02. Doxycycline (Vibramycin)

100 mg twice daily

50 to 100 mg daily

Take with meals

03. Minocycline (Minocin)

50 to 100 mg twice daily

50 to 100 mg daily

Take with meals

04. Erythromycin 500 mg twice daily

250 to 500 mg daily

Take with meals

Note : Initial dosages should be continued until clear improvement in acne

is seen, usually three to six weeks.

Table No. 13b. Adverse reactions associated with oral antibiotic usage.

SL. DRUG ADVERSE REACTION 01. Tetracycline Dyspepsia, Vaginal yeast infection, Photosensitivity,

Possible interference with oral contraceptives, Tooth discolouratation in children younger than 13 years or in developing fetuses, Propionibacterium acnes antibiotic resistance, Pseudotumor cerebri, Single organ dysfunction, Hypersensitivity, reaction, Serum sickness like reaction

02. Doxycycline (Vibramycin)

Same as tetracycline

03. Minocycline (Minocin)

Same as tetracycline except Propionibacterium acnes antibiotic resistance

04. Erythromycin Dyspepsia, Vaginal yeast infection, Photosensitivity,

HORMONE THERAPY

Oral contraceptives may be a useful adjunctive therapy for all types

of acne in women and adolescent girls. Sebum production is controlled by

androgens, and oral contraceptives are known to reduce androgen levels

by increasing sex hormone binding globulin levels, thus reducing the

availability of biologically active free testosterone such as third-generation

progestin norgestimate, Ortho Tri-Cyclen combination of norgestimate,

ethinyl estradiol are recomeended in women and adolescent girls. Other

contraceptive agents that contain norgestimate (Ortho-Cyclen) or

desogestrel (Desogen) are also reasonable choices.

Two to four months of therapy may be required before improvement

is seen, and relapses are common if medication is discontinued.

Spironolactone, at dosages of 100 to 200 mg daily, may be effective in

treating acne vulgaris in most women and adolescent girls; frequent

adverse effects include menstrual irregularities, breast tenderness and

fatigue. Hyperkalemia is rarely a problem in adolescents taking

spironolactone for acne.

IN GENERAL ADVISES

� Wash the face twice a day with a mild soap and warm water.

� Don't scrub skin or use harsh soap. Washing too hard can make

pimples worse.

� Don't pick or squeeze pimples this can also make them worse.

� Don't use oil-based make-up, hair products or suntan lotions. If wear

make-up, use products that are water-based or that have the word

"non-comedogenic" on the label. This means that they don't cause

acne or make it worse.

Over-the-counter medicines for pimples can be helpful. Acne

medicine might irritate skin or make it too dry. If skin doesn't get better

after usage of medicine for a few weeks then consult family doctor.

DIET

There are no specific food habits which directly precipitate in acne.

Dermatologists have differing opinions on the importance of diet in the

management of acne. One thing is certain; a strict diet by itself will not

clear skin. On the other hand, if certain foods seem to make acne worse,

so try to avoid those food items. It is always important to eat a well

balanced diet.

SPECIAL PRECAUTIONS

� Clean the skin gently but thoroughly with soap and water.

� Wash as often as needed to control oil.

� Shampoo hair whenever gets time, use anti-dandruff shampoo if

necessary.

� Comb or pull hair back to keep hair out of the face.

� Do not squeeze, scratch, pick, or rub lesions as these activities can

increase skin damage.

� Wash your hands before and after caring for skin lesions to reduce

the chance of infection.

� Don't rest face on hands this irritates the skin of the face.

� Identify and avoid the things that aggravate the acne.

� Though no substance is proven to cause acne in everyone, triggers

may include foods, lotions, make-up, and so on. Avoid greasy

cosmetics or creams, which can aggravate acne.

DRUG REVIEW Table No. 14. Drugs used during clinical study.

GANA SL NAME LATIN NAME

FAMILY PART USED CS SS

01. Shunti Zingiber officinale

Zingiberaceae Roots Traptighna, Arshoghna, Deepaneeya, Trishna-nigrahana, Shula-prashamana

Trikatu, Pippalyadi

02. Maricha Piper nigrum

Piperaceae Fruits Deepaneeya, Shulaprashamaniya, Krimighna, Sirovirechan

Trikatu, Pippalyadi

03. Pippali Piper longum

Piperaceae Fruits Kasahara, Hikkanigrha, Sirovirechana, Vamana, Traptighna, Deepaneeya, Shulaprashamaniya

Pippalyadi, Urdhwa-Bhagahara, Shirovirechana

04. Kritavedhana Luffa acutangula

Cucurbitaceae Fruits Vamana, Phalini Urdhvabhagahara, Ubhayatobhagahara

05. Yastimadhu Glycyrrhiza glabra

Fabaceae Roots Kanthya, Jeevaneeya, Varnya, Kandughna, Mutravirechaneeya, Shonitasthapana,

Kakolyadi, Sarivadi, Anjanadi, Snehopaga, Vamanopaga, Asthapanopaga.

06. Manjistha Rubia cordifolia

Rubiaceae Roots Varnya, Vishaghna, Jwarahara

Priyangwadi, Pittasamshamana

07. Saindava Lavana

Sodium Chloridum

09. Tila Taila Sesamum indicum

Pedaliaceae Seeds

10. Madhu Maldepuratum

Hymenoptera

Table No. 15. Properties of Drugs Used in this Clinical Study. SL NAME RASA GUNA VEERYA VIPAKA

01. Shunti1 Katu Laghu, Snigdha Ushna Madhura

02. Pippali Katu Snigdha,Teekshna Anushnasheeta Madhura

03. Maricha Katu Laghu,Teekshna Ushna Katu

04. Grita2 Madhura, Snigdha,Guru, Sukshma Sheeta Madhura

05. Tila taila3 Madhura,

Anurasa

Tikta, Kashaya

Ushna, Tikshna, Vyavayi, Vikashi,

Sukshma,Vishada, Guru Sara

Ushna Madhura

06. Kritavedhana Tikta Laghu, Rukshna, Tikshna Ushna Katu

07. Yastimadhu Madhura Guru, Snigdha Sheeta Madhura

08. Saindhava

Lavana

Lavana, Madhura Snigdha, Tikshna, Sukshma &

Laghu

Anushna Sheeta

& Sheeta

Madhura

09. Manjishta Tikta, Kashaya,

Madhura

Guru, Rukshna Ushna Katu

10. Madhu4 Madhura Sheeta, Laghu , Ruksha, Guru. Sheeta Katu.

Table No. 16. Karma & indication of Drugs Used in this Clinical Study. SL NAME KARMA INDICATION 01. Shunti Agnideepana, Paachana, Vaatanulomana,

Rochana, Triptighna, Shothahara Aruchi, Chhardi, Agnimandya, Vatavyadhi, Shwasa, Kasa

02. Pippali Deepana, Triptighna, Vatanulomana, Shoolaprashamana, Krimighna, Kushtaghna, Jwaraghna

Aruchi, Agnimandhya, Amavata, Udarashoola, Shotha

03. Maricha Pachana, Deepana, Yakrit Uttejaka, Vatanulomana, Lekhana

Agnimandya, Adhmana, Shoola, Charma Roga, Srotorodha etc.

04. Ghrit Pitta-Vatahara, Rasa and Shukra Dhatu Vardhaka, Oja Vriddikara, Swara, Varna Prasadana, Mardavakara.

Krisha, Unmad, Apasmar, Agni Dagda, Shastra, Visha

05. Tila taila Twak Mridukara, Krimighna, Netrya, Shoolaghna, Yonivishodhana

Sthoulya, Vatavyadhi, Krimi, Krurakoshta, Nadivrana

06. Kritavedhana Ubhayatobhagahara, Vamaka, Rechaka, Raktashodhaka, Shothahara, Kusthaghna, Kapha Nissarak

Raktavikara, Shotha, Kushta

07. Yastimadhu Shlesmhara, Kasahara, Kanthya, Chhardinigrahana, Vatanulomana, Mrudu Rechana, Dahashamaka, Amashayastamlata Nashaka, Medhya, Balya, Bruhaniya.

Varnavikara, Kandu, Charmavikara, Kasa, Shwasa, Hikka, Kantha vikara, Adhoga urdhwagata Raktapitta, Vatavikara, Amavata, Chhardi, Trishna, Udarashula

08. Saindhava Lavana

Agni Deepaka, Pachaka, Ruchikaraka, Kapha Vilayana & Chhedana, Vrisya, Chakshusya, Hridya & Srustamutrapurisa.

09. Manjishta Raktaprasadana, Raktashodak, Kaphaghna, Deepana, Pachana, Shothahara, Vrunaropana, Kustaghna, Varnya

Raktavikar, shotha, Kushta. Visarpa, Vispota, Pidika, Ksudraroga, Nilika, Vyanga, Krimiroga

10. Madhu Varnya, Grahi, Lekhana, Chakshusya, Deepana, Vranashodhana, Sandhana, Ropana , Medohara, Krimihara, Yogavahi, Kaphapitta Rakta Shamak

Kushta, Prameha, Krimi, Kaasa, Shwasa, Hikka, Atisara, Malasangha, Trishna, Daha, Kushta

��

M.Pharm, Ph.D.

Professor, Dept. of PHARMACOGNOSY,

Karnataka College of Pharmacy,

Bidar, Karnataka- 585403.

Cell: +91-944918196 E-mail: [email protected]

CERTIFICATE

This is to certify that Dr. Anil. S Managuli, Final year P.G. Scholar,

P.G. Department of Panchakarma, N.K.J. Ayurvedic Medical College &

P.G. Centre, Bidar has performed phytochemical study of his following

research trial drugs under my supervision.

� Kritavedhana (Luffa acutangula) as an emitic drug

� Manjishta (Rubia cardifolia) mixed with Honey in paste form as an

external application.

Dr. Mallikarjun Malipatil M.Pharm, Ph.D.

PLACE : BIDAR.

DATE :

PHYTOCHEMICAL REPORT OF TRIAL DRUGS

Powder of Luffa acuttangula

� Nature of Drug – Powder

� Colour – Yellowish Brown

� Odour – Characteristic

� Taste – Bitter

The preliminary phytochemical screening of trial drug are –

Test for Carbohydrates :

� Bendict’s Test – Negative

� Fehling’s Test – Negative

Test for Proteins :

� Million’s test – Positive

Test for Vitamins :

Powder of Luffa Acutangula + Cloroform+ H2So4 with light violet

colour Changing to purple colour – Negative

Test For saphonins :

� Saponins with water shows foaming – Positive

Tests for Alkaloids done :

� Dragendroff’s test – Positive

� Hegar’s test – Positive

� Wagner’s Test – Positive

� Mayer’s Test – Positive

Tests for Glycosides :

� Keller Killani Test – Positive

Test for Fatty Acids :

� Lieberman Buchard test – Positive

Phytochemical content of the clinical trial drug powder of

Kritavedhana (Luffa acutangula)

SL. COMPONENT AVAILABILITY

01. Carbohydrate – ve

02. Proteins + ve

03. Vitamins – ve

04. Alkaloids + ve

05. Saphonin glycosides + ve

06. Glycosides + ve

07. Fatty acids + ve

Saphonins have bitter & acrid taste, they causes irritation of mucus

membrane induces the nausea & vomiting. High dosage of alkaloids

directly stimulates the vomiting center in the Central Nervous System.

These might be the reasons for inducing vomiting.

PASTE OF MANJISHTA (Rubia cardifolia) & HONEY

� Nature of Drug – Paste

� Colour – Brick Red

� Odour – Pleasant

� Taste – Sweet

� Solubility – It is soluble in water, petroleum solvents &

ether. But soluble in ethyl acetate, chloroform, n-butanol & benzene.

The preliminary phytochemical screening of trial drug are –

Test for Carbohydrates :

� Bendicts’ s Test – Positive

� Fehling’s Test – Positive

Test for Protiens :

� Million’s test – Positive

Test for Vitamins :

Paste of manjishta & honey + Cloroform + H2So4 with light violet

colour Changing to purple colour – Positive.

Test for saphonins :

� Saponins with water shows Foaming – Negative

Tests for alkaloids done :

� Dragendroff’s test – Negative

� Hegar’s test – Negative

� Wagner’s Test – Negative

� Mayer’s Test – Negative

Tests for cardiac glycosides :

� Keller Killani Test – Positive

Test for fatty acids :

� Lieberman Buchard test – Negative

Test for Tannins :

� Goldbeaters Skin test – Negative

DRUGS USED FOR PROCEDURS

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MATERIALS & METHODS

AIMS & OBJECTIVES OF THE STUDY

� Evaluate the effect of Manjishta-Madhu Lepa in Youvana Pidaka.


by Lepa in Youvana Pidaka.

� Compare the effect of Lepa over the Vamana followed by Lepa in

Youvana Pidaka.

SOURCES OF DATA

01. Patients – The patients with classical signs and symptoms of Youvana

Pidaka were randomly selected by preset inclusion and exclusion criteria

from the OPD and IPD of Post-graduate studies in Panchakarma of Shri

Siddharoodha Charitable Hospital, Bidar attached to N. K. Jabshetty

Ayurvedic Medical College & P.G. Research Center Bidar, Karnataka.

02. Trial Drugs – All the raw drugs were identified, purchased from local

market and processed under good manufacturing practice in N. K.

Jabashetty Ayurvedic Pharmacy under the supervision of Dravyaguna &

Rasashala specialists.

The Kritavedhana (bitter variety) was cultivated in our herbal garden

and used for the present clinical trial. The well matured fruits were

collected and dried them in a sunshade. Fine powder is prepared out of it

and stored in a dry glass bottle to use as required.

METHOD OF DRUG PREPARATION FOR VAMANA

Drugs for the Deepana-Pachana (Trikatu Churna), Snehapana

(Moorchhita Ghrita) and Sarvanga Abhyanga (Moorcchita Tila Taila) were

taken from N. K. Jabashetty Ayurveda Pharmacy, Bidar.

� Yavagu preparation – It was prepared with Tila Kalka, Guda, Ghee,

Shaali, Ksheera. It is to be prepared in 1:6 proportion of the liquids

and Shaali.

� Aakantha Drava Dravya preparation – 2 liters of schemed milk or

Fresh Ikshu juice is to be prepared with machine.

� Vamaka Dravya – One Tola of Kritavedhana Phala Churna

(Approximately 12 gms) soaked in one Anjali (Approximately 192 ml)

of Yashtimadhu Kwatha soaked over night. Then it is to be filtered in

the morning. Add Madhu and Saindhava Lavana to it before

administration for Vamana. (Approximately 40 ml of Madhu and 5

gms of Saindhava Lavana are taken according to Balaabala of the

patient)

� Vamanopaga Dravya – Yashtimadhu Kwatha Churna is soaked in

hot water for over night in 1:6 proportion. (5 liters of hot water is to

be soaked in 30 gms of Yashtimadhu Kwatha Churna for over night.)

� Shuddhi Drava Dravya – 2 liters of Sukhoshna Jala is mixed with

20 gms of Saindhava Lavana.

METHOD OF PREPARATION OF SAMSARJANA PROCEDURE

Table No. 17. Preparation of Peyadi Samsarjana Krama.

SL. SAMSARJANA RECIPE TO PREPARE

01. Peya 1 cup of old rice + 14 cups of water. Cook the rice

and collect the supernatant part of it. (Ganji)

02. Vilepi 1 cup of old rice + Add 6 cups of water and cook

the rice and collect the semisolid rice.

03. Akrita Yusha 1 cup of old green gram + 14 cups of water, cook

it and have it with cooked rice

04. Krita Yusha 1 cup of old green gram + Add 14 cups of water

and cook it. Add Pope, Salt and little spice and

have it with cooked rice.

05. Akrita Mamsa

Rasa

50 gms of pounded meet + Add 4 cups of water

and reduce to one cup. Have it with cooked rice.

06. Akrita Masha

Yusha

50 gms of blackgram + 14 cups of water and boil,

have with cooked rice.

07. Krita Mamsa

Rasa

50 gms of pounded meet + Add 4 cups of water

and reduce to one cup. Add Pope, Salt and little

spice and have it with cooked rice.

08. Krita Masha

Yusha

50 gms of blackgram + 14 cups of water and boil.

Add Pope, Salt and little spice and have it with

cooked rice.

Patient is advised to follow Samsarjana Krama according the nature

of Shuddhi obtained. After evaluating the status of Agni the patient is

shifted to normal diet regimens. For vegetarians Masha Yusha was used

and for mixed food habits patients were advised Mamsarasa.

METHOD OF DRUG PREPARATION FOR LEPA Daily fresh Lepa drug was prepared for Lepa. Required quantity of

fine powder (Approximately 7 to 10 gms) of Manjishtha (Rubia cardifolia) was taken in a vessel. Add Madhu (Honey) to it slowly (Approximately 5 to 7 gms) with stirring it, to mix them and prepare homogenous paste of it. PROCEDURE OF CONDUCTING VAMANA KARMA

The Vamana karma is conducted at early in the morning at 5 am. Table No. 17a. Procedure of conducting Vamana.

SL. PROCEDURE PREPARATION DURATION 01. Deepana-Pachana Trikatu Churna

(5-10gms) Till Nirama Dosha Lakshana appears

02. Snehana Abyantara Snehapana

Moorchhit Ghrita Arohana Snehapana was carried out till Samyaka Snigdha Lakshana appears (Less than 7 days)

Snehana Bahya sneha (Sarvanga Taila Abhyanga)

Moorchhit Tila Taila

Sarvanga Abhyanga was carried out with Moorcchita Tila Taila on the day of Virama Kala & on the day of Vamana. It was done in the morning till Samyaka Swedana Lakshana appears. In the night Khapha Utkleshaka diet was given prior to the day of Vamana.

Swedana (Sarvaanga Swedana)

Bashpa Sweda Till Samyaka Swedana Lakshana observed

03. Pradhana karma Vamaka Dravya is to be prepared in prescribed manner.

Yavagu was given. Aakanthapaana Drava Dravyas was given. Vamaka Dravya was given. Wait for 1 Moohurta. Yashtimadhu Phanta as a Vamanopaga. Shuddhi Lavana Jala was given for Shuddhi.

04. Pashchat karma � Dhoomapana � Samsarjana

Krama

Dhooma varti Peyadi Samsarjana Karma

Till Samyak Yoga Laxana. According to Shuddi of Vamana it was followed. Pravar Shuddi – 7days, 3 Annakaala Madhyama Shuddi – 5 days, 2 Annakaala Avara Shuddi – 3 days, 1 Annakaala

After Samsarjan Krama, the patients were advised to start

Manjishta-Madhu Lepa as per the regimen of Lepa for 15 days.

PROCEDURE OF CONDUCTING LEPA

The patient was advised to conduct Lepa in morning hours between

7 to 10 am.

Procedure of Lepa karma:-

It was conducted in three steps. Viz. –

� Poorva Karma

� Pradhana Karma and

� Paschat Karma

Poorva karma

� The patient was asked to wash the face with luke warm water prior

to application of Lepa with gentle massage against the hair follicles.

Pradhana Karma

� Lepa was applied preferably in morning hours between 7 and 10 am.

Keep the Lepa over face at least for 30 minutes or until it gets dried.

� Required quantity of Manjishta Choorna Lepa was taken and applied

to the affected site in opposite direction of hair roots.

� The Lepa was applied with the thickness of 4 to 5 mm.

Paschyat Karma

� After completing Lepa the patients were advised to wash the face

with luke warm water.

INTERVENTION CHART

The details of Vamana Karma and Samsarjana Karma procedures

were recorded in interventional proforma.

METHODS OF COLLECTION OF DATA

Patients who were fulfilling the criteria for diagnosis and inclusion

were randomly selected for study.

A. Research Design : Comparative study with pre and post test design.

B. Sample Size : 30 patients.

C. Diagnostic Criteria : Diagnosis was established on the basis of history,

symptoms mentioned in classical texts and by objective parameters /

investigations mentioned in contemporary texts.

D. Inclusion Criteria :

� Patients fulfilling the diagnostic criteria.

� 16 to 30 years of age group.

� Irrespective of sex, religion, socioeconomic status and occupation.

� Patients who are fit for Vamana karma & Lepa karma.

� Chronicity less than 7 years.

E. EXCLUSION CRITERIA

� Patients having Pidika other than face

� Patient having other type of Kshudraroga and Kushta.

� Pidika produced due to side effect of any drug.

� Patients who were contraindicated for Vaman and Lepa in classics.

� The patients suffering from systemic pathologies like DM, HTN, etc.

F. LABORATORY INVESTIGATIONS

Blood and Urine routines were carried out for all the patients to rule

out the secondary things related to Youvana Pidaka.

G. Treatment Groups

All 30 patients were divided in 2 groups. Viz. –

� Group A : 15 Patients were subjected for administered Vaman with

Kritavedhana Yoga followed by Manjishtha-Madhu Lepa all over the

face for 30 minutes or until it get dried up. Lepa was done daily in

the morning for the period of 30 days.

� Group B : 15 Patient were subjected for Manjishtha-Madhu Lepa

over the affected part of the face for 30 minutes or until it get dried. It

was done daily in the morning for the period of 30 days.

H. POSOLOGY :

For Vamana the drugs were requires in following dosages.

� Trikatu Churna – 50 gms to 75 gms.

� Moorcchita Ghrita – 150 ml to 320 ml.

� Moorcchita Tila Taila – 200 ml.

� Yavagu – 100 to 150 gms.

� Aakanthapana Drava Dravya – 2 liters of schemed milk or Ikshurasa.

� Vamaka Dravya – Approximately 200 ml. (192 ml)

� Vamanopaga Drava Dravya – 5 liters of Yashtimadhu Phanta.

� Shuddhi Drava Dravya – 2 liters of Lavana Jala.

For Lepa each patient was supplied with Manjishta-Madhu.

� Fine power of Manjishta – Approximately 150 gms.

� Shuddha Madhu – Approximately 125 to 150 gms.

I. STUDY DURATION : 30 days.

J. FOLLOW UP :

After the treatment 3 follow ups were done. 1st follow up assessment

was done 15 days after the treatment. 2nd follow up assessment was done

30 days after the treatment. 3rd follow up assessment was done 60 days

after the treatment in both the groups. (AT-30 days, FU1-45 days, FU2-75

days, FU3-105 days)

K. RECURRENCE : Reappearance of the symptoms within follow up

period were considered as recurrence of the disease.

ASSESSMENT OF RESULTS

Effect of the therapies was compared before and after the treatment

on the basis of self formulated scoring scale to signs and symptoms in

subjective and objective parameters.

Subjective parameters

� Pain

� Burning sensation

Objective parameters

� Pictorial presentation

� Number of Pidaka

� Size of Pidaka

� Number of scars

� Oiliness of the face

� Dryness of the face

� Score of Pidaka on the basis of affected place

� Global Acne Grading System

PARAMETERS GRADATION INDEX

SUBJECTIVE PARAMETER

PAIN

0 – No pain

1 – Occasionally pain on deep pressure

2 – Pain on mild pressure

3 – Pain on touch

4 – Continuous pain even without touch

BURNING SENSATION

0 – No burning sensation

1 – Occasionally burning sensation

2 – Burning sensation on rubbing

3 – Burning sensation on deep touch

4 – Intolerable burning sensation

OBJECTIVE PARAMETER

NUMBER OF PIDAKA

0 – No Pidaka

1 – 0 – 5 on Right side & 0 – 5 on Left side



4 – More than 20 Pidaka on Right side & More than 20 Pidaka on Left side

SIZE OF PIDAKA

0 – No Pidaka

1 – Less than 5 mm

2 – 6 mm to 10 mm

3 – 11mm to 15 mm

4 – More than 16 mm

NUMBER OF SCAR

0 – No Scar

1 – 1-5 Scars

2 – 5-10 Scars

3 – 10-15 Scars

4 – >15 Scars

OILINESS ON THE FACE

0 – Normal skin

1 – Face becomes oily 3 to 4 hours after face wash

2 – Face becomes oily 1 to 2 hours after face wash

3 – Requires face wash within 1 hour

4 – Require face wash frequently

DRYNESS OF THE FACE

0 – No Dryness / Normal Skin

1 – Feels dryness in winter season only

2 – Dryness subsides with application of moisturizers

3 – Dryness feels during all seasons

4 – Feels dryness in all seasons and require moisturizers frequently

SCORE OF PIDAKA ON THE BASIS OF AFFECTED PLACE

2 – Forehead

2 – Right Cheek and Right side of face

2 – Left Cheek and Right side of face

1 – Nose

4 – Chin

4 – Chest & upper back

GLOBAL ACNE GRADING SYSTEM

Grade Score Description

None 0 No lesion

Mild 1 01 – 18 Comedons

Moderate 2 19 – 30 Comedons

Severe 3 31 – 38 Comedons

Very severe 4 > 39 Comedons

GRADATION INDEX FOR OVERALL RESPONSE

The overall results were assessed based on data obtained before

and after the treatment. The percentage of improvement is calculated and

graded in following ways –

� No improvement – Less than 25% of the obtained result.

� Mild relief – 25% to 50% of the obtained result.

� Moderate relief – 50% to 75% of the obtained result.

� Marked relief – More than 75% of the obtained result.

� Complete relief – 100% relief in the obtained result.

STATISTICAL ANALYSIS OF THE RESULTS

The obtained data was subjected for paired ‘t’ test and ‘p’ value less

than 0.05 is considered as statistically significant in this study.

��

OBSERVATIONS

The present clinical study was conducted to evaluate the

comparative efficacy of Vamana followed by Lepa and only Lepa in

Youvana Pidaka. The patients were randomly registered irrespective of

age, sex, socio-economical status and religion. All the patients were

received the trial drug as per the research protocol.

For the present clinical study 38 patients were registered. The

patients were divided into 2 groups.

Table No. 18. Distribution of patients registered in trial groups.

SL. Trial Groups Total Registered Discontinued Completed

01. Group A 18 03 15

02. Group B 20 05 15

Among the 38 patients, only 30 patients completed the duration of

research protocol. In group A, 03 patient discontinued the treatment and in

group B, 05 patients discontinued the treatment schedule due to several

reasons, like fear, anxiety to the therapy, irregular in follow up, etc.

The data was recorded in special research proforma designed. The

results were assessed on the basis of changes in subjective and objective

parameters recorded accordingly during the study. The collected data is

broadly classified under four groups. Viz. –

� Section A – Demographic Data

� Section B – Data related to Disease

� Section C – Statistical Analysis

� Section D – Overall Response

SECTION A – DEMOGRAPHIC DATA The demographic data collected during the study is as follows –

Table No. 19. Distribution of the patients according to age.

Gr. A Gr. B TOTAL SL.

Age in Yrs No. of Pt’s % No. of Pt’s % No. of Pt’s %

01. 14-17 00 00.00 01 06.66 01 03.33

02. 18-21 07 46.66 09 60.00 16 53.33

03. 22-25 06 40.00 05 33.33 11 36.66

04. 26-29 01 06.66 00 00.00 01 03.33

05. 30-33 01 06.66 00 00.00 01 03.33

Among 30 patients, maximum numbers of 16 patients (53.33%) were

in 18-21 years, 11 patients (36.66%) were in 22-25 years, 01 patient

(03.33%) each was in 14-17 years, 26-29 years, 30-33 years of age group.

Table No. 20. Distribution of the patients according to sex.


Sex No. of Pt’s % No. of Pt’s % No. of Pt’s %

01. Male 03 20.00 05 33.33 08 26.66

02. Female 12 80.00 10 66.66 22 73.33


female and 08 patients (26.66%) were male. Table No. 21. Distribution of the patients according to religion.


Religion No. of

Pt’s % No. of

Pt’s % No. of

Pt’s %

01. Hindu 09 60% 10 66.66 19 63.33

02. Muslim 02 13.33 02 13.33 04 13.33

03. Christian 01 6.66 02 13.33 03 10.00

04. Others 03 20 01 6.66 04 13.33


Hindu, 04 patients (13.33%) each were Muslim and other religion, 03

patients (10%) were christian.

Graph No. 01. Age-wise distribution of the patients.

Age-wise distribution of Pt.'s

0

76

1 11

9

5

0 00123456789

10

14-17 18-21 22-25 26-29 30-33

Age in Years

No.

of P

t.'s

Gr. A Gr. B

Graph No. 02. Sex-wise distribution of the patients.

Sex-wise distribution of Pt.'s

3

12

5

10

0

2

4

6

8

10

12

14

Male FemaleSex

No.

of P

t.'s

Gr. A Gr. B

Graph No. 03. Religion-wise distribution of patients.

Religion-wise distribution of Pt.'s

9

21

3

10

2 21

0

2

4

6

8

10

12

Hindu Muslim Christian Others

Religion

No

. of

Pt.

's

Gr. A Gr. B

Table No. 22. Distribution of the patients according to education. Gr. A Gr. B TOTAL

SL.

Education No. of Pt’s

% No. of Pt’s

% No. of Pt’s

%

01. Illiterate 01 06.66 01 06.66 02 06.66 02. PUC & Below 06 40.00 09 60.00 15 50.00 03. Graduation 06 40.00 03 20.00 09 30.00 04. Postgraduate 02 13.33 02 13.33 04 13.33

Among 30 patients, maximum numbers of 15 patients (50.00%) were PUC and below, 09 patients (30.00%) were graduates, 04 patients (13.33%) were post-graduates and 02 patients (06.66%) were illiterate. Table No. 23. Distribution of the patients according to occupation.


Occupation No. of

Pt’s % No. of

Pt’s % No. of

Pt’s %

01. Students 10 66.66 11 73.33 21 70.00 02. House wife 03 20.00 02 13.33 05 16.66 03. Agriculture

/ Labour 01 06.66 01 06.66 02 06.66

04. Business 00 00.00 00 00.00 00 00.00 05. Office work 01 06.66 01 06.66 02 06.66

Among 30 patients, maximum numbers of 21 patients (70.00%) were students, 05 patients (16.66%) each were house wife, 02 patients (06.66%) each were in agriculture, labour occupation. Table No. 24. Distribution of the patients according to S-E Status.


S-E Status No. of

Pt’s % No. of

Pt’s % No. of

Pt’s %

01. Lower Class 03 20.00 02 13.33 05 16.66 02. Middle Class 07 46.66 09 60.00 16 53.33 03. Upper Class 05 33.33 04 26.66 09 30.00


of middle class, 09 patients (30.00%) were of upper class and 05 patients

(16.66%) were of lower class socio-economic status.

Graph No. 04. Educational status-wise distribution of the patients.

Education-wise distribution of Pt.'s

1

6 6

21

9

3

1

0123456789

10

Illiterate PUC & Below Graduation Postgraduate

Education

No.

of P

t.'s

Gr. A Gr. B

Graph No. 05. Occupation-wise distribution of the patients.

Occupation-wise distribution of Pt.'s

10

3

10

1

11

21

01

0

2

4

6

8

10

12

Students House wife Agriculture /Labour

Business Office work

Occupation

No

. of P

t.'s

Gr. A Gr. B

Graph No. 06. Socio-Economic status-wise distribution of the patients

S-E Status-wise distribution of Pt.'s

2

7

5

2

9

4

0123456789

10

Lower Class Middle Class Upper Class

S-E Status

No. o

f Pt.'s

Gr. A Gr. B

Table No. 25. Distribution of the patients according to habitat.

Gr. A Gr. B TOTAL

SL.

Habitat No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Slum 02 13.33 02 13.33 04 13.33

02. Rural 03 20.00 03 20.00 06 20.00

03. Suburban 04 26.66 08 53.33 12 40.00

04. Urban 06 40.00 02 13.33 08 26.66


residing in sub-urban area, 08 patients (26.66%) were residing in urban

area, 06 patients (20.00%) were residing in rural and 04 patients (13.33%)

were residing in slum area.

Table No. 26. Distribution of the patients according to marital status.


Marital Status

No. of Pt’s % No. of Pt’s

% No. of Pt’s

%

01. Married 04 26.66 03 20.00 07 23.33

02. Unmarried 11 73.33 12 80.00 23 76.66


unmarried and 07 patients (23.33%) were married.

Table No. 27. Distribution of the patients according to dietary habits.

Gr. A Gr. B TOTAL

SL.

Dietary

Habits No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Vegetarian 05 33.33 07 46.66 12 40

02. Mixed 10 66.66 08 53.33 18 60


mixed food habits and 12 patients (40.00%) were vegetarian.

Graph No. 07. Habitat-wise distribution of the patients.

Habitat-wise distribution of Pt.'s

2

34

6

2

3

8

2

0

12

34

5678

9

Slum Rural Suburban Urban

Habitat

No

. of

Pt.

's

Gr. A Gr. B

Graph No. 08. Marital status-wise distribution of the patients.

Marital Status-wise distribution of Pt.'s

4

11

3

12

0

2

4

6

8

10

12

14

Married Unmarried Marital Status

No. o

f Pt.'s

Gr. A Gr. B

Graph No. 09. Dietary habits-wise distribution of the patients.

Diatory Habit-wise distribution of Pt.'s

5

10

78

0

2

4

6

8

10

12

Vegetarian MixedDiatory Habits

No.

of P

t.'s

Gr. A Gr. B

Table No. 28. Distribution of the patients according to Prakriti.

Gr. A Gr. B TOTAL

SL

Prakriti No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Vata-Pitta 05 33.33 06 40.00 11 36.66

02. Kapha-Pitta 03 20.00 04 26.66 07 23.33

03. Vata-Kapha 07 46.66 05 33.33 12 40.00


of Vata-Kapha Prakriti, 11 patients (36.66%) were of Vata-Pitta Prakriti and

07 patients (23.33%) were of Kapha-Pitta Prakriti.

Table No. 29. Distribution of the patients according to Satwa.

Gr. A Gr. B TOTAL

SL.

Satwa No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Pravara 07 46.66 04 26.66 11 36.66

02. Madhyama 06 40.00 05 33.33 11 36.66

03. Avara 02 13.33 06 40.00 08 26.66

Among 30 patients, maximum numbers of 11 patients (36.66%) each

were having Pravara Satwa and Madhyama Satwa and 08 patients

(26.66%) were having Avara Satwa.

Table No. 30. Distribution of the patients according to Desha.

Gr. A Gr. B TOTAL

SL.

Desha No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Anupa 08 53.33 07 46.66 15 50.00

02. Janghal 04 26.66 05 33.33 09 30.00

03. Sadharana 03 20.00 03 20.00 06 20.00


from Anupa Desha and 09 patients (30.00%) were from Jangala Desha

and 06 patients (20.00%) were Sadharana Desha.

Graph No. 10. Prakriti-wise distribution of the patients.

Prakriti-wise distribution of Pt.'s

5

3

7

6

4

5

0

1

2

3

4

5

6

7

8

Vata-Pitta Kapha-Pitta Vata-KaphaPrakriti

No

. of

Pt.

's

Gr. A Gr. B

Graph No. 11. Satwa-wise distribution of the patients.

Satwa-wise distribution of Pt.'s

7

6

2

4

5

6

0

1

2

3

4

5

6

7

8

Pravara Madhyama Avara

Satwa

No.

of P

t.'s

Gr. A Gr. B

Graph No. 12. Desha-wise distribution of the patients.

Desha-wise distribution of Pt.'s

8

43

7

5

3

0123456789

Anupa Jangal Sadharana

Desha

No

. of

Pt.

's

Gr. A Gr. B

Table No. 31. Distribution of the patients according to Vyayama Shakti.

Gr. A Gr. B TOTAL

SL.

Vyayama

Shakti No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Pravara 07 46.66 04 26.66 11 36.66

02. Madhyama 06 40.00 05 33.33 11 36.66

03. Avara 02 13.33 06 40.00 08 26.66

Among 30 patients, maximum numbers of 11 patients (36.66%) each

were having Pravara and Madhyama Vyayama Shakti, and 08 patients

(26.66%) were having Avara Vyayama Shakti.

Table No. 32. Distribution of the patients according to Satmya.

Gr. A Gr. B TOTAL

SL.

Satmya No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Pravara 00 00.00 00 00.00 00 00.00

02. Madhyama 15 100.00 15 100.00 30 100.00

03. Avara 00 00.00 00 00.00 00 00.00

Among 30 patients were having Madhyama Saatmya.

Table No. 33. Distribution of the patients according to Diwaswapna.

Gr. A Gr. B TOTAL

Sl. Diva

Swapna No. of Pt’s % No. of Pt’s % No. of Pt’s %

01. No 13 86.66 08 53.33 21 70.00

02. <1 hr 01 06.66 02 13.33 03 10.00

03. 1-2 hrs 01 06.66 05 33.33 06 20.00

04. >2 hrs 00 00.00 00 00.00 00 00.00

Among 30 patients, maximum numbers of 21 patients (70.00%) were not

sleeping at day time, 06 patients (20.00%) were sleeping 1-2 hours and 03

patients (10.00%) patients were habituated for day sleep less than 1 hour in

day time.

Table No. 34. Distribution of the patients according to Agni. Gr. A Gr. B TOTAL

SL.

Agni No. of Pt’s

% No. of Pt’s

% No. of Pt’s

%

01. Sama 13 86.66 09 60.00 22 73.33 02. Vishama 00 00.00 00 00.00 00 00.00 03. Manda 02 13.33 06 40.00 08 26.66 04. Teekshna

Agni 00 00.00 00 00.00 00 00.00

Among 30 patients, 22 patients (73.33%) were having Samagni and 08 patients (26.66%) were having Mandagni. Graph No. 13. Vyayama Shakti-wise distribution of the patients.

Vyayama Shakti-wise distribution of Pt.'s

76

2

45

6

012345678


Vyayama Shakti

No.

of P

t.'s

Gr. A Gr. B

Graph No. 14. Satmya-wise distribution of the patients.

Satmya-wise distribution of Pt.'s

0

15

00

15

00

2

4

6

8

10

12

14

16


Satmya

No.

of P

t.'s

Gr. A Gr. B

Graph No. 15. Diwaswapna-wise distribution of the patients.

Diwaswapna-wise distribution of Pt.'s13

1 10

8

2

4

00

2

4

6

8

10

12

14

No <1 hr 1-2 hrs >2 hrs

Diwaswapna

No.

of P

t.'s

Gr. A Gr. B

Graph No. 16. Status of Agni-wise distribution of the patients.

Status of Agni-wise distribution of Pt.'s13

0

2

0

9

0

6

00

2

4

6

8

10

12

14

Sama Vishama Manda Teekshna Agni

Status of Agni

No.

of P

t.'s

Gr. A Gr. B

SECTION B – DATA RELATED TO DISEASE Table No. 35. Distribution of the patients according to Nidana in Ahara specifications.


Ahara

specifications No. of Pt’s

% No. of Pt’s

% No. of Pt’s

%

01. Excess use of Masha

00 00.00 00 00.00 00 00.00

02. Excess use of Dadhi

02 13.33 02 13.33 04 13.33

03. Excess use of Dugdha Vikara 02 13.33 01 06.66 03 10.00

04. Excess use of Ice creams 00 00.00 00 00.00 00 00.00

05. Excess use of oily food 04 26.66 03 20.00 07 23.33

06.

Excess use of Sore items / Pickles

00 00.00 00 00.00 00 00.00

07.

Excess use of Bakery items / Spicy items

02 13.33 03 13.33 05 16.66

08.

Excess use of Sweets / Ikshu Vikara / Chocalate

02 13.33 03 33.33 05 16.66

09. Excess use of Matsya 00 00.00 00 00.00 00 00.00

10. Excess use of Chicken / Meat 03 20.00 03 26.66 06 40.00


habituates to excess use of oily food and 06 patients (26.66%) were

habituates to Chicken / Meat and, 05 patients (16.66%) each were

habituates to excess use of sweets / Ikshu Vikara / Chocolates, Excess

use of bakery items / Spicy items. 04 patients (16.66%) were habituated to

excess use of Dadhi and 03 patients (10%) were habituated to excess use

of Milk products.

Table No. 36. Distribution of the patients according to Nidana in Vihara

specification.

Gr. A Gr. B TOTAL

SL.

VIHARA No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Exposure to

Dhooma 03 20.00 04 26.66 07 23.33

03. Exposure to

Atapa 00 00.00 03 20.00 03 10.00

04. Exposure to

dust 02 13.33 00 00.00 02 06.66

06. Diwaswapna 04 26.66 02 13.33 06 20.00

07. Nishajagarana 03 20.00 02 13.33 05 16.66

08. Pravasa 02 13.33 02 13.33 04 13.33

09. Ativyayama 03 20.00 02 13.33 05 16.66

10. Avyayama 00 00.00 00 00.00 00 00.00

Among 30 patients, 07 (23.33%) were exposed to Dhooma, 06

patients (20.00%) were doing Deewaswpna, 05 patients (16.66%) each

were doing Nishajagarana & Ativyayam, 04 patients (13.33%) were

exposed to Pravasa, 03 patients (10.00%) were exposed to Aatapa, 02

patients (06.66%) were exposed to dust.

Table No. 37. Distribution of the patients according to Site of

Pidaka.

Gr. A Gr. B TOTAL

SL.

Site of

Pidaka No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Face 15 100 15 100 30 100

02. Neck 03 20.00 02 13.33 05 16.66

03. Chest 03 20.00 00 00.00 03 10.00

04. Back 05 33.33 03 20.00 11 36.66

05. Shoulder 03 20.00 02 13.33 05 16.66

Among 30 patients, all patients were having Pidaka over face, 11

patients (36.66%) were having Pidaka on the back, 05 patients (16.66%)

were having Pidaka on the shoulder and neck and 03 patients (10.00%)

were having Pidaka on the chest.

Table No. 38. Distribution of the patients according to Chronicity.

Gr. A Gr. B TOTAL

SL.

Chronicity No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. 0 – 1 yrs 05 33.33 06 40.00 11 36.66

02. 2 – 3 yrs 08 53.33 05 33.33 13 43.33

03. 4 – 5 yrs 01 06.66 02 13.33 03 10.00

04. 6 – 7 yrs 01 06.66 02 13.33 03 10.00


having 2-3 yrs chronicity, 11 patients (36.66%) were from 0-1 yrs of

chronicity and 03 patients (10.00%) each were having chronicity of 4-5 yrs

and 6-7 yrs.

Graph No. 17. Aharaja Nidana-wise distribution of the patients.

Aharaja Nidana-wise distribution of Pt.'s

0

2 2

0

4

0

2 2

0

3

0

2

1

0

3

0

3 3

0

3

00.5

11.5

22.5

33.5

44.5

Masha Dadhi Dugdha Vikar a Ice cr eams Oi ly f ood Sor e i tems / Pickles Baker y i tems /Spicy i tems

Sweets / IkshuVikar a / Chocalate

Matsya Chicken / Meat

Aharaja Nidana

No

. of P

t.'s

Gr. A Gr. B

Graph No. 18. Viharaja Nidana-wise distribution of the patients.

Viharaja Nidana-wise distribution of Pt.'s

3

0

2

4

3

2

3

0

4

3

0

2 2 2 2

00

0.51

1.52

2.53

3.54

4.5

Exposur e to Dhooma Exposur e to Atapa Exposur e to dust Diwaswapna Nishajagar ana Pr avasa Ativyayama Avyayama

Viharaja Nidana

No.

of P

t.'s

Gr. A Gr. B

Graph No. 19. Site of Pidaka-wise distribution of the patients.

Site of Pidaka-wise distribution of Pt.'s15

3 3

5

3

15

2

0

32

0

2

4

6

8

10

12

14

16

Face Neck Chest Back ShoulderSite of Pidaka

No.

of P

t.'s

Gr. A Gr. B

Table No. 39. Distribution of the patients according to Varna of patient.

Gr. A Gr. B TOTAL

SL.

VARNA No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Goura 03 20.00 02 13.33 05 16.66

02. Shyava 08 53.33 10 66.66 18 60.00

03. Krishna 04 26.66 03 20.00 07 23.33

Among 30 patients, maximum numbers of 18 patients (60.00%)

patients were having Shyava Varna, 07 patients (23.33%) were having

Krishna Varna and 05 patients (16.66%) were having Goura Varna.

Table No. 40. Distribution of the patients according to Shotha of Pidaka.

Gr. A Gr. B TOTAL

SL.

SHOTHA No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Bahala 07 46.66 07 46.66 14 46.66

02. Alpa 08 53.66 08 53.66 16 53.33


having Alpa Shotha and 14 patients (47%) were having Bahala Shotha.

Table No. 41. Distribution of the patients according to onset of Pidaka.

Gr. A Gr. B TOTAL

SL.

ONSET No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Sudden 00 00.00 02 13.33 02 06.66

02. Gradual 15 100 13 87.00 28 93.33

03. Insidious 00 00.00 00 00.00 00 00.00

Among 30 patients, 28 patients (93.33%) were having gradual onset

and 02 patients (06.66%) were of sudden onset.

Graph No. 20. Chronicity-wise distribution of the patients.

Chronicity of Pidaka-w ise distribution of Pt.'s

5

8

1 1

65

2 2

0

2

4

6

8

10

0 – 1 yrs 2 – 3 yrs 4 – 5 yrs 6 – 7 yrs

Chronicity in years

No

. of

Pt.

's

Gr. A Gr. B

Graph No. 21. Varna of the patient-wise distribution of the patients.

Varna of the Pt-wise distribution

3

8

4

2

10

3

0

2

4

6

8

10

12

Goura Shyava KrishnaVarna Specification

No.

of P

t.'s

Gr. A Gr. B

Graph No. 22. Shotha of the Pidaka-wise distribution of the patients.

Shotha of Pidaka-wise distribution of Pt.'s

78

78

1

2

3

4

5

6

7

8

9

10

Bahala AlpaShotha of the Pidaka

No

. of

Pid

aka

Gr. A Gr. B

Graph No. 23. Onset of Pidaka-wise distribution of the patients.

Onset of Pidaka-wise distribution of Pt.'s

0

15

02

13

002468

10121416

Sudden Gradual InsidiousOnset of Pidaka

No.

of P

idak

a

Gr. A Gr. B

Table No. 42. Distribution of the patients according to aggravation

of Pidaka in various seasons.

Gr. A Gr. B TOTAL

SL.

Aggravation No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Summer 05 33.33 04 26.66 09 30.00

02. Winter 01 06.66 00 00.00 01 03.33

03. Sunlight 03 20.00 01 06.66 04 13.33

04. Menstruation 06 40.00 06 40.00 12 40.00

05. No relation 06 40.00 07 46.66 13 43.33

Among 30 patients, maximum numbers of 13 patients (43.33%)

shows no relation of Pidaka with season. 12 patients (40.00%) were

complaining aggravation of Pidaka at menstruation. 09 patients (30.00%)

were complaining of aggravation of Pidaka during summer. 04 patients

(13.33%) were complaining of aggravation of Pidaka during sunlight and

01 patient (03.33%) was complaining of aggravation of Pidaka during

winter season.

Table No. 43. Distribution of the patients according to family

history of Acne.

Gr. A Gr. B TOTAL

SL.

Family

history

No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Sister 04 26.66 03 20.00 07 29.16

02. Brother 05 33.33 04 26.66 09 37.50

03. Mother 02 13.33 02 13.33 04 16.66

04. Father 02 13.33 02 13.33 04 16.66

Among 30 patients 24 patients represented with the family history of

acne. Among those maximum numbers of 09 patients (37.50%) patients

were having family history of Acnes to their brothers, 07 patients (29.16%)

were reported with the history of Acne to their sisters and 04 patients

(16.66%) each were having history Acne to their mothers and fathers.

Table No. 44. Distribution of the patients of Acne eruption in

relation with Rajopravrutti reported by 24 female patients.

Gr. A Gr. B TOTAL

SL.

Relation with

Menses No. of Pt’s

% No. of Pt’s

% No. of Pt’s

%

01. Aggravates 07 46.66 06 40.00 13 54.16

02. No relation 05 33.33 06 40.00 11 45.83

Among 24 females patients, maximum numbers of 13 patients

(54.16%) were complains of aggravation of Pidaka during menstrual period

and 11 patients (45.83%) says no relation of Pidaka with menstruation.

Graph No. 24. Distribution of patients according to season-wise

aggravation of Pidaka.

Distribution of Pt.'s according to Season-wise aggravation of Pidaka

5

1

3

6 6

4

01

67

0

2

4

6

8

Summer Winter Sunlight Menstruation No relation

Seasonal Variations

No

. of

Pt.

's

Gr. A Gr. B

Graph No. 25. Distribution of patients according to family history of Pidaka.

Family History-wise distirbution of Pt.'s

4

5

2 2

3

4

2 2

0

1

2

3

4

5

6

Sister Brother Mother Father

Family History

No.

of P

t.'s

Gr. A Gr. B

Graph No. 26. Distribution of patients according to relation with menses.

Distribution of Pt.'s according to relation with Menses

7

56 6

012345678

Aggravates No relationRelation with Menses

No

. of

Pt.

's

Gr. A Gr. B

Table No. 45. Distribution of the patients of according to the type of Vedana experienced by the patient.


VEDANA No. of

Pt’s % No. of

Pt’s % No. of

Pt’s %

01. Kandu 01 06.66 01 06.66 02 06.66 02. Daha 06 40.00 04 26.66 10 33.33 03. Shoola 08 53.33 10 66.66 18 60.00

Among 30 patients, maximum numbers of 18 patients (60%) was complaint of Shoola, 10 patients (33.33%) were having Kandu and 02 patients (06.66%) were having Daha. Table No. 46. Distribution of the patients according to number of Pidaka.


No of PIDAKA No. of

Pt’s % No. of

Pt’s % No. of

Pt’s %

01. 1 to 5 00 00.00 00 00.00 00 00.00 02. 6 to 10 03 20.00 01 06.66 04 13.33 03. 11 to 15 09 60.00 09 60.00 18 60.00 04. >15 03 20.00 05 33.33 08 26.66

Among 30 patients, maximum numbers of 18 patients (60.00%) was having 11-15 Pidaka on each Right & Left side of face, 08 patients (26.66%) were having > 15 Pidaka and 04 patients (13.33%) were having 6-10 Pidaka on each Right & Left side of face. Table No. 47. Distribution of the patients according to density of Pidaka.


Density of Pidaka

No. of Pt’s

% No. of Pt’s

% No. of Pt’s

%

01. <1 cm2 00 00.00 00 00.00 00 00.00 02. 1-5 cm2 05 33.33 07 46.66 12 40.00 03. 5-10 cm2 09 60.00 06 40.00 15 50.00 04. >10 cm2 01 06.66 02 13.33 03 10.00


having Pidaka in 5-10/cm2 area, 12 patients (40%) were having Pidaka 1-

5/cm2 area and 03 patients (10%) were having Pidaka in >10/cm2 area.

Graph No. 27. Distribution of patients according to type of Vedana.

Type of Vedana-wise distribution of Pt.'s

1

6

8

1

4

10

0

2

4

6

8

10

12

Kandu Daha ShoolaType of Vedana

No. o

f Pt.'s

Gr. A Gr. B

Graph No. 28. Distribution of patients according to number of Pidaka.

Number of Pidaka-wise distribution of Pt.'s

0

3

9

3

01

9

5

0

2

4

6

8

10

1 to 5 6 to 10 11 to 15 More than 15

Number of Pidaka

No.

of P

t.'s

Gr. A Gr. B

Graph No. 29. Distribution of patients according to density of Pidaka.

Density of Pidaka-w ise distribution of Pt.'s

0

5

9

10

76

2

0

2

4

6

8

10

<1 cm2 1-5 cm2 5-10 cm2 >10 cm2

Density of Pidaka

No.

of P

t.'s

Gr. A Gr. B

Table No. 48. Distribution of the patients according to nature of

Pidaka.


Nature of Pidaka

No. of Pt’s

% No. of Pt’s

% No. of Pt’s

%

01. White

comedone 02 13.33 02 13.33 04 13.33

02. Black

comedone 05 33.33 04 26.66 09 30.00

03. Papule 00 00.00 01 06.66 01 03.33

04. Pustule 04 26.66 04 26.66 08 26.66

05. Nodule 03 20.00 03 20.00 06 20.00

06 Cyst 01 06.66 01 06.66 02 06.66


having black comedone, 08 patients (26.66%) were having pustules, 06

patients (20.00%) were having nodule, 04 patients (13.33%) were having

white comedone and 02 patients (06.66%) were of cysts and 01 patient

(03.33%) was having papules.

Table No. 49. Distribution of the patients according to area

affected.


Area affected No. of

Pt’s % No. of

Pt’s % No. of

Pt’s %

01. Localized 08 53.33 09 60.00 17 56.66

02. Generalized 04 26.66 04 26.66 08 26.66

03. Symmetrical 00 00.00 00 00.00 00 00.00

04. Asymmetrical 03 20.00 02 13.33 05 16.66


having localized Pidaka, and 08 patients (33.3%) were having generalized

Pidaka and 05 (16.66%) were having asymmetrical Pidaka.

Table No. 50. Distribution of the patients according to size of

Pidaka.

Gr. A Gr. B TOTAL

SL.

Size of

Pidaka No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. 1-5mm 04 26.66 01 6.66 05 16.66

02. 6-10mm 06 40.00 08 53.33 14 46.66

03. 11-15mm 05 33.33 06 40.00 11 36.66

04. >15 mm 00 00.00 00 00.00 00 00.00


having 6-10 mm Pidaka, and 11 patients (37%) were having 11-15 mm

Pidaka and 05 patients (16.66%) were having 1-5 mm Pidaka.

Table No. 51. Distribution of the patients according to number of

scar.

Gr. A Gr. B TOTAL

SL.

Number of

scar

No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. 1-5scar 07 46.66 05 33.33 12 40.00

02. 6-10scar 05 33.33 06 40.00 11 37.00

03. 11-15scar 03 20.00 03 20.00 06 20.00

04. >16 scar 01 06.66 00 00.00 01 03.33

Among 30 patients, maximum numbers of 12 patients (40%) were

having 6-10 scars on each Rt & Lt side of face, and 10 (33.3%) were

having 01-05 scars and 06 (20%) were having 11-15 scars on each Right

& Left side of face.

Table No. 52. Distribution of the patients according to pain.

Gr. A Gr. B TOTAL

SL.

PAIN No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Grade I 02 13.33 02 13.33 04 13.33

02. Grade II 05 33.33 04 26.66 09 30.00

03. Grade III 06 40.00 05 33.33 11 37.00

04. Grade IV 02 13.33 03 20.00 04 13.33

Among 30 patients, maximum numbers of 11 patients (37%) were

having Grade III pain during Pidaka appearance, 09 patients (30%) were

having Grade II pain and 04 patients (13.33%) each were having Grade I &

IV grade pain.

Table No. 53. Distribution of the patients according to burning sensation.

Gr. A Gr. B TOTAL

SL.

Burning

sensation No. of

Pt’s

% No. of

Pt’s

% No. of

Pt’s

%

01. Grade I 05 33.33 04 26.66 09 30.00

02. Grade II 05 33.33 05 33.33 10 33.33

03. Grade III 03 20.00 05 33.33 08 26.66

04. Grade IV 02 13.33 00 00.00 02 06.66


having Grade II burning sensation during eruptions of Pidaka, 09 patients

(30.00%) were having Grade I burning sensation, 08 patients (26.66%)

were having Grade III burning sensation & 02 patients (6.66%) were

having Grade IV burning sensation.

Graph No. 30. Distribution of patients according to nature of Pidaka.

Nature of Pidaka-w ise distribution of Pt.'s

2

5

0

4

3

1

2

4

1

4

3

1

0

1

2

3

4

5

6

White comedone Black comedone Papule Pustule Nodule CystNature of Pidaka

No.

of P

t.'s

Gr. A Gr. B

Graph No. 31. Distribution of patients according to area of Pidaka involved.

Area of Pidaka involved in distribution of Pt.'s

4

8

0

34

9

0

2

0

2

4

6

8

10

Localized Generalized Symmetrical Asymmetrical

Pidaka involved

No

. of

Pt.

's

Gr. A Gr. B

Graph No. 32. Distribution of patients according to size of Pidaka.

Size of Pidaka-wise distribution of Pt.'s

4

65

01

8

6

00

2

4

6

8

10

1-5mm 6-10mm 11-15mm >15 mm

Size of Pidaka

No.

of P

t.'s

Gr. A Gr. B

Graph No. 33. Distribution of patients according to number of scars.

Number of Scars-w ise distribution of Pt.'s7

5

3

1

56

3

00

2

4

6

8

1-5scar 6-10scar 11-15scar >16 scar

No. of Scars

No.

of P

t.'s

Gr. A Gr. B

Graph No. 34. Distribution of patients according to pain.

Pain-wise distribution of Pt.'s

2

56

22

4

5

3

0

12

3

4

56

7

I Grade II Grade III Grade IV GradePain

No.

of P

t.'s

Gr. A Gr. B

Graph No. 35. Distribution of patients according to burning sensation.

Burning Sensation-w ise distribution of Pt.'s

5 5

32

45 5

00123456

I Grade II Grade III Grade IV Grade

Burning Sensation

No

. of

Pt.

's

Gr.A Gr. B

Table No. 54. Distribution of the patients according to use of cosmetics.


Use of cosmetics

No. of Pt’s

% No. of Pt’s

% No. of Pt’s

%

01. Soaps 05 33.33 05 33.33 10 33.33

02. Oil based

Cream 06 40.00 05 33.33 11 36.66

03. Water

based

Cream

02 13.33 03 20.00 05 16.66

04. Bleach 02 13.33 02 13.33 04 13.33


using oil based cosmetics, 10 patients (33.3%) were using frequent

change of soaps, 05 patients (16.66%) were water based face creams, 04

patients (13.33%) were habituated to frequent use of bleach.

Table No. 55. Distribution of the patients according to Dosha Pradhanata.


DOSHA No. of Pt’s % No. of

Pt’s % No. of

Pt’s %

01. Vata- Pittaja

06 40.00 08 53.33 14 46.66

02. Kapha-Pittaja

03 20.00 02 13.33 05 16.66

03 Vata- Kaphaja

06 40.00 05 33.33 11 37.00


having Vata-Pittaja Youvana Pidaka, 11 patients (37%) were having Vata-

Kapha Youvana Pidaka and 05 patients (23.33%) were having Kapha-

Pittaja Pradhana Youvana Pidaka.

Graph No. 36. Distribution of patients according to use of cosmetics.

Use of cosmetics-wise distribution of Pt.'s

5

6

2 2

5 5

3

2

0

1

2

3

4

5

6

7

Soaps Oil based Cream Water based Cream Bleach

Use of cosmetics

No.

of P

t.'s

Gr. A Gr. B

Graph No. 37. Distribution of patients according to Dosha Pradhanata in

Pidaka.

Dosha Pradhanata-wise distribution of Pt.'s

6

3

6

8

2

5

0123456789

Vata-Pittaja Kapha-Pittaja Vata- kaphaja

Dosha Pradhanata

No

. of

Pt.

's

Gr. A Gr. B

��

��

��

��

SECTION C – STATISTICAL ANALYSIS

The effect of the therapy on each parameter of assessment is as

follows –

EFFECT ON PAIN

Table No. 56. The “t” test result showing the difference between the

means of samples before and after the treatment in reduction of severity of

pain in both the groups.

Mean Score Pain BT AT

Reduction in mean score

% of reduction in mean score

SD of mean

SE of mean

t value p value

GROUP – A After 30 days

2.53 0.20 2.33 92.10 0.899 0.232 10.041 <0.001

After 45 days

2.53 0.33 2.22 86.84 0.676 0.174 12.598 <0.001

After 70 days

2.53 0.46 2.06 81.57 0.593 0.153 13.480 <0.001

After 105 days

2.53 0.73 1.80 71.05 0.676 0.174 10.308 <0.001

GROUP – B After 30 days

2.53 0.53 2.0 78.94 0.654 0.169 11.829 <0.001

After 45 days

2.53 0.60 1.93 76.31 0.703 0.181 10.637 <0.001

After 70 days

2.53 1.06 1.46 57.89 0.990 0.255 5.733 <0.001

After 105 days

2.53 1.26 1.26 50.00 0.798 0.206 6.139 <0.001

In group A, the reduction in mean severity of the Pain is,

� Before and after treatment shows changes from 2.53 to 0.20

showing a reduction of 2.33 (92.10%) which is statistically significant

at the level of p<0.001.

� Changes after 15 days follow up is from 2.53 to 0.33 showing a

reduction of 2.22 (86.84%) which is statistically significant at the

level of p<0.001.

� Changes after 1st month follow up is from 2.53 to 0.46 showing a


level of p<0.001.

� Changes after 2nd month follow up is from 2.53 to 0.73 showing a


level of p<0.001.

In group B, the reduction in mean severity of the Pain is,






level of p<0.001.



level of p<0.001.


reduction of 1.26 (50%) which is statistically significant at the level of

p<0.001.

EFFECT ON BURNING SENSATION



burning sensation in both the groups.




SD of mean

SE of mean

t value p value


2.13 0.13 2.0 93.75 0.845 0.218 9.162 <0.001

After 45 days

2.13 0.20 1.93 90.62 0.798 0.206 9.371 <0.001

After 70 days

2.13 0.33 1.80 84.37 0.774 0.200 8.990 <0.001

After 105 days

2.13 0.46 1.66 78.12 0.617 0.159 10.455 <0.001


1.93 0.33 1.60 82.75 0.632 0.163 9.795 <0.001

After 45 days

1.93 0.73 1.20 62.06 0.676 0.174 6.872 <0.001

After 70 days

1.93 1.13 0.80 41.37 0.676 0.174 4.581 <0.001

After 105 days

1.93 1.66 0.26 13.79 0.457 0.118 2.255 <0.05

In group A, the reduction in mean severity of the burning

sensation is,

� Before and after treatment shows changes from 2.13 to 0.13showing

a reduction of 2.00 (93.75%) which is statistically significant at the

level of p<0.001.



level of p<0.001.



level of p<0.001.



level of p<0.001.

In group B, the reduction in mean severity of the burning

sensation is,






level of p<0.001.



level of p<0.001.



level of p<0.001.

EFFECT ON NUMBER OF PIDAKA



number of Pidaka in both the groups.




SD of mean

SE of mean

t value

p value


3.00 0.33 2.66 88.88 0.487 0.126 21.16 <0.001

After 45 days

3.00 0.40 2.60 86.66 0.828 0.213 12.15 <0.001

After 70 days

3.00 0.46 2.53 84.44 0.516 0.133 18.99 <0.001

After 105 days

3.00 0.73 2.26 75.55 0.457 0.118 19.17 <0.001


3.26 1.00 2.26 69.38 0.457 0.118 19.173 <0.001

After 45 days

3.26 0.93 2.33 71.42 0.487 0.126 18.515 <0.001

After 70 days

3.26 1.20 2.06 63.26 0.457 0.118 17.481 <0.001

After 105 days

3.26 1.46 1.80 55.10 0.414 0.106 16.833 <0.001

In group A, the reduction in mean severity of the number of

Pidaka is,






level of p<0.001.



level of p<0.001.



level of p<0.001.

In group B, the reduction in mean severity of the number of

Pidaka is,






level of p<0.001.



level of p<0.001.



level of p<0.001.

Graph No. 38. % of reduction in mean score of pain of Pidaka.

% of Reduction in Mean Score of Pain

92.186.84

81.57

71.0578.94 76.31

57.8950

0102030405060708090

100

AT FU1 FU2 FU3

Assigned Groups & Assessment

% o

f Im

pro

vem

ent

Gr. A Gr. B

Graph No. 39. % of reduction in mean score of burning sensation.

% of Reduction in Mean Score of Burning Sensation93.75 90.62

84.3778.12

82.75

62.06

41.37

13.79

0102030405060708090

100

AT FU1 FU2 FU3Assigned Groups & Assessment

% o

f Im

pro

vem

ent

Gr. A Gr. B

Graph No. 40. % of reduction in mean score of number of Pidaka.

% of Reduction in Mean Score of Number of Pidaka

88.88 86.66 84.44

75.5569.38 71.42

63.2655.1

0102030405060708090

100


% o

f Im

rpo

vem

ent

Gr. A Gr. B

EFFECT ON SIZE OF PIDAKA



size of Pidaka in both the groups.




SD of mean

SE of mean

t value p value


2.06 0.13 1.93 93.54 0.883 0.228 8.470 <0.001

After 45 days

2.06 0.26 1.80 87.09 0.774 0.200 8.997 <0.001

After 70 days

2.06 0.40 1.66 80.64 0.487 0.126 13.225 <0.001

After 105 days

2.06 0.60 1.44 70.96 0.743 0.191 7.640 <0.001


2.33 0.53 1.80 77.14 0.414 0.106 16.833 <0.001

After 45 days

2.33 0.73 1.60 68.57 0.507 0.130 12.217 <0.001

After 70 days

2.33 0.93 1.40 60.00 0.507 0.130 10.689 <0.001

After 105 days

2.33 1.13 1.20 51.42 0.560 0.144 8.288 <0.001

In group A, the reduction in mean severity of the size of Pidaka

is,






level of p<0.001.



level of p<0.001.



level of p<0.001.

In group B, the reduction in mean severity of the size of Pidaka

is,






level of p<0.001.



p<0.001.



level of p<0.001.

EFFECT ON NUMBER OF SCAR



number of scar in both the groups.




SD of mean

SE of mean

t value

p value


1.73 1.06 0.66 38.46 0.487 0.126 5.290 <0.001

After 45 days

1.73 1.06 0.66 38.46 0.487 0.126 5.290 <0.001

After 75 days

1.73 1.06 0.66 38.46 0.487 0.126 5.290 <0.001

After 105 days

1.73 1.13 0.60 34.61 0.507 0.130 4.581 <0.001


1.86 1.40 0.46 25.00 0.516 0.133 3.499 <0.01

After 45 days

1.86 1.40 0.46 25.00 0.516 0.133 3.499 <0.01

After 70 days

1.86 1.40 0.46 25.00 0.516 0.133 3.499 <0.01

After 105 days

1.86 1.53 0.33 17.85 0.487 0.126 2.645 <0.02

In group A, the reduction in mean severity of the number of

scar is,






level of p<0.001.



level of p<0.001.



level of p<0.001.

In group B, the reduction in mean severity of the number of

scar is,


showing a reduction of 0.46 (25%) which is statistically significant at

the level of p<0.001.



p<0.001.



p<0.001.



level of p<0.001.

EFFECT ON OILINESS OF THE FACE



oiliness of the face in both the groups.




SD of mean

SE of mean

t value

p value


1.53 0.40 1.13 73.91 0.743 0.191 5.904 <0.001

After 45 days

1.53 0.53 1.00 65.21 0.845 0.218 4.581 <0.001

After 70 days

1.53 0.80 0.73 47.82 0.703 0.181 4.034 <0.01

After 105 days

1.53 1.00 0.53 34.78 0.516 0.133 3.998 <0.01


1.33 0.40 0.93 70.00 0.703 0.181 5.135 <0.001

After 45 days

1.33 0.53 0.80 60.00 0.676 0.174 4.581 <0.001

After 70 days

1.33 0.73 0.60 45.00 0.736 0.190 3.153 <0.01

After 105 days

1.33 0.86 0.46 35.00 0.743 0.191 2.431 <0.05

In group A, the reduction in mean severity of the oiliness of the

face is,

� Before and after treatment shows changes from 1.53 to 0.40 showing


level of p<0.001.



level of p<0.001.



level of p<0.001.



level of p<0.001.

In group B, the reduction in mean severity of the oiliness of the

face is,


showing a reduction of 0.93 (70%) which is statistically significant at

the level of p<0.001.



p<0.001.



p<0.001.



p<0.001.

Graph No. 41. % of reduction in mean score of size Pidaka.

% of Reduction in Mean Score of Size of Pidaka93.54

87.0980.64

70.9677.14

68.5760

51.42

0102030405060708090

100


% o

f Im

pro

vem

ent

Gr. A Gr. B

Graph No. 42. % of reduction in mean score of number of scars

% of Reduction in Mean Score of Number of Scars

38.46 38.46 38.4634.61

25 25 25

17.85

0

5

10

15

20

25

30

35

40

45


% o

f Im

prov

emen

t

Gr. A Gr. B

Graph No. 43. % of reduction in mean score of oiliness of the face.

% of Reduction in Mean Score of Oiliness of Face

73.91

65.21

47.82

34.78

70

60

45

35

0

10

20

30

40

50

60

70

80


% o

f Im

pro

vem

ent

Gr. A Gr. B

EFFECT ON DRYNESS OF THE FACE



dryness of the face in both the groups.




SD of mean

SE of mean

t value

p value


0.46 0.40 0.06 14.28 0.258 0.066 0.999 >0.1

After 45 days

0.46 0.40 0.06 14.28 0.258 0.066 0.999 >0.1

After 70 days

0.46 0.40 0.06 14.28 0.258 0.066 0.999 >0.1

After 105 days

0.46 0.40 0.06 14.28 0.258 0.066 0.999 >0.1


0.53 0.00 0.53 100.00 0.915 0.236 2.255 <0.05

After 45 days

0.53 0.13 0.40 75.00 0.736 0.190 2.102 <0.1

After 70 days

0.53 0.26 0.26 50.00 0.457 0.118 2.255 <0.05

After 105 days

0.53 0.40 0.13 25.00 0.351 0.090 1.467 >0.1

In group A, the reduction in mean severity of the dryness of the

face is,






level of p<0.001.



level of p<0.001.



level of p<0.001.

In group B, the reduction in mean severity of the dryness of the

face is,


showing a reduction of 0.53 (100%) which is statistically significant




p<0.001.



p<0.001.



p<0.001.

EFFECT ON SCORE OF THE PIDAKA ON THE BASIS OF AFFECTED

PLACE



score of the Pidaka on the basis of affected place in both the groups.




SD of mean

SE of mean

t value

p value


4.93 0.73 4.20 85.13 0.560 0.144 29.00 <0.001

After 45 days

4.93 1.13 3.80 77.02 0.861 0.222 17.07 <0.001

After 70 days

4.93 1.26 3.66 74.32 1.112 0.287 12.75 <0.001

After 105 days

4.93 1.40 3.53 71.62 1.125 0.290 12.15 <0.001


4.93 1.53 3.40 68.91 0.985 0.254 13.357 <0.001

After 45 days

4.93 1.93 3.00 60.81 1.195 0.308 9.718 <0.001

After 70 days

4.93 2.20 2.73 55.40 1.279 0.330 8.269 <0.001

After 105 days

4.93 2.80 2.13 43.24 0.990 0.255 8.340 <0.001

In group A, the reduction in mean severity of the score of the

Pidaka on the basis of place is,

� Before and after treatment shows changes from 4.93to 0.73 showing


level of p<0.001.



level of p<0.001.



level of p<0.001.



level of p<0.001.

In group B, the reduction in mean severity of the score of the



showing a reduction of 3.40(68.91%) which is statistically significant




level of p<0.001.



level of p<0.001.



level of p<0.001.

EFFECT ON GLOBAL ACNE GRADING SYSTEM


means of samples before and after the treatment in reduction of global

acne grading system in both the groups.




SD of mean

SE of mean

t value p value


2.20 0.26 1.933 87.87 0.593 0.153 12.610 <0.001

After 45 days

2.20 0.26 1.933 87.87 0.593 0.153 12.610 <0.001

After 70 days

2.20 0.53 1.666 75.75 0.487 0.126 13.225 <0.001

After 105 days

2.20 1.00 1.200 54.54 0.774 0.200 5.998 <0.001


2.26 00.53 1.73 76.47 0.703 0.181 9.536 <0.001

After 45 days

2.26 01.00 1.26 55.88 0.593 0.153 8.262 <0.001

After 70 days

2.26 01.00 1.26 55.88 0.593 0.153 8.262 <0.001

After 105 days

2.26 01.00 1.26 55.88 0.593 0.153 8.262 <0.001

In group A, the reduction in mean severity of the score of the







level of p<0.001.



level of p<0.001.



level of p<0.001.

In group B, the reduction in mean severity of the score of the







level of p<0.001.



level of p<0.001.


reduction of 1.26 (%) which is statistically significant at the level of

p<0.001.

Graph No. 44. % of reduction in mean score of dryness of face.

% of Reduction in Mean Score of Dryness of Face

14.28 14.28 14.28 14.28

100

75

50

25

0

20

40

60

80

100

120

AT FU1 FU2 FU3

Assigned Groups & Assessment

% o

f Im

prov

emen

t

Gr. A Gr. B

Graph No. 45. % of reduction in mean score of score of Pidaka on the basis pf affected place.

% of Reduction in Mean Score of Score of Pidaka on the basis of affected place

85.1377.02 74.32 71.6268.91

60.8155.4

43.24

0102030405060708090

AT FU1 FU2 FU3Assigned Group & Assessment

% o

f Im

pro

vem

ent

Gr. A Gr. B

Graph No. 46. % of reduction in mean score of global acne grading system

% of Reduction in Mean Score of Global Acne Grading System

87.87 87.87

75.75

54.54

76.47

55.88 55.88 55.88

01020

3040506070

8090

100


% o

f Im

pro

vem

ent

Gr. A Gr. B

OVERALL RESULTS

The overall assessment of percentage of improvement of the

therapy was assessed on the basis of 09 parameters immediately after

treatment and third follow up.

Table No. 42. The percentage of improvement in individual symptoms of

Yuvana Pidika (Acne vulgris) after treatment and third follow-up.

Improvement in percentage Group A Group B

SL.

PARAMETERS AT FU3 AT FU3

01. Pain 92.10 71.05 78.94 50.00

02. Burning Sensation 93.75 78.12 82.75 13.79

03. Number of Pidaka 88.88 75.55 69.38 55.10

04. Size of Pidaka 93.54 70.69 77.14 51.42

05. Number of Scars 38.46 34.61 25.00 17.85

06. Oiliness of the face 73.91 34.78 70.00 35.00

07. Dryness of the face 14.28 14.28 100.00 25.00

08. Score of the Pidaka on the basis

of the place 85.13 71.62 68.91 43.24

09. Global acne grading system 87.87 54.54 76.47 55.88

Table No. 43. The overall response of the therapy.

Group – A Group – B

SL.

Response

AT % FU3 % AT % FU3 %

01. No

improvement

00 00.00 00 00.00 00 00.00 01 06.66

02. Mild relief 00 00.00 00 00.00 00 00.00 14 93.33

03. Moderate

relief

05 33.33 13 86.66 09 60.00 00 00.00

04. Marked relief 08 53.33 02 13.33 06 40.00 00 00.00

05. Complete

relief

02 13.33 00 00.00 00 00.00 00 00.00

Graph No. 35. Results obtained after treatment & FU3 in Gr. A.

Results obtained after treatment & FU3 in Gr. A

92.1 93.7588.88

93.54

38.46

73.91

14.28

85.13 87.87

71.0578.12 75.55

70.69

34.61 34.78

14.28

71.62

54.54

0102030405060708090

100

A B C D E F G H IParameters

% o

f im

prov

emen

t

AT FU3

Graph No. 36. Results obtained after treatment & FU3 in Gr. B.

Results obtained after treatment & FU3 in Gr. B

78.94 82.75

69.3877.14

25

70

100

68.9176.47

50

13.79

55.1 51.42

17.85

3525

43.24

55.88

0102030405060708090

100

A B C D E F G H I

Parameters

% o

f im

prov

emen

t

AT FU3

Graph No. 37. Overall improvement in group A. (AT & FU3)

Overall improvement in Gr. A

0 0

5

8

2

0 0

13

2

00

2

4

6

8

10

12

14

NR MiR MoR MrR CROverall improvement

No. o

f Pt.'s

AT FU3

Graph No. 38. Overall improvement in Gr. B. (AT & FU3)

Overall improvement in Gr. B

0 0

9

6

01

14

0 0 00

2

4

6

8

10

12

14

16

NR MiR MoR MrR CROverall improvement

No. o

f Pt.'s

AT FU3

DISCUSSION

Discussion expands the mind with new ideas and analytic thinking

which grows into a multidimensional approach. Hence, discussion on this

study is made under following categories –

� Discussion on Literary Review

� Discussion on Observations and Results

� Probable mode of action of the drugs and therapeutics

DISCUSSION ON LITERARY REVIEW

This includes the discussion on nature of disease, Adhisthana of

Youvana Pidaka, Vyutpatti, Nirukti, Nidanapanchaka, Chikitsa, correlation

of Tundikeri along with the recent advancement and researches.

HISTORICAL REVIEW

By casting a glance on the literatures available regarding, Youvana

Pidika we may conclude that, it might not be prevalent during those days.

Hence, Sushruta was first who explained the condition and then

forthcoming texts.

NATURE OF THE DISEASE

Youvana Pidaka is a disease which harms the beauty of the face

typically during adolescent. It is the age when all are most conscious about

their beauty.

It is estimated that, nearly 80% of young adult between the ages of

12- 24 years suffers from Youvana Pidaka (Acne vulgaris). Majority of

patients recover within the ages of 20-30 years, perhaps 10-20% of adults

may continue to experience severe form of complications.

Looking into above facts there is a need of treatment which can

prevent complications of the disease as well as reduces the recurrence

effectively, which was tried to solve through this work.

CLASSIFICATION OF THE DISEASE

In most of the instances this disease is self limiting. It runs its course

and then gradually disappears. This could be the reason why Acharyas

might have classified this disease under Kshudraroga.

ADHISHTANA OF YOUVANA PIDAKA

In the context of Kshudraroga, Sushruta has explained various

diseases occurring in different layers of skin. Though Sushruta was the

first to explain Youvana Pidaka. but not mentioned the exact site of the

lesion. This could be because Sushruta might have seen various

conditions togetherly in which the acnes are involving the whole body

involving the neck, chest, back, etc.

Though, the term Kushta includes all types of skin diseases, there is

no specific reference about the involvement of particular layer of Twak in

Youvana Pidaka. Dr. Ghanekar in his commentary on Sushruta Samhita

has been correlated Vedini and Rohini layer of Twak with papillary layer &

reticular layer of the skin. This explanation withholds much similarity in

view of aetio-pathological review of Acne vulgaris.

Sushruta has documented the course of the disease and its typical

presentation which resembles with the features of Acne vulgaris. Acne

vulgaris is an inflammatory dermatological condition of saebaceous gland

situated in dermis. Papillary and reticular layer are layers of dermis.

Reticular layer fibres are found in hair bulbs, sweat gland & sebaceous

gland. Hence, with this we can consider Rohini Kala (reticular layer of

dermis) as the site of origin of Youvana Pidaka.

Most commonly affected site of Youvana Pidaka is the face leaving

the mouth and all the parts of face like checks, fore head, nose and chin

are affected.

NIDANA

01. AHARAJ NIDANA

This condition has its own nature and course of the disease. Diet

has very less relevance with the causation of the disease. Even though the

patients with the habits of using bakery, spicy, fast and junk food habits got

higher incidence than the patients under normal and routine diet.

02. VIHARAJ NIDANA

Daily regimens have very less relevance with the causation of the

disease. But, higher incidence was noted in the patients who were

indulging in excess of physical exercise, sexual intercourse, exposure to

dust, smoke, sunlight, etc may be taken as some of the predisposing

factors for acne vulgaris.

03. MANASIKA KARANA

Behavioral regimens have very less relevance with the causation of

the disease. But, higher incidence was noted in the patients who were

indulging in mental / psychological abuse like excess of Kama, Krodha,

Bhaya, Lobha, Moha, Chinta, Shoka, etc may be taken as some of the

predisposing factors for acne vulgaris.

04. ANYA KARANA

Though the classic says that, Kapha, Vata, Rakta are the causative

factors for the disease, Bhavaprakasha added Swabhava. (i.e. It one of the

natural process which runs its course) Sharangdhara added

Vaktrasnigdhata and Pidika as Mala of Shukradhatu.

Active production of Shukradhatu starts at Youvana Avastha. Due to

Swabhava at particular age there is active Shukra Utpatti and

simultaneously Mala formation in other terms production of Youvana

Pidaka occurs.

Use of oil & gel based cosmetics may predispose to the production

of Acne. Excess production of androgen, progesterone & steroids causes

hyperplasia of sebaceous oil glands. This could be a predisposing factor.

POORVAROOPA

These premonitory signs and symptoms of Youvana Pidika are not

mentioned in classics. Clinically it was observed that, patient feels

unctuousness burning sensation, itching of the face and mild pain.

ROOPA

For better understanding of subject, comparison is the tool by which

we can get the proper knowledge of the subject. Following are some of the

terms being used in classics while describing the features of Youvana

Pidaka.

01. SALMALI KANTAKAVAT

While describing Youvana Pidika, sages used the word Shalmali

Kantaka which denotes following things –

� For the exact diagnoses of the Youvana Pidaka and to differentiate it

with other skin disorders.

� The pain which is felt by the patient in Youvana Pidaka is same as

pricking of Shalmali Kantaka.

� To indicate Shalmali Kantaka as the drug of choice in Youvana

Pidaka.

� To tell the shape of Pidaka as Shalmali Kantaka. (i.e. Follicle with

broad base and triangular elevation and pustule)

02. PIDIKA

Pidika means eruption. The disease is in the form of eruptions. The

Pidaka word refers to the various types of the pain are being experienced

by the patient.

In this disease, the external beauty of an individual is affected,

hence called as Mukhadooshika.

03. SARUJA

The eruptions are painful. The pain may be mild tolerable and

frequently unknowingly disturbs an individual.

04. GHANA

The word Ghana means thick, hard or indurate. So the eruptions in

this disease are hard and thick caused by the aggravated Kapha.

05. MEDOGARBHI

Vagbhata added the Medo Garbhata which refers to existence of a

substance inside the Pidaka resembling the qualities of Meda Shlakshana,

Sthira Mrudu, Pichilla)

Similarly the patho-physiological consequences of acne show

obstruction of pilo-sebaceous gland which secretes sebum rich in fatty

acids.

Acne vulgaris occurs due to excessively secreted / infected /

obstructed secretion of sebum through pilo-sebaceous gland. When it

undergoes Paka and squeezed, it gives whitish, slimmy, thick secretions.

In white head also we can see the keratin and sebum.

As the Pidaka are packed with Meda in them. It comes out in the

form of discharge when the pressure is applied over the eruption. This

discharge may vary in colour according to the dominant Dosha.

06. YUNA MUKHE

The characteristic feature of the disease is, it appears in the

adulthood and typically vitiates face. This pinpoints towards the exclusion

of other types of acnes.

After the compilation of all the above symptoms we find following

characters of this disease.

There is increased activity of androgens during adulthood, which

intern causes stimulation of sebaceous gland through an enzyme called 5

alpha reductase. This enzyme binds to specific receptors in the sebaceous

glands and increases the sebum secretion and which leads to blockage of

the pilosebacious duct and leads to production of an irruption associated

with pain, burning sensation and discharge, called as acne.

SAMPRAPTI

Specific Samprapti is not mentioned in classics. Though the disease

occurs as a part of its Swabhava, it has influence of Vata, Kapha and

Rakta Dosha in the appearance of pain and nature of Pidaka.

If the Youvana Pidaka occurs due to Vata predominance, it gives

thin, stingy, watery discharge with pricking type pain associated with

dryness, etc.

If the Youvana Pidaka occurs due to Pifta predominance, it gives

thin, yellowish-pink tinged secretions, burning sensation, etc.

If the Youvana Pidaka occurs due to Rakta predominance, it gives

the features of Pitta predominance along with Pustulo-papillary

appearance, etc.

If the Youvana Pidaka occurs due to Kapha Dosha Predominance, it

gives big cystic swelling, thick, curdy white discharge with less pain, etc.

CLINICAL TYPES OF YOUVANA PIDAKA

There is no direct reference which tells about types of Youvana

Pidaka. An attempt is made to classify the Youvana Pidaka based on the

associated features and relevant Doshika involvement. Youvana Pidaka

can be categorized into four types as Vataja, Pittaja, Kaphaja & Raktaja

Youvana Pidaka. The signs and symptoms of them are as follows –

01. Vatika Youvana Pidaka

This type of eruption assumes a black colour and felt rough to touch,

and characterized by excruciating pain and scanty discharge.

02. Paittika Youvana Pidaka

The Pidaka appears abruptly with yellowish colour. These are hot

and soft in touch, associated with severe burning sensation. Pidaka grows

rapidly and suppurates quickly. These Pidaka gives out hot yellowish red

discharge.

Pitta and Rakta Dosha got Ashraya-Ashrayee relation. Hence, both

types of Pidaka appear in similar features. Papules and papillary pustular

Pidaka may resembles with Rakta and Pitta predominant Pidaka.

03. KAPHAJA YOUVANA PIDAKA

This type of Pidaka requires long time to manifest and also to cure.

These appear pale white in colour, heavy, unctuous, smooth, and

compact. It is characterized by numbness, itching and mild pain. The

growth of Pidaka and its suppuration is slow.

The discharge is thick whitish in colour. The lesions are pale, hard,

and fairly large in size. These have oily secretions which tend to aggravate

in cold weather. Cysts and nodular verity of Pidaka can be considered

under this type of Pidaka.

04. Raktaja Youvana Pidaka

These eruptions assume a black or reddish colour. Intolerable

burning sensation and pain occurs along with all the features of Pitta

Dosha predominant Youvana Pidaka. The discharge will be of pinkish-red

in colour.

COMPLICATIONS OF MOOKHADOOSHIKA

This condition does not have serious and life threatening

complications except cosmetic disfigurement of the face. During adulthood,

people are much concern about their physical appearance. If their face is

disfigured due to such eruptions then they loose their self confidence and

develop nurvousness. So, the patients of Mookhadooshika will have

psychological complications rather than physiological complications.

CHIKITSA

There is no satisfactory remedy for Kulaja, Swabhavaja Vikara.

Though, dozens of external applications are elaborated in classics for

Youvana Pidaka, only to obtain symptomatic relief.

The treatment is explained in various steps like just external

application, applications with certain internal medications, local and

systemic therapeutic procedures. It is also advised that, when one

treatment is not enough to manage the condition, shift the patient in further

steps of management like Vamana, Virechana, etc in Panchakarma.

Youvana Pidaka is a palliative condition which gives symptomatic

relief with local application. Hence, to get long term relief and to prevent

unwanted complications Vamana was specially advised.

Yogaratnakar praised Manjishta & Madhu Lepa, as a single drug

formulation. Thus, the present study was done to check additional efficacy

and utility of Vamana in Youvana Pidaka.

DISCUSSION ON OBSERVATIONS

AGE

In present study among 30 patients, maximum numbers of 16

patients (53.33%) were in 18-21 years, 11 patients (36.66%) were in 22-25

years of age group. This statistical data supports the

Charaka says that, during the age of 16-30 years, all the Dhatus

undergo increase in their quantity and quantity and especially at this age

Shukra Dhatu start functioning. In this stage of life person becomes more

Chanchala and there is predominance of Pitta. (Cha. Vi. 8/122)

SEX


patients (77.33%) were female and 08 patients (26.66%) were male. This

would be because of the early onset of puberty in females. In incidence of

this disease is slightly more in females than in males.

In general females are more conscious about the beauty than males.

Hence, females got convinced for the therapy early than males. This could

be one of the reasons for high number of female patients registered and

completed treatment protocol promptly.

RELIGION


patients (63.33%) were Hindu, 04 patients (13.33%) were Muslim, 04

patients (13.33%) were other religion and 03 patients (10%) was christian.

As such there is no relation of religion with the incidence of the

disease. During the study sample selection was done randomly

irrespective of religion. Hospital is located in Hindu dominant area.

EDUCATION

In present study among 30 patients, 15 patients (56%) were

students (PUC and below), 09 patients (30%) were graduates.

Maximum number of patients was in adolescent stage, in which the

incidence of the disease is high. This could be due to high levels of

androgens at this age of life.

Most of them were students who were exposed to excess of dust,

smoke, fast food, sweets, bakery products, soared items, etc.

OCCUPATION


patients (70.00%) were students in adolescent age group. Particularly, in

this age group hormonal changes play a major role.

SOCIO-ECONOMIC STATUS


patients (53.33%) were from middle class families. 09 patients (30%) were

from upper class families.

The study sample was collected incidentally. The study was

conducted in a private institute located in urban area. Lower socio-

economical group people much concern about their physical appearance

and beauty conscious. In middle class families, after satisfying their routine

needs, people think of other relevant things.

HABITAT

In present study among 30 patients, 12 patients (40%) were residing

in urban and 08 patients (26.66%) were residing in sub-urban area.

The study was conducted in urban area hence the incidence of

urban patient might be more. Recent studies have shown that the

incidence of the disease is more in middle socio-economical groups and in

urban habitat.

MARITAL STATUS


patients (76.66%) were unmarried and 07 patients (23.33%) were married.

Legally the age of marriage in India is 18 years for female and 21 for

male. But, due to long courses of higher education and less opportunities

of employment the age of marriage is raised till 30 years. Maximum

number of patients reported was students. This could be one of the

reasons for reporting maximum of un-married patients.

Marriage is like a mile stone which comes after the age of

adolescence and from which the incidence of Youvana Pidaka decreases.

HABITAT / DIET

In present study among 30 patients 18 patients (60%) were of mixed

food habit and 12 patients were reported with vegetarian food habits.

As such there is no proven and specific food which triggers Youvana

Pidaka. Usually, non-vegetarian food contains more of spicy, irritant and

lipid rich. Excessive intake of such substances vitiates Vata, Pitta and

Rakta in tern vitiates Meda to enhance the pathology of Youvana Pidaka.

PRAKRITI

In present study among 30 patients 12 patients (40%) were of Vata-

Kapha Prakriti and 11 patients (36.66%) were of Vata-Pitta Prakriti.

Maximum number of 14 patients (46.66%) reported with Vata-Pitta

variety of Pidaka as well as Deha Prakriti. Maximum number of 11 patients

(37%) reported with Vata-Kapha variety of Pidaka as well as Deha Prakriti.

This shows higher incidence of the similar Doshik anomalies in

similar type of Doshik Deha Prakriti. The prognosis is also poor because of

the Balabala of the Vyadhi in similar type of Doshik predominance.

SATWA AND VYAYAMA SHAKTI

In present study among 30 patients 11 patients each 36.66% were

having Pravara and Madhyama Shareerika as well as Maanasika Bala.

As such no relation of physical and mental potency in relation to

Youvana Pidaka is found. In general, Pravara Satwa patients were referred

for Vamana, as these patients were capable of bearing the strain of

Vamana. And those with Avara Satwa were taken for Lepa procedure.

DIWASWAPNA

In present study among 30 patients 21 patients (70%) were reported

with no habit of Diwaswapna. Maximum number of patients was students

who were busy in their academic activities.

The incidence of no Diwaswapna was found. As such the relation of

Diwaswapna with Youvana Pidaka is not found in practice, but those who

indulge in Nishajagarana, suffering with sleep disturbances have greater

the incidence of this condition.

AGNI

In present study among 30 patients 22 (73.3%) patients were having

Samagni and 08 (27%) were having well Mandagni.

The status of Agni is directly less concern with the development of

Youvana Pidaka. Agni is an entity of the body which maintains all the

physio-pathological changes in body. There is no specific cause for the

evolution of Pidaka similarly it subsides gradually. But, during its

appearance it gets Balaabala for its clinical features through the status of

Agni.

AHARA SPECIFIC NIDANA

Though there is no direct relation of etiological factors concern to

food habits, in present study all most all patients were exposed to one or

the other pre-disposing factor for Youvana Pidaka. But, the obtained

statistics is not up to the universal acceptability of it as an etiological factor.

VIHARA SPECIFIC NIDANA

There is very poor co-relation between etiological factors concern to

daily and seasonal regimens. In present study all most all patients were

exposed to one or the other pre-disposing factor for Youvana Pidaka. But,

the obtained statistics is not up to the universal acceptability of it as an

etiological factor.

SITE OF PIDIKA

In present study almost all patients were included with the Pidaka on

Mukha including Ganda, Lalata Pradesha, Chibuka and Nasika. The

definition of Youvana Pidaka itself says that, Pidaka occurs on face.

It could be because of the maximum number of sebaceous glands

found on these sites are comparatively larger in size.

CHRONICITY


patients (43.33%) were having 2-3 yrs chronicity, 11 patients (36.66%) had

0-1 yrs of chronicity and 03 patients (10.00%) each were having chronicity

of 4-5 yrs and 6-7 yrs.

This condition appears typically during adolescence age group and

subsides gradually. So, as the time passes the history of similar complaints

might not have re-occurred. In few patients it might have given trouble in

adult and late adulthood, which may require systemic line of management.

VARNA

In present study among 30 patients maximum number of 18 patients

(60%) was having Shyava Varna and 7 patients (23.33%) Krishna Varna.

Shyava and Krishna Varna skin people usually have Vata-Pitta

Prakriti and are more prone to get Youvana Pidaka. The incidence of

Youvana Pidaka is slightly higher than in white races.

SHOTHA


(57%) were having Alpashotha, 14 patients (47%) had Bahala Shotha.

This might be because of the nature of condition itself. Youvana

Pidika is a chronic inflammatory dermatological condition, where the lesion

starts as a small comedon, eruption and land up to the formation of cysts.

ONSET


(93.33%) was had the history of gradual development of the eruptions and

only 02 patients (6.66%) had faster the rate of acne development.

This could be because of the nature of the disease. Another reason

that can be though is gradual increase in sex hormones during adults.

AGGRAVATING FACTORS OF ACNE


(43.33%) had no relation of seasonal variation in acne, 12 patients (40%)

had relation with menstrual changes where as only 9 patients (30%) had

seasonal changes in disease typically during summer.

This entire disease process is course of natural physiological

changes that takes place in body. Hence, less interference is found in the

course of disease with various influencing factors.

FAMILY HISTORY


(66.66%) reported with the family history of acne in siblings. 08 patients

(33.32%) had the family history with their parents.

The genetical inheritance of the disease is not found. But, according

to the present study statistical values denotes that, siblings are suffering

means it shows the natural run coarse of the disease.

RAJOPRAVRUTTI

In present study among 22 females 13 patients (59%) patients were

having increase in number of the Pidaka one or two days prior to the onset

of menses and some says increase during the menstrual period and

subsides after the cessation of bleeding. This shows the involvement of

oestrogen hormone in the course of the disease.

VEDANA


(60%) had pricking type of pain, 10 patients (33.33%) had burning

sensation and only 2 patients (6.66%) were had Kandu.

This shows that almost all patients were had some sort of pain. Pain

is the typical features of Vata Dosha. Many of the patients had pricking

type of pain means Vata dominancy is found.

NUMBER OF PIDAKA


(60%) had more than 11 to 15 Pidaka on right and left side of face.

This shows that, most of the patient represented with moderate

severity of the disease.

DENSITY OF PIDAKA


(50%) had density of 5 to 10 cm2 Pidaka. 12 patients (40%) were had

density of 1 to 5 cm2.

This shows that, most of the patient represented with moderate

severity of the disease.

NATURE OF PIDAKA


(30%) reported with black comedone, 08 patients (26.66%) reported with

pustules, 06 patients (20%) reported with nodules.

This shows that, maximum number of patients reported with black

comedones and other types of pathologies are found in Youvana Pidaka.

AREA AFFECTED


reported with localized Pidaka only on face. 08 patients reported with

localized as well as few Pidaka over the other body parts also. The

distribution of Pidaka in all the patients was asymmetrical.

This shows that the classical feature i.e. Yuna Mukhe was

prominently found in present study.

SIZE OF PIDAKA


(46.66%) reported diameter of with 6 to 10 mm Pidaka, 11 patients

(36.66%) with 11 to 15 mm diameter Pidaka.

This shows that, in present clinical study moderate severe form of

Pidaka patients were included.

USE OF COSMETICS

In present study maximum number of 21 patients was habituated for

use of soap and oil base cosmetics.

This shows that, though maximum number of patients had the

history of use of cosmetics and less fluctuation of the condition noted in

aggravating factors too. This could be because of the nature of the disease

itself.

DISCUSSION ON RESULTS

The effect of Vamana with Kritavedhana followed by Manjishtha-

Madhu Lepa and Only Manjishtha-Madhu Lepa in Youvana Pidaka was

studied over 30 patients in assigned two groups. The patients were

assessed four times throughout the study protocols based on nine

parameters. The assessment was done with self defined scoring for each

parameter.

PAIN

In present study, majority of the patients were of Vata-Pitta type of

Youvana Pidaka. Local dermatological inflammatory condition causes

moderate to severe but tolerable pain to the patients.

The pain felt by the patient was assessed on the basis of its

frequency and intensity. The intensity, appearance and nature of pain

changes as the inflammatory process come down or aggravates.

In Gr. A, the reduction in pain immediately after the treatment was

92.10% with significant p value <0.001. In Gr. B, the reduction in pain after

the treatment was 78.94% with significant p value <0.001.

This data shows that, both the treatment modalities were effective in

reducing the pain but, the response in Gr. A was better than in Gr. B.

In Gr. A, the reduction in pain after 3rd follow up was 71.05% with

significant p value <0.001. In Gr. B, the reduction in pain after 3rd follow up

was 50% with significant p value <0.001.


reducing the pain statistically, but there is big gap of percentage of relief in

both the group. In Gr. A the recurrence of symptoms is less and with good

percentage of improvement is observed.

Pain is the characteristic feature of inflammatory process. Reduction

in pain indicates subsiding the local inflammatory process.

This could be because of the systemic effect of Vamana in Youvana

Pidaka. Vamana might have done Chhedana of Vikrita Kapaha and

Rukshana dries up the Vikrita Meda and Lasika.

The local therapy might have done the counter action over the

inflammatory process, resulted in temporary relief. Hence, in that group

50% patient got recurrence during the period of follow up itself.

BURNING SENSATION



moderate to severe but tolerable burning sensation to the patients.

The burning sensation felt by the patient was assessed on the basis

of its frequency and intensity. The intensity, appearance and nature of

burning sensation changes as the inflammatory process come down or

aggravates.

In Gr. A, the reduction in burning sensation immediately after the

treatment was 93.75% with significant p value <0.001. In Gr. B, the

reduction in burning sensation after the treatment was 82.75% with

significant p value <0.001.


reducing the burning sensation but, the response in Gr. A was better than

in Gr. B.

In Gr. A, the reduction in burning sensation after 3rd follow up was

78.12% with significant p value <0.001. In Gr. B, the reduction in burning

sensation after 3rd follow up was 13.79% with significant p value <0.05.


reducing the burning sensation statistically, but there is big gap of

percentage of relief in both the group. In Gr. A the recurrence of symptoms

is less and with good percentage of improvement is observed.

Burning sensation is the characteristic feature of inflammatory

process. Reduction in burning sensation indicates subsiding the local

inflammatory process.


Pidaka. As already discussed, Vamana has got long term effect over the

body to reduce the inflammatory processes as well as burning sensation.

In Gr. A, though there is small gap of 15.63% of result in immediately

after the treatment and 3rd follow up, it could be because of recurrence of

comparatively less severe eruptions.



71.96% result was decreased during the period of follow up itself.

EFFECT ON NUMBER OF PIDAKA



eruptions.

In Gr. A, the reduction in number of Pidaka immediately after the


reduction in number of Pidaka after the treatment was 69.38% with

significant p value <0.001.


reducing the number of Pidaka but, the response in Gr. A was better than

in Gr. B.

In Gr. A, the reduction in number of Pidaka after 3rd follow up was

69.38% with significant p value <0.001. In Gr. B, the reduction in number of

Pidaka after 3rd follow up was 55.10% with significant p value <0.001.


reducing the number of Pidaka statistically, but there is big gap of



Number of Pidaka shows the recurrence of inflammatory process.

Reduction in number of Pidaka indicates subsiding the local inflammatory

process.



body to reduce the inflammatory processes as well as number of Pidaka.







EFFECT ON SIZE OF PIDAKA


Youvana Pidaka. Extend of local dermatological inflammatory condition

influences on the effect of size of Pidaka.

In Gr. A, the reduction in size of Pidaka immediately after the


reduction in size of Pidaka after the treatment was 77.14% with significant

p value <0.001.


reducing the size of Pidaka but, the response in Gr. A was better than in

Gr. B.

In Gr. A, the reduction in size of Pidaka after 3rd follow up was

70.96% with significant p value <0.001. In Gr. B, the reduction in size of

Pidaka after 3rd follow up was 51.42% with significant p value <0.001.


reducing the size of Pidaka statistically, but there is big gap of percentage

of relief in both the group. In Gr. A the recurrence of symptoms is less and

with good percentage of improvement is observed.

Sizes of Pidaka show the chronicity and extend of inflammatory

process. Reduction in size of Pidaka indicates subsiding the local

inflammatory process though-out its indurations.



body to reduce the inflammatory processes as well as size of Pidaka.







EFFECT ON NUMBER OF SCAR

Scar formation is the grave result of local inflammatory process.

Several depressions are formed over the face due to eruptions and

evacuation of Pidaka. Number of scar shows the chronicity as the as the

high indurations of Pidaka in the surface of the skin. There is very less

effect of tropical application in reducing the number of scars. These should

be healed spontaneously as part of natural healing process.

In Gr. A, the reduction in number of scars immediately after the


reduction in number of scars after the treatment was 25% with significant p

value <0.001.


reducing the number of scars but, the response in Gr. A was better than in

Gr. B.

In Gr. A, the reduction in number of scars after 3rd follow up was

34.61% with significant p value <0.01. In Gr. B, the reduction in number of

scars after 3rd follow up was 17.85% with significant p value <0.02.


reducing the size of Pidaka statistically, but there is not a big difference in




Pidaka. Though, this is a Rukshana Chikitsa, during Snehapana, Sarvanga

Abhyanga some sort of Brimhana process occurs which might have helped

in healing of scars. Majishtha and Madhu both have got anti-oxidant effect

as well as healing properties. But, these works better in wet pathologies

like active eruptions. Where as the scar is bundle of fibroblasts that makes

up the scar. Scars have blood supply but no oil glands or elastic tissues. In

Youvana Pidaka, patient develops atrophic scars.



comparatively less severe eruptions as well growth of atrophic scar.




EFFECT ON OILINESS OF THE FACE


Youvana Pidaka. Usually, the patients with Pitta Dosha dominancy in

Prakriti posses oiliness of skin, which is one of the predisposing factor for

eruptions.

In Gr. A, the reduction in oiliness of the face immediately after the


reduction in oiliness of face after the treatment was 70% with significant p

value <0.001.


reducing the oiliness of face equally.

In Gr. A, the reduction in oiliness of face after 3rd follow up was

34.78% with significant p value <0.001. In Gr. B, the reduction in oiliness of

face after 3rd follow up was 35% with significant p value <0.001.


reducing the oiliness of face statistically. There is no big gap of percentage

of relief in both the group. In both the groups the recurrence of symptoms

was observed. This could be due to the involvement of the Prakriti itself

which is formed at the birth and maintained throughout the life without any

fluctuations.

Though, the recurrence in oiliness of face might be the cause for the

recurrence of the symptoms, there was significant reduction in pain,

burning sensation, number of Pidaka, size of Pidaka, number of scar, etc.



body to reduce the inflammatory processes as well as number of Pidaka.

In Gr. A, though there is big gap of 39.13% of result in immediately

after the treatment and 3rd follow up, it could be because of clearance of

the Srotases through the Vamana Karma. Vamana might have cleared the

obstructive pathology at pilosebaceous gland and reduced the rate of

recurrence.


oiliness of the face and resulted in temporary relief. Hence, in that group

50% result was decreased during the period of follow up itself.

EFFECT ON DRYNESS OF THE FACE


Youvana Pidaka. Usually, the patients with Vata Dosha dominancy in

Prakriti posses dryness of skin, which is not a predisposing factor for

eruptions. But, even though, patients of dry skin developed eruptions in

Youvana Pidaka. This feature was found in only 23.33% patients.

In Gr. A, the reduction in dryness of face immediately after the

treatment was 14.28% with significant p value >0.1. In Gr. B, the reduction

in dryness of face after the treatment was 100% with significant p value

<0.05.


reducing the dryness of face. But, in Gr. B the results were encouraging.

This could be due to local Guruta & Snigdhata of Majishtha and Madhu.

In Gr. A, the reduction in dryness of face after 3rd follow up was

14.28% with significant p value >0.1. In Gr. B, the reduction in dryness of

face after 3rd follow up was 25% with significant p value >0.1.

This data shows that, both the treatment modalities were not

effective in reducing the dryness of the face. There is no big gap of

percentage of relief in both the group. In both the groups the recurrence of

symptoms was observed. This could be due to the involvement of the

Prakriti itself which is formed at the birth and maintained throughout the life

without any fluctuations.

It is very difficult to assess the rationality behind the relation between

dryness of the face, effect of the therapy and recurrence of the eruptions.

In Gr. A, there is difference in the results of immediately after the

treatment and third follow up.


oiliness of the face and resulted in temporary relief. Hence, in that group

75% result was decreased during the period of follow up itself.

EFFECT ON SCORE OF THE PIDAKA ON THE BASIS OF AFFECTED

PLACE

Score of the Pidaka based on the affected place is globally accepted

parameters.

In Gr. A, the reduction in Score of the Pidaka based on the affected

place immediately after the treatment was 85.13% with significant p value

<0.001. In Gr. B, the reduction in Score of the Pidaka based on the

affected place after the treatment was 68.91% with significant p value

<0.001.


reducing the Score of the Pidaka based on the affected place but, the

response in Gr. A was better than in Gr. B.

In Gr. A, the reduction in Score of the Pidaka based on the affected

place after 3rd follow up was 71.62% with significant p value <0.001. In Gr.

B, the reduction in Score of the Pidaka based on the affected place after

3rd follow up was 43.24% with significant p value <0.001.


reducing the Score of the Pidaka based on the affected place statistically.

But there is big gap of percentage of relief in both the group. In Gr. A the

recurrence of symptoms is less and with good percentage of improvement

is observed.

This score is just an evaluation of the Pidaka at various places.

Reduction in this score refers to the gross reduction in all the parameters

responsible for the eruptions.


Pidaka.







EFFECT ON GLOBAL ACNE GRADING SYSTEM

Effect on global acne grading system is globally accepted scale for

the assessment of acne vulgaris.

In Gr. A, the reduction in global acne grading system immediately

after the treatment was 87.87% with significant p value <0.001. In Gr. B,

the reduction in global acne grading system after the treatment was

54.54% with significant p value <0.001.


reducing the global acne grading system but, the response in Gr. A was

better than in Gr. B.

In Gr. A, the reduction in global acne grading system after 3rd follow

up was 76.47% with significant p value <0.001. In Gr. B, the reduction in

global acne grading system after 3rd follow up was 55.88% with significant

p value <0.001.


reducing the global acne grading system statistically. But there is big gap

of percentage of relief in both the group. In Gr. A the recurrence of

symptoms is less and with good percentage of improvement is observed.

This score is just an evaluation of the Pidaka at various places.

Reduction in this score refers to the gross reduction in all the parameters

responsible for the eruptions.


Pidaka.

In Gr. A, though there is a gap of 33.33% of result in immediately






OVERALL RESULTS

Parameter wise result of the clinical study shows the better

performance of Gr. A in all most all parameters except dryness of the face.

In Gr. B the results based on all most parameters were good except in

number of scars.

MODE OF ACTION OF VAMANA

Vamana is a systemic line of management, specially praised by

Sushruta in the management of Youvana Pidaka. Vamana has got a prime

role All these Karma has got there won actions in order to combat the

physio-pathological consequences of Youvana Pidaka is discussed as

follows –

Vamana drugs posses following properties. Viz. –

� Ushna

� Teekshna

� Sukshma

� Vyavayi

� Vikasi

� Urdhwabhagahara

Following pharmacological action of Vamaka Dravya work in

collaboration with each other to produce emesis –

� Due to Ushna Guna, it produces Pachana, Dahana, Svedana and

spreading of the Drug at cellular level. Lavana produces

Vishyandana in the body that is why Vamana Dravyas are

administered with Lavana.

� Tikshna Guna of Vamaka Dravya is responsible for its quick action,

Sodhana, Pachana, Chhedana and Sravana of Doshas at their own

places.

� With the help of Sukshma Guna, the Vamana Dravya enters at the

level of micro circulatory channels (Srotasas) and leads to Pachana

and Vishyandana of Doshas and ultimately directs Doshas towards

Koshtha, from where they are eliminated easily.

� Due to Vishyandi and Vikasi Gunas, the Vamaka Dravya reaches at

the cellular level (all Dhatus) without being digested and produces

Sandhi Saithilya i.e. Doshas Leena in Dhatus are attacked by the

Vamaka Dravya and migrated to Koshtha for elimination

� Vamaka Dravyas produce Vamana due to it is “Urdhwa Bhagahara

Prabhava.” (Ch.Ka.1/5)

The main action of Vamaka Dravya is on stomach of the individual.

In the stomach it acts on the very root cause of the vitiation of Kapha. The

vitiated Kapha present in entire body is alleviated and expelled out through

the mechanism of Vamana and disease process is suppressed up to the

maximum level. The Snehana and Svedana therapy aggravates the

Doshas i.e. Kleda of the body is increased. Ushna and Tikshna Guna of

Vamaka Dravyas are responsible for removal of Kleda from the body in the

form of Vomitus.

The fat contents of the blood (serum cholesterol etc.) increase

temporarily after Snehana, but after the Vamana Karma is over, these fat

contents return to normal level, because infect Sneha is brought from the

cellular level to the Koshtha from Rasadi Dhatus (tissues and cells) and

finally is thrown out of the body. As per the mode of action of Vamana

Karma, as described above, it clears the channels (Srotasas) from the

Sanga, created by vitiated Kapha, Meda and Ama.

Maximum Doshas are thrown out from the body, by this process.

Thus detoxifying the body up to a certain level. The remaining Doshas are

controlled by Shamana therapy which holds Pitta Shamaka, Rakta

Prasadana, Vranaropana, Kapha-Vatahara etc. properties. Because it is

much easier to pacify the small quantity of Doshas with Shamana therapy

which remain after Shodhana, in spite of starting medication in the full

bloom vitiation of Doshas.

MODE OF ACTION OF LEPA

In this study, Manjishtha-Madhu was used for the external

application over the affected part of the face. Both the drugs have got their

own action in the management of Youvana Pidaka.

The probable mode of action the drugs used in Lepa can be thought

as follows –

MANJISHTHA

� It has got Tikta, Kashaya and Madhura Rasa, which predominantly

acts on Pitta and Rakta Vikara. The appearance of Pidaka is one of

the characteristic features of Pitta malformations. Majishtha due to

its Tikta, Kashaya and Madhura Rasa reduced the Vikrita Pitta and

Rakta effectively.

� Manjishtha is a widely used herb for the management of chronic

wound, discoloured skin, microbial diseases, leprosy and known

blood purifier.

� It also prevents the lipid peroxidation, which is involved in the

pathogenesis of acne vulgaris. Its protective effect was found better

than Vitamin E and Parabenzoquinine.

� It has iron chelatoin property and rubiadin was associated for its anti-

oxidant property. This maintains the healthy status of skin as well as

maintains the integrity.

� Extracts of Rubia cordifolia inhibited platelet activation factor induced

aggregation of rabit blood. In classics also it is mentioned that, it is

Pitta and Rakta Shamaka. Hence, might have acted better in pusto-

papillar lesions of Acne vulgaris.

� It has got anti-pyogenic property, which prevents the formation of

new skin lesions.

� It has got anti-inflammatory activity, which might have acted to

conquer the local pathology in acne vulgaris.

� Antioxidant activity – The antioxidant properties have been well

established. The herb significantly inhibited FeS04-induced lipid

peroxidation and glutathione depletion...7 The activity was ascribed

to the quinone rubiadin.

� Antiinflammatory activity – Rubia cordifolia inhibited the lip

oxygenase enzyme pathway" and the production of cumene

hydroperoxides. The lip oxygenase pathway catalyses the

production ofvarious inflammatory mediators such as the

leukotrienes which are involved in asthma, arthritis and other

inflammatory disorders.

� Antiplatelet activity – Platelet -activating factor (PAF) is a

phospholipid involved in thrombosis, allergy and nervous disorders.

Rubia cordifolia extract inhibited the aggregation of rabbit platelets in

a dosedependent manner, measured in a binding assay using 3H-

labelled PAF.

� Anticancer activity – The cyclic hexapeptidel and quinones of

Rubia exhibited a significant anticancer activity against various

proliferating cells. The hexapeptides showed potent antitumour

activity by binding to eukaryotic 80S ribosomes, resulting in inhibition

of aminoacyl-tRNA binding and peptidyl-tRNA translocation, thus

leading to the stoppage of protein synthesis.

� Hepatoprotective activity – Protection against different liver toxins

has been established. It has been found to be effective against

acute and chronic hepatitis caused by the hepatitis B virus (HBY) by

interfering with the secretion of hepatitis B surface antigen (HBsAg)

in human hepatoma cells (Hep3B). The quinone derivatives are

thought to be the active components.

� Others – The plant has activity against allergies,t8 bacterial

infection,t9 excessive bleeding20 and diabetic ulcer.

� Safety profile – No adverse effects have been reported at

recommended doses and the herb is usually categorised as GRAS

(generally recognisedas safe).

MADHU

Application of Madhu and Ghrita is indicated in superficial lesions

like wounds, burns, cuts, bed sores, diabetic wounds, etc. Infected

wounds that had not responded to conventional treatments were free of

infection within 7 days of the first honey application. During the course

of honey application, the dead tissues were quickly replaced with

healthy granulation tissues. In some cases, diabetic ulcers were

successfully treated with honey and skin grafts.

Honey is a saturated or super saturated solution of sugars and is

said to have osmotic properties. Due to which it has got anti-bacterial

property. The presence of hydrogen peroxide generated by the

enzymatic activity of glucose oxidase in dilute honey also contributes to

its antibacterial activity. As hydrogen peroxide decomposes, it

generated highly reactive free radicals which react with and kill bacteria.

� It prevents infection because of its antibacterial or bacteriostatic

properties (i.e. inhibits the growth of both Gram- negative and Gram-

positive bacteria)

� It provides a viscous barrier to fluid loss and wound invasion by

bacteria thus preventing infection.

� It contains enzymes which may aid the healing process by promoting

tissue formation.

� It absorbs edema fluid (pus) thereby cleaning the wound.

� It reduces pain and irritation and eliminates offensive smell.

COMBINE EFFECT OF THE BOTH THERAPIES

The properties of Majishtha and Madhu acts as Dosha Pratyanika as

well as Vyadhi Pratyaneeka Chikitsa. It also acts an healing as well as

preventive agent in the management of Youvana Pidaka.

Both the drugs combat the local pathology in Youvana Pidaka

through their anti-inflammatory, anti-biotics, healing promotion, etc.

properties.

��

��

��

��

��

CONCLUSION

� Youvana Pidaka in considered among one of the Kshudraroga with

less explanation in most of instances resembles with Acne vulgaris.

� Combine understanding of all available reference defines the

condition clearly.

� Usually, it is a self-limiting condition caused by Tridosha vitiation &

Rakta.

� Incidence is more in the age group of 16-27 and after this it slowly

disappears in 70% to 80% of individuals.

� Both the sexes are prone to develop the condition in equal strength,

but with slightly more incidence in female.

� The incidence of the condition with religion, occupation, socio-

economical status, marital status and dietic regimens of patient.

� Excessive intake of oily substances, irritants, Teekshna food articles

and use of oily cosmetics, etc are predisposing factors.

� In this study reveals that the effect of Vamana followed by Lepa

group was much better than the only Lepa group.

� In Group A, marked improvement in 53.33% patients, Moderate

improvement in 33.33% patients, complete relief in 13.33% of

patients were observed.

� In Group B, marked relief was found in 40.00%, moderate relief was

found in 60.00% patients.

� The effect of Vamana followed by Lepa is also better in subsequent

follow-up with minimal recurrence.

� The effect of only Lepa is good only immediately after treatment had

greater rate of recurrence.

� The hypothesis of Sushruta i.e. Vamana is Vishesha Chikitsa in

Youvana Pidaka proved with significant statistical values obtained

immediately after the treatment.

� This shows the additional effect of Vamana in the management of

Youvana Pidaka as compared with the Lepa therapy.

� Both Vamana followed by Lepa & only Lepa are found effective as a

Dosha Pratyanika Chikitsa in the management of Youvana Pidaka.

� During the procedure of vamana & lepa no complication had been

noted. So, it can be concluded that for the management of Mukha

Dushika vamana & lepa karma can be administer as safest &

effective procedure.

� Results of this study are very encouraging but the study was

conducted in small group of patients because of various limitations,

so trial should be conducted on large sample with better parameters.

��

SUMMARY

INTRODUCTION

Youvana Pidika is a most common anomaly, usually self limiting,

found in teenagers and young adults. This results in disfigurement of facial

skin leads to feeling of inferiority complex and sometimes depression,

isolation from society, suicidal tendency, etc. It is produced due to combine

association of vitiated of Vata, Pitta, Kapha Doshas along with Rakta as

dushya. It is explained under the concept of Kshudraroga.


pilosebaceous units of the skin of certain body parts with formation of

comedone, papules and pustular eruption commonly known as pimples.

AIMS & OBJECTIVES

� Evaluate the effect of Manjishta-Madhu Lepa in Youvana Pidaka


by Lepa in Youvana Pidaka

� Compare the effect of only Lepa over the Vamana followed by Lepa

in Youvana Pidaka

REVIEW OF LITERATURE

It is seen in adolescent age groups with irrespective of age, sex,

religion, socio-economical status & geographical distribution. The classical

description of Youvana Pidaka in most of the instances resembles with

Acne vulgaris.

The clinical features of Youvana Pidaka like Shalmali Kantakvat

Pidika, Medogrbhi, Ruja, Shotha, Daha and Vaktre Snigdhata.

MATERIALS AND METHODS

Research worked was done in 30 patients in two groups.

� Group A – 15 patients received Vamana with Kritavedhana

followed by Majishtha-Madhu Lepa for one month.

� Group B – 15 patients received only Majishtha-Madhu Lepa for

one month.

Routine blood investigations were done in order to rule out the

secondary conditions and to know the general health. Clinical data was

graded as per gradation index of assessment criteria. Pre-test and post-

test data was collected and subjected for statistical analysis in paired ‘t’

test. The statistical significance level was decided at <0.05.

OBSERVATION AND RESULTS

Observations were collected on basis of demographic data which

includes age, sex, religion, occupation, socio-economical status,

educational status, marital status, Satwa, Prakriti, etc. The data related

disease includes Nidana, predisposing factors, chief complaints, etc. The

collected data were subjected for statistical analysis and results are

interpreted accordingly.

Table No. 66a. The percentage of improvement in individual parameters of

Youvana pidika after the treatment and Third follow up.

Improvement in percentage Group A Group B

SL.

PARAMETERS

AT FU3 AT FU3 01. Pain 92.10 71.05 78.94 50.00 02. Burning Sensation 93.75 78.12 82.75 13.79 03. Number of Pidaka 88.88 75.55 69.38 55.10 04. Size of Pidaka 93.54 70.69 77.14 51.42 05. Number of Scars 38.46 34.61 25.00 17.85 06. Oiliness of the face 73.91 34.78 70.00 35.00 07. Dryness of the face 14.28 14.28 100.00 25.00 08. Score of the Pidaka on the basis

of the place 85.13 71.62 68.91 43.24

09. Global acne grading system 87.87 54.54 76.47 55.88

Table No. 66b. The over all improvement in both groups after treatment in

all the parameters were as follows –

Group – A Group – B

SL.

Response AT % FU3 % AT % FU3 % 01. No

improvement 00 00.00 00 00.00 00 00.00 01 06.66

02. Mild relief 00 00.00 00 00.00 00 00.00 14 93.33 03. Moderate

relief 05 33.33 13 86.66 09 60.00 00 00.00

04. Marked relief 08 53.33 02 13.33 06 40.00 00 00.00 05. Complete

relief 02 13.33 00 00.00 00 00.00 00 00.00

The results obtained after the treatment shows that the Vamana

followed by Lepa is having better efficacy than only Lepa immediately after

the treatment. But, in group A, there was less recurrence (10%) where as

in group B, there (30%) of recurrence was observed.

RECOMMENDATION FOR FUTURE STUDY

� The same study can be planned in large number of sample with a

long term follow up period.

� The study should be conducted in comparison with related internal

medication.

� To standardize the therapeutic procedure the similar type of study

can be planned in particular type of lesions like only comedons, only

pustules, only pustular-papules, only cysts, etc.

��

��

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20. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit samsthan Varanasi 61/31 PN-587.

21. Yoga Ratnakara with Vaidhyaprabha Hindi commentary By. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni. Shloka 34 PN-694

22. Basavaraajeeyam Kshudra Roga Nidana, Lakshana Chikitsadayah Adhyaaya Published through Vavilal Ramaswamy Shastrilu and Sons 22/68 PN-942

23. Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai. PN-246

24. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Su.Stha. 21/25 PN-104

25. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Su.Stha. 21/22 PN-104

26. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Su-24/5-16 PN-124

27. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Ch. Vi 5/23 PN-252

28. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Chakrapani on Su. Su. 24/07 PN-114

29. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/31 PN-587

30. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Ch. Chi. 28/19 PN-617

31. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Su. Ni 13/39 PN-323

32. Vagbhata, Ashthanga Sangrha of Vagbhataa Text English Translation Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 36/05 PN-316

33. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 31/05 PN-888

34. Madhava Nidana with Mudhukosha Vyakhyaya reprinted 2003 By.Dr.Brahmananda Tripathi Choukambha Surabharati Prakashana Varanasi 55/33 PN-276



37. Basavaraajeeyamu Kshudra Roga Nidana, Lakshana Chikitsadayah Adhyaaya Published through Vavilal Ramaswamy Shastrilu and sons 1926, 22/68 PN-942.


39. Sharangadhara Prathama Khanda By. Pandit Sharngdharaachaarya by Pandit Parashuram Shastri Vaidhyasagar Reprinted 1986 - 07/94 Teeka PN-101.


41. Vagbhata, Ashthanga Sangraha of Vagbhataa Text English Translatio Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 36/05 PN-316

42. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 31/05-888


44. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 31/05, PN-888

45. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Ni.13/39 PN-323


47. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 31/05-888




51. Basavaraajeeyamu Kshudra Roga Nidana, Lakshana Chikitsadayah Adhyaaya Published through Vavilal Ramaswamy Shastrilu and Sons 22/68 PN-942


53. Shargnadhara Prathama Khanda By. Pandit Sharngdharaachaarya by Pandit Parashuram Shastri Vaidhyasagar Reprinted 1986 - 07/94 Teeka PN-101.


55. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Ni 13/39 PN-323.




59. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/31 PN-587.



62. Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai PN-246.


64. Shabda Kalpadruma by Raja Radha Kanta Deva 3rd edt. 1967 IIIrd Part PN-735.



67. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 31/05- PN-888


69. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/31 PN-587.



72. Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai PN-246.


74. Shabda Kalpadruma by Raja Radha Kanta Deva 3rd edt. 1967 IIIrd Part PN-735.

75. Vagbhata, Ashthanga Sangra of Vagbhataa Text English Translatio Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 36/05 PN-316.

76. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Ayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 31/05-888.

77. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Si. Sth. 2/10 PN-688

78. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Chi 20/37 PN-480




82. Chakradatta with “Bhavaartha Sandeepino” Hindi commentary - Vaidya Jagadeeshwaraprasaada Tripathi 5th Edition 1983 Chap- 55/43 PN-425

83. Yoga Ratnakara with Vaidhyaprabha Hindi commentary By. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni.Shloka-124 PN-694

84. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Si. Sth. 2/22 PN-690


86. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Su. Chi 21/37

87. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Su. Chi 20/37-480

88. Vagbhata, Ashthanga Sangraha of Vagbhataa Text English Translatio Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 37/05 PN- 321



91. Y.R Kshu. Ro. Ni-Chi Shloka-124 PN-694 92. Sharangadhara Samhita of Shargadharaachaarya English

Translation Translated By.Dr.Himasagara Chandra Murthy 2nd edition 2007 Sha. U. Kha 11/12 PN-371

93. Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai Kshu.Ro. Chi PN-247.

94. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Chi 20/ 37 1/2 PN-480.








102. Yoga Tarangini Chapter Ashtha Shashtistamastaranga Kshudraroga Adhyaya Shloka- 22. Y. T.68/22

103. Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni.Shloka-123 PN-694

104. Sharngdhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Sha. U. Kha 11/12 PN-371

105. Bhaishajya Ratnavali of Govind Dasji Bhishagratna English Translated by Dr.Kanjiv .Lochan Volume-3 1st edition Bh.R. 60/38 PN-173


107. Chakradatta with “Bhavaartha Sandeepino” Hindi commentary – Vaidya Jagadeeshwaraprasaada Tripathi 5th Edition 1983 Chap- 55/43 PN-425


109. Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni.Shloka-123

110. Sharangadhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Utt. Kha11/11 PN-371

111. Sharangadhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Utt. Kha11/11 PN-371

112 Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/35 PN-587

113 Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai Kshu.Ro. Chi PN-247

114 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-125 PN-695

115 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni. Shloka-122 PN-695

116 Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai PN-247



119 Sharangadhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Utt. Kha11/12 PN-371



122 Sharngdhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Utt. Kha11/12 PN-371

123 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-129-132nd Shloka PN-703

124 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-135-140th Shloka PN-704

125 Rasaratna Samucchaya edited with Hindi Commentary by Kaviraj Shri Ambikadatta Shastri 8th edition 1998 Kshudraroga Adhyaya 25/03 PN-520

126 Bhaarat Bhaishajya Ratnaakara By. Shri. Ganidasa Chaganalal Shaha Rasa Vaidya 2nd edition 1928 reprinted August 1999 B.Jain Publishers Pri.Ltd. Newdehli. Bh.Bhai. Ra 5th part Ksudra Rogadhikar 5th Chap Drug No-7950

127 Rasendra Saara Sangraha of Shri Gopal Krishna English Translation By. Ashok. D. Satpute 1st edition 2003 Chapter 3/01 PN-615

128 Brihat Yogatarangini 2nd Part 27/12 129 Bhaishajya Ratnavali of Govind Dasji Bhishagratna English

Translated by Dr.Kanjiv Lochan. Volume-3 1st edition Kshudraraogadhikara

130 Vagbhata, Ashthanga Sangraha of Vagbhataa English Translation, Volume3 translated by Prof. Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 37/05 PN- 321

131 Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 32/03 PN-890

132 Chakradatta with “Bhavaartha Sandeepino” Hindi commentary - Vaidya Jagadeeshwaraprasaada Tripathi 5th Edition 1983 Chap- 55/43 PN-425

133 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by.Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi.Kshu. Ro. Ni-Chi Shloka-121 Shloka PN-695

134 Shrimattrimalla Bhattavaidhyarajavirachitaa Yogatarangini by shri Dattaram Mathur Prastavana Lekhak Dr.Chandrabhooshan Jha Reprinted 2003 Vaidya Bhavana Varanasi, 6th chapter 22nd shloka.

135 Rasaratna Samucchaya edited with Hindi Commentary by Kaviraj Shri Ambikadatta Shastri 8th edition 1998 Kshudraroga Adhyaya 25/1-2 PN-520

136 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-172-173 PN-707

137 Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi 24 /15-17. PN-487.

138 Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt.2/8 PN-26

139 Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 2/15 PN-28

140 Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001, Chi. 24/10 PN-124

LEPA 1. Markandeya 2. Shabda Kalpadruma by Raja Radha Kanta Deva 3rd edt. 1967 IIIrd

Part 3. Sharangadhara, Sharangadhara Samhita of Sharngdharacharya text

English translation 2ND Edition 2007 translated by Dr. P.Himasagar chandramoorthy chapter.11/01 PN-370

4. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003-Choukamba Surabhaarati Prakashana Varanasi Su.Su.18/06 PN-85

5. Charaka , Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/110 PN-196

6. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/111 PN-196





11. Charaka,Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/117 PN-196


13. Vagbhata,Ashthanga Sangra of vaagbhataa Text English Translation Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt.30/08 PN-264-265

14. Sharangadhara,Sharangadhara Samhita of Sharngdharacharya text English translation 2ND Edition 2007 translated by Dr. P.Himasagar chandramoorthy chapter.11/01-02 PN-370

15. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/14-15 PN-300

16. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi. Stha. 21/101-117 PN-534,535

17. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya repr. 2003 Choukamba Surabhaarati Prakashana Varanasi Su 18/11 PN85

18. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi. Stha.21/100 PN-534

19. Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya repr. 2003 Choukamba Surabhaarati Prakashana Varanasi Su 18/12-15 PN-85,86.

20. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/16 PN-301

21. Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya repr. 2003 Choukamba Surabhaarati Prakashana Varanasi Su.18/10 PN-85

22. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit samsthan Varanasi 5/94 PN-119

23. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/19-21 PN-301

24. Vagbhata,Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/18 PN-301



27. Yoga Ratnakara with Vaidhyaprabha Hindi commentary By. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Nitya Pravrutti Prakarana Shloka 77-78 PP-52

28. Vagbhata,Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/17 PN-301

VAMANA 1. Charaka, Charaka Samhita with Ayurveda Dipika Commentary,

Choukhamba Sanskrit series .Varanasi.1994.Kalpa Sthana 1 / 4. 2. Charaka, Charaka Samhita with Ayurveda Dipika Commentary,

Choukhamba Sanskrit series .Varanasi.1994.Sutra Sthana 16th chap. 3. Charaka, Charaka Samhita with Ayurveda Dipika Commentary,

Choukhamba Sanskrit series .Varanasi.1994.Sidhi Sthana 2 /10 pn 979. 4. Charaka, Charaka Samhita with Ayurveda Dipika Commentary,

Choukhamba Sanskrit series .Varanasi.1994.Sidhi Sthana 2 /10 pn 978. 5. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya

shastri kashinath,Chaukhambha Bharati Academy,Varanasi,Chikitsa sthana,7/43 pn 255.

6. Charaka, Charaka Samhita with Ayurveda Dipika Commentary, Choukhamba Sanskrit series .Varanasi.1994.Sutra Sthana 7/46.

7. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya shastri kashinath,Chaukhambha Bharati Academy,Varanasi, Kalpa sthana,1/10 pn 895.

8. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya Shastri Kashinath,Chaukhambha Bharati Academy,Varanasi, Kalpa sthana,1/14 pn 890.

9. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya Shastri Kashinath, Chaukhambha Bharati Academy, Varanasi, Sidhisthana,1

10. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya shastri kashinath,Chaukhambha Bharati Academy,Varanasi, Sidhi sthana,1/13-14, pn 963.

11. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya shastri kashinath,Chaukhambha Bharati Academy,Varanasi, Sidhi sthana,1/15-16, pn 964

12. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya shastri kashinath,Chaukhambha Bharati Academy,Varanasi, Sidhi sthana,6/29-30 pn 1023


14. Sushruta, Sushruta Samhita with Nibandha Sangraha commentary Choukhamba Sanskrit series 2002.Chikitsa Sthana 39/3-5

15. Charaka, Charaka Samhita with Ayurveda Dipika Commentary, Choukhamba Sanskrit series .Varanasi.1994.Sidhi Sthana 1/11.


Anatomy of Skin 1. Text book of Human Histology by Inderbir Singh 4th Edition 2005

reprint PN 193-199 2. K. Sembulingam, Essential of Medical Physiology, 2ndEdition,2003, pn

261. ACNE VULGARIS 1. Dorlands Pocket Medical dictionary 27th edition PN-09 and Stedman’s

concise medical dictionary 2. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02. 3. Hand book of dermatology and venerology By.Dr. A.S.M.T. Hossain 2nd

edition 4. Roxburg’s common skin diseases PN-149 5. Practice of dermatology 9th edition 2004 by. P. N. Behll, A.Agarwal,

Govind Srivatsava chapter-31 PN-408 6. Roxburg’s common skin diseases PN-149 7. www.emedicine .com 8. www.aha.org 9. Illustrated synopsis of dermatology and sexually transmitted diseases

1st edition 2005, PN-84-85. 10. Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in

acne triggers inflammatory cytokine responses. J Immunol. Aug 1 2002;169 (3):1535-41. [Medline].

11. Webster GF. Inflammatory acne represents hypersensitivity to Propionibacterium acnes. Dermatology. 1998;196(1):80-1. [Medline].

12. Ingham E, Eady EA, Goodwin CE, Cove JH, Cunliffe WJ. Pro-inflammatory levels of interleukin-1 alpha-like bioactivity are present in the majority of open comedones in acne vulgaris. J Invest Dermatol. Jun 1992;98(6):895-901. [Medline].

13. Practice of dermatology 9th edition 2004 By.P.N.Behll, A.Agarwal, Govind Srivatsava chapter-31 PN-408

14. Dermatology and venerology by Ajay choudhri 1st edition PN-113 15. Roxburg’s common skin diseases PP-152-153 16. Dermatology and venerology by Ajay choudhri 1st edition PN-113 17. Roxburg’s common skin diseases PN-149 18. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02

19. Illustrated synopsis of dermatology and sexually transmitted diseases 1st edition1st Edition 2005, PN-84-85

20. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th edition PN-02

21. Illustrated synopsis of dermatology and sexually transmitted diseases 1st edition 2005, PN-84-85

22. Dermatology an illustrated color text 3rd edition by. David J. Gawkrodger PN-60-61


24. Illustrated synopsis of dermatology and sexually transmitted diseases 25. Dermatology an illustrated color text 3rd edition by. David J.

Gawkrodger PN-60-61 26. Roxburg’s common skin diseases PN-149 27. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02 28. Illustrated synopsis of dermatology and sexually transmitted diseases

Practice of dermatology 9th edition 2004 By.P.N.Behl, A.Agarwal, Govind Srivatsava chapter-31 PN-408


30. Illustrated synopsis of dermatology and sexually transmitted diseases 31. Roxburg’s common skin diseases PN-149 32. Illustrated synopsis of dermatology and sexually transmitted diseases 33. Dermatology an illustrated color text 3rd edition by. David J.

Gawkrodger PN-60-61 34. Practice of dermatology 9th edition 2004 By.P.N.Behll, A.Agarwal,

Govind Srivatsava chapter-31 PN-408 35. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02 36. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02 37. Practice of dermatology 9th edition 2004 By.P.N.Behll, A.Agarwal,

Govind Srivatsava chapter-31 PN-408 38. Practice of dermatology 9th edition 2004 By.P.N.Behll, A.Agarwal,

Govind Srivatsava chapter-31 PN-408 39. Illustrated synopsis of dermatology and sexually transmitted diseases 40. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02 41. www.emedicine .com 42. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02 43. Illustrated synopsis of dermatology and sexually transmitted diseases 44. www.emedicine.com 45. www.emedicine.com


47. Roxburg’s common skin diseases PN-149 48. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02 49. Illustrated synopsis of dermatology and sexually transmitted diseases 50. Dermatology an illustrated color text 3rd edition by. David J.

Gawkrodger PN-60-61 51. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th

edition PN-02 52. Dermatology an illustrated color text 3rd edition by. David J.

Gawkrodger PN-60-61 53. Illustrated synopsis of dermatology and sexually transmitted diseases 54. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th



edition PN-02 57. Illustrated synopsis of dermatology and sexually transmitted diseases 58. Illustrated synopsis of dermatology and sexually transmitted diseases 59. www.emedicine .com 60. www.emedicine .com 61. www.emedicine .com 62. Illustrated synopsis of dermatology and sexually transmitted diseases 63. Fitzpatrick’s PN-2 64. Illustrated synopsis of dermatology and sexually transmitted diseases 65. Roxburg’s common skin diseases 66. Illustrated synopsis of dermatology and sexually transmitted diseases 67. Skin disease and sexually transmitted infection PN-112-117, 5th

edition reprint 2005. 68. www.emedicine.com 69. www.emedicine.com DRUG REVIEW 1. Dravya Guna Vignana By Prof Sharma PV, Vol II, Choukhambha

Bharati Academy ,Varanasi,Reprint 2005, 2. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya

shastri kashinath,Chaukhambha Bharati Academy,Varanasi, Sutra sthana, 13 th Chapter

3. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya shastri kashinath,Chaukhambha Bharati Academy, Varanasi, Sutra sthana, 13 th Chapter

4. Dravya Guna Vignana By Prof Sharma P V , Vol III, Choukhambha Bharati Academy ,Varanasi,Reprint 2005.

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RESEARCH PROFORMA DEPARTMENT OF P. G. STUDIES IN PANCHAKARMA N.K.J.A.M.C.P.G. RESEARCH CENTER, BIDAR–585 403.

TITLE – “COMPARATIVE CLINICAL STUDY ON EFFECT OF VAMANA WITH LEPA AND ONLY LEPA

IN YOUVANA PIDAKA (ACNE VULGARIS)”.” GUIDE – Dr. Sanghamitra Patnaik. M. D. (Ayu)

CO-GUIDE – Dr. Anilkumar Bacha. M.D. (Ayu)

SCHOLAR – Dr. Anil S. Managuli P. G. Scholar.

Pt. Name Group & Sl. No.

OPD No. Address

IPD No

Age DOA

Sex DOD

Religion Education

Occupation Socio-economic status

Habitat Dietary Habits

Marital Status

A. PRADHANA VEDANA Duration

B. ANUBANDHI VEDANA

Burning sensation / Pain / Fever / Irritation / Itching /

Roughness of skin / Redness / Swelling / Discharge / Others _ _ _ CONSENT

I here by agree that, I have been fully educated and informed with the disease and nature of the treatment. Here, by satisfied whole heartedly accept the medical trial over me.

Signature of the investigator Signature of the patient

C. PRADHANA VEDANA VRUTTANTA

Onset of the disease in order with chronicity

Onset : Sudden / Gradual / Insidious

Duration : Acute / Sub-acute / Chronic

D. POORVA VYADHI VRUTTANTA

History of similar previous complaints – Present / Absent

Give details –

Diseases

Skin

Disorders

Vyanjaka

Nidana

Trauma Infection Climate Drugs Tropical

agents

Food

History of other diseases like Measles / Mumps / Rubella / Herpes,

etc

Specify if any other –

E. POORVA CHIKITSA VRUTTANTA

Whether patient has taken treatment for present complaints?

Yes / No. If yes, give details _ _ _

History of any medical management – Yes / No.

History of any surgical procedures – Yes / No.

If Yes, give details – (Give the details of the previous management with

similar complaints) Topical Steroids

antibiotics Anti-allergic

Hormonal therapy

Anti-depressants

other Treat-

-ment

F. KAUTUMBIKA VRUTTANTA

Any history of similar complaints in the family? Yes / No.

Details –

H/o of any other disease –

G. VAIYAKTIKA VRUTTANTA

01. Appetite –

02. Bowel – Sama / Nirama / Santushta / Asantushta

Kathina / Sandhra / Drava / Sakashta / Vivarna / Alpa / Muhurmuhu

Frequency – 0 / 1 / 2 / 3 / > 3 per day

03. Sleep – Alpa / Madhyama / Prabhuta / Khandita

04. Micturation – Frequency – 0 / 1 / 2 / 3 / 4 / 5 / > 5 per day

Samyaka / Kricchra / Vaivarnya / Sadaha / Alpa / Prabhuta

05. Facial Hygine – Poor / Good / Moderate / Best

Face-wash Frequency – 0 / 1 / 2 / 3 / > 3 per day

Soap in use :

Use of Cosmetics : oil based creams/water based creams/gels/face

bleach/moisturizers etc.

Mukha Akriti – Normal / Jolly / Tensive / Anxious / Depressed /

Sentimental

06. Artava Pravritti – Normal Regular / Irregular / With pain & other

troubles

Period duration & Cycle –

Any relation of Pidaka with Artava Pravruti -

07. Habits –

08. Ahara – Regular / Irregular

Proportionate / Dis-proportionate

Timely / Irrespective of time schedule

a) Vegetarian – Excess use of – Masha / Dadhi / Dugdha vikara / Ice

creams / Cold drinks / Pickles / Bakery items / Sweets / Ikshu vikara /

Soared items / Any specific –

b) Non-vegetarian – Chiken/Matsya / Mahisha / Varaha / Any specific –

c) Drinking water – Normal / Luke warm / Filter / Boiled & Cooled /

Mineral / Tap water / Well water

09. Vihara – Exposure to Dhooma / Raja / Aatapa / Sheetajala /

Avashyaya / Diwaswapna / Nishajagarana / Pravasa / Ativyayama /

Ativyavaya / Avyayama

a) Nature of work – Sedentary / Poorly active / Less active / Moderate /

Heavy

b) Diwaswapna – No / <1 Hour / 1 – 2 Hours / > 2 Hours

c) Vegadharana / Exercise after meals / Exposure to sunlight / Exposure to

dust / Fear / Day sleep / Unhygienic leaving / Polluted climate / Use of

various cosmetics, synthetics / Hair dyes / Drug allergies / Local irritants

d) Manasika Bhava – Bhaya / Chinta / Shoka / Krodha / kaama / harsha /

moha

10. Vyasana – Smoking / Tobacco Chewing / Alcohol / Tea / Coffee

If yes – Smoking – No & Frequency, Tobacco – Frequency –

Alcohol, Coffee, Tea – Frequency & ml

11. Agni Bala – Sama / Vishama / Tikshna / Manda

12. Koshta – Mridu / Madhyama / Krura

13. Rasa Dominancy – Madhura / Amla / Lavana / Katu / Tikta / Kashaya

14. Guna Dominancy – Guru / Laghu / Snigdha / Ruksha / Sita / Ushna

15. Aggravation factor – Summer / Winter / Sunlight / Menstruation / No

relation

16. Deggration factor – Summer / Winter / Rainy season

17. Swasthya Niayamana – Achamana / Nitya Abhyanga / Snana /

Alepana / Shuchitwa

18. Nidana (Predisposing factors) –

a) Virddha Ahara – Lavana + Dugdha / Tila + Guda + Dadhi / Milk + Amla

Dravyas / Matsya + Dugdha

b) Garishta Ahara – Curd / Fish / Pastries / Fermented food articles /

Drava / Guru / Sneha Bahula

c) Fast food – Dosa / Burger / Sandwitch / Panipuri / Chinese / Pizza /

Manachuri / Kababa / Chips, etc

d) Asatmya Ahara – Soared items / Kokama / Pickle / Vinegar / Baking

powder / Cold drinks / Ushna-Tikshna-Vidahi foods / Excessive intake of

Mulaka / Garlic / Onion / Tila / Lavana / Amla / New Annapana

H. GENERAL EXAMINATION

01. Pulse – / Min

02. Blood pressure – / mm of Hg

03. Temperature – 0F / Afrebrile

04. Respiratory rate – / Min

05. Conjunctiva –

06. Tongue –

07. Prakriti – V / P / K / VP / PK / VK / T

08. Satwa – Satwik / Rajasika / Tamasika

Pravara / Madhyama / Heena

09. Desha – Anupa / Jangala / Sadharana

I. SYSTEMIC EXAMINATION

a) Respiratory system –

b) Cardio-vascular system –

c) Per abdomen –

J. LOCAL EXAMINATION

INSPECTION OF PIMPLE –

01. Varna – Shyava / Krishna / Rakta / Shweta

02. Srava – Tanu / Alpa / Raktabha / Puyabha / Prabhuta / Picchhala /

Shweta / Prabhuta

03. Vedana – Supti / Shoola / Daha / Kandu / Osha / Chosha

04. Visarpana – Sthira / Visarpanasheela

05. Pidaka affected area – > 1 cm / 1 – 5 cm / 5 – 10 cm / > 10 cm

06. Number of Pidaka – Rt side of face – Lt side of face –

07. Affected area with number of Pidaka –

AREA AFFECTED RIGHT SIDE LEFT SIDE

Forehead

Cheeks

Nose

Neck

Photo sketch of face

08. Shape – Round / Oval / Polygonal / Irregular

09. Types – Comedone / Macular / Papules / Vesicle / Nodule / Cystic

10. Extension – Localized / Generalized / Symmetrical / Asymmetrical

11. Boarder – Well marked / Demarked

12. Swelling – No swelling / Mild swelling / Moderate swelling / Marked

swelling

13. Redness – No redness / Mild redness / Moderate redness / Severe

redness

PALPATION –

01. Pain – Mild tolerable / Felt only after touching / Moderate pain / Severe

intolerable pain

02. Temperature – No increase in local temperature / Mild increase in

local temperature / Moderate rise in temperature / Severe temperature

K. LABORATORY INVESTIGATIONS –

HB% – gms% TC – cells/cumm

DC – N – %, L – %, E – %, M – %, B – %,

ESR – ____ For 1st Hr. RBS – mg/dl

L. DIAGNOSIS –

M. TREATMENT SCHEDULE

Group A – Vamana Followed by Lepa

Vamana Poorvakarma :

� Deepana-Pachana was given with Trikatu Churna.

From _ _ _ _ _ _ _ To _ _ _ _ _ _ _.

� Snehapana with Moorcchita Ghrita.

From _ _ _ _ _ _ _ To _ _ _ _ _ _ _.

Observations Date No of Day

Matra Time of Snehapatra

Time of Appetite Jry L Jr L Sm L

01 02 03 04 05 06 07 *Jry L – Sneha Jeeryamana Lakshana, *Jr L – Sneha Jeerna Lakshna,

*Sm L – Sneha Samyak Lakshana

NOTE : Sneha Jeeryamana Lakshana

A Shiro Ruja B Lalasrava C Sneha Udwega D Anga Sada E Arati F Klama G Trishna H Daha I Bhrama J Moorccha Sneha Jeerna Lakshna

A Udgara Shuddhi B Vatanulomana C Kshudha Pravritti D Trishna Pravritti E Mala Pravritti F Shareera Laghuta Sneha Samyak Lakshana

A Vatanulomana B Agnideepti C Sneha Udwega

D Asamhata Varchasu E Anga Laghawata F Gatra Snigdhata

G Purisha Snigdhata H Klama

� Vishrama Kala was given. On that day Sarvanaga Abhyanga with Moorcchita Tila Taila followed by Bashpaswedana was planned.

From _ _ _ _ _ _ _ To _ _ _ _ _ _ _. � Patient advised for Guru, Snigdha, Abhishyandi, Kapha Utkleshaka

Ahara advised at night. � Next day prior to Vamana Sarvanaga Abhyanga with Moorcchita Tila

Taila followed by Bashpaswedana was planned. Date _ _ _ _ _ _ _.

Vamana Pradhanakarma – i) Freshly prepared Yavagu given at _ _ _ _ _ _ _ on _ _ _ _ _ _ _. ii) Akanthapoorna Ksheerapana / Ikshu Rasa

Sl. Drug Time Qty BP/PR Vega Colour App. Qty

Remarks

01. Milk 02. Vamana

Yoga Swedapradurbhava

Kukshi Adhmana Romaharsha Vamana Vegapradhurbhava

03. Vamanopaga Yoga (Yashti-madhu Phanta)

04. Saindhava Jala

Vamana Shuddhi Obtained –

ANTIKI MANIKI VAIGIKI LAINGIKI

Paschyata Karma –

Dhoomapana –

Samyaka Lakshana –

Observation up to 4 pm –

Group B – Manjishtha-Madhu Lepa

Patients advised for external application of Manjishta-Madhu Lepa

for 15 days early morning once in a day for 30 minutes and washed with

luke warm water.

� Weight of the patient before Vamana Karma – Kgs

� Weight of the patient after Vamana Karma – Kgs

N. RESULT ASSESSMENT

BT AT FOLLOW UP (In days) Sl. PRESENT COMPLAINT 0 30 45 75 105

01. Pain 02. Burning Sensation 03. Number of Pidaka 04. Size of Pidaka 05. Number of scars 06. Oiliness of the face 07. Dryness of the face 08. Score of Pidaka on the

basis of affected place

09. Global Acne Grading System

DATE Signature of SCHOLAR Signature Of GUIDE

O. RESULTS – No Improvement / Mild Relief / Moderate Relief / Marked Relief / Complete Relief

Signature of Guide Signature of PG Scholar

REFERENCES OF YOUVANA PIDAKA IN CLASSICS��SUSHRUTA SAMHITA

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MASTER CHART FOR GROUP – A Table No. 67. Master Chart Showing Demographic Data of patients in Gr. A.

SL. DATE NAME OPD Place AGE SEX REL Ed MS Pr St OCC SE Hab Fh

01. 02/02/09 Alok Kumar 1847 Bidar 21 M H BE UN VP P Std MC U V

02. 23/02/09 Meenu wahi 5621 Bidar 24 F H Pg UN KP A Std UC U M

03. 25/02/09 Shika 5622 Bidar 24 F H Pg UN VP P Std UC U M

04. 25/03/09 Geeta 8808 Chitaguppa 18 F H PU UN VP P Busin MC R M

05. 26/03/09 Shivasharanappa 8351 Bidar 20 M H Di UN VP P Std MC R V

06. 28/03/09 Niharika 8971 Bidar 22 F O Ug UN PV M Std UC SU M

07. 06/04/09 Ashwini 8999 Bidar 22 F O Ug UN VP A Std MC SU M

08. 10/04/09 Namadev 9284 Bidar 19 M O Ug UN KP M Std MC R M

09. 19/08/09 Habiba 26904 Bidar 19 F M Ug UN KP P Std UC U M

10. 22/08/09 Padmavati 20446 Bidar 30 F H Phd M PV P HS UC U M

11. 29/08/09 Goutami 29591 Bidar 18 F H Ug UN VK P Std MC U M

12. 29/08/09 Treesa 30012 Bidar 24 F C N UN PK M Std MC R M

13. 31/08/09 Sridevi 30120 Bidar 28 F H Pg M VK M HS UC SU V

14. 03/09/09 Rasika 30136 Bidar 23 F H Ug UN VP M Std UC SU M

15. 06/09/09 Fathima 30224 Bidar 19 F M 10 UN KV M Std LC R M

*SL. – Serial Number, *Date – Date of Registration in the trial, *OPD – Out Patient Department Number, *REL – Religion, *Ed – Education, *I – Illiterate, *PU – Pre-university College, *PG – Post-graduate, *MS – Marital Status, *UN – Unmarried, *M – Married, *Pr – Prakriti, *KP – Kapha-Pitta, *PV – Pitta-Vata, *KV – Kapha-Vata, *St – Satwa, *P – Pravara, *M – Madhyama, *A – Avara, *Or Hy – Oral Hygiene, *G – Good, *M – Moderate, *P – Poor, *OC – Occupation, *Std – Student, *Ag – Agriculture, *Busi – Business, *Lab – Labour, *HW – House wife, *SE – Socio-economical status, *UC – Upper class, *MC – Middle class, *LC – Lower class, *Hab – Habitat, *U – Urban, *Su – Sub-urban, *Sl – Slum, *Fh – Food Habits, *V – Vegetarian, *M – Mixed.

MA

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Tabl

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07.

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S

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15.

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– S

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– M

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d, *

Pr

– P

rakr

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– K

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-Pitt

a, *

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– P

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-Vat

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St

– S

atw

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Hy

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, *G

– G

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*M

– M

oder

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*P

– P

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*OC

–

Occ

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dent

, *A

g –

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ture

, *B

usi

– B

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ess,

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b –

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ur,

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– H

ouse

wife

, *S

E –

Soc

io-

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omic

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tatu

s, *

UC

– U

pper

cla

ss, *

MC

– M

iddl

e cl

ass,

*LC

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ower

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ss, *

Hab

– H

abita

t, *U

– U

rban

, *S

u –

Sub

-ur

ban,

*S

l – S

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, *Fh

– F

ood

Hab

its, *

V –

Veg

etar

ian,

*M

– M

ixed

.

MASTER CHARTS OF RESPONSE Table No. 69. The assessment of Pain before & after the treatment and in all three follow ups

Group A Group B Follow Up Follow Up Sl. BT AT

FU-1 FU-2 FU-3 Sl. BT AT

FU-1 FU-2 FU-3 01. 3 1 1 1 1 01. 2 0 0 1 1 02. 2 0 0 0 1 02. 3 1 1 1 1 03. 2 0 0 0 1 03. 1 0 0 1 1 04. 2 0 0 0 0 04. 3 1 1 1 1 05. 3 0 0 1 1 05. 4 1 1 2 2 06. 2 0 0 0 0 06. 2 0 1 1 1 07. 1 0 0 0 0 07. 4 1 1 1 2 08. 3 0 0 1 1 08. 3 1 1 1 1 09. 4 0 1 1 1 09. 3 1 1 1 1 10. 3 1 1 1 1 10. 4 1 1 1 2 11. 3 1 1 1 1 11. 1 0 0 1 1 12. 3 0 0 0 1 12. 3 1 1 1 2 13. 2 0 0 0 1 13. 2 0 0 1 1 14. 1 0 0 0 0 14. 2 0 0 1 1 15. 4 0 1 1 1 15. 1 0 0 1 1

Table No. 70. The assessment of burning sensation before & after the treatment and in all three follow ups



FU-1 FU-2 FU-3 01. 4 1 1 1 2 01. 1 0 0 1 1 02. 2 0 0 0 0 02. 2 0 0 1 2 03. 2 0 0 0 0 03. 1 0 0 1 1 04. 1 0 0 0 0 04. 3 1 2 2 2 05. 3 0 1 1 1 05. 3 1 2 2 2 06. 2 0 0 0 0 06. 1 0 1 1 1 07. 1 0 0 0 0 07. 3 1 2 2 2 08. 3 0 0 1 1 08. 2 0 0 0 2 09. 3 0 0 0 0 09. 2 0 0 0 2 10. 2 0 0 1 1 10. 3 1 2 2 3 11. 1 0 0 0 0 11. 1 0 0 1 1 12. 1 0 0 0 0 12. 3 1 2 2 2 13. 2 0 0 0 0 13. 2 0 0 1 2 14. 1 0 0 0 0 14. 2 0 0 1 2 15. 4 1 1 1 2 15. 0 0 0 0 0

Table No. 71. The assessment of number of Pidaka before & after the

treatment and in all three follow ups



FU-1 FU-2 FU-3 01. 4 1 0 1 1 01. 3 1 0 0 1 02. 2 0 0 0 0 02. 3 0 0 1 1 03. 2 0 0 0 0 03. 3 0 0 1 1 04. 3 0 1 1 1 04. 4 2 2 2 2 05. 3 0 1 1 1 05. 4 2 2 2 2 06. 3 0 1 1 1 06. 2 0 0 1 1 07. 3 0 1 1 1 07. 4 2 2 2 2 08. 3 0 0 0 1 08. 3 1 1 1 2 09. 3 0 0 0 0 09. 3 1 0 1 1 10. 4 1 0 1 1 10. 4 2 2 2 2 11. 4 1 0 1 1 11. 3 0 1 1 1 12. 3 0 0 0 1 12. 4 2 2 2 2 13. 2 0 0 0 0 13. 3 1 1 1 2 14. 3 1 1 0 1 14. 3 0 1 1 1 15. 3 1 1 0 1 15. 3 1 0 0 1 Table No. 72. The assessment of size of Pidaka before & after the




FU-1 FU-2 FU-3 01. 3 0 0 1 1 01. 2 0 0 1 1 02. 1 0 0 0 0 02. 2 1 1 1 1 03. 1 0 0 0 0 03. 2 0 1 1 1 04. 2 0 0 0 0 04. 2 1 1 1 1 05. 2 1 1 1 1 05. 3 1 1 1 1 06. 2 0 0 0 0 06. 1 0 0 0 1 07. 2 1 1 0 0 07. 3 1 1 1 1 08. 3 0 1 1 1 08. 3 1 1 1 2 09. 3 0 0 1 1 09. 3 1 1 1 1 10. 1 0 0 0 1 10. 3 1 1 1 2 11. 2 0 0 0 1 11. 2 0 1 1 1 12. 3 0 0 1 1 12. 2 0 1 1 1 13. 1 0 0 0 1 13. 2 0 0 1 1 14. 3 0 1 1 1 14. 3 1 1 1 1 15. 2 0 0 0 0 15. 2 0 0 1 1

Table No. 73. The assessment of number of scars before & after the




FU-1 FU-2 FU-3 01. 1 1 1 1 1 01. 2 1 1 1 1 02. 1 0 0 0 0 02. 2 1 1 1 1 03. 1 0 0 0 0 03. 2 2 2 2 2 04. 3 2 2 2 2 04. 1 1 1 1 1 05. 4 3 3 3 3 05. 3 3 3 3 3 06. 1 0 0 0 0 06. 1 0 0 0 0 07. 1 1 1 1 1 07. 2 2 2 2 2 08. 3 2 2 2 2 08. 1 1 1 1 1 09. 1 1 1 1 1 09. 2 2 2 2 2 10. 1 1 1 1 1 10. 2 2 2 2 2 11. 3 2 2 2 3 11. 2 2 2 2 2 12. 2 1 1 1 1 12. 1 0 0 0 0 13. 1 0 0 0 0 13. 3 2 2 2 3 14. 1 1 1 1 1 14. 1 0 0 0 0 15. 2 1 1 1 1 15. 3 2 2 2 3 Table No. 74. The assessment of oiliness of the face before & after the treatment and in all three follow ups



FU-1 FU-2 FU-3 01. 3 1 1 2 2 01. 2 1 1 1 2 02. 1 0 1 1 1 02. 2 1 1 1 1 03. 1 0 1 1 1 03. 2 1 1 1 1 04. 0 0 0 0 0 04. 1 0 0 1 1 05. 2 1 1 1 1 05. 0 0 0 0 0 06. 0 0 0 0 0 06. 1 0 1 1 1 07. 1 0 0 0 0 07. 0 0 0 0 0 08. 0 0 0 0 0 08. 3 1 1 1 1 09. 1 0 0 1 1 09. 2 0 1 1 2 10. 3 1 1 2 2 10. 2 1 1 1 1 11. 2 1 1 1 1 11. 0 0 0 0 0 12. 3 1 1 1 2 12. 1 0 0 1 1 13. 3 1 1 1 2 13. 0 0 0 0 0 14. 1 0 0 0 1 14. 1 0 0 1 1 15. 2 0 0 1 1 15. 3 1 1 1 1

Table No. 75. The assessment of dryness of face before & after the




FU-1 FU-2 FU-3 01. 0 0 0 0 0 01. 0 0 0 0 0 02. 0 0 0 0 0 02. 0 0 0 0 0 03. 0 0 0 0 0 03. 0 0 0 0 0 04. 3 2 2 2 2 04. 0 0 0 0 0 05. 0 0 0 0 0 05. 2 0 1 1 2 06. 2 2 2 2 2 06. 0 0 0 0 0 07. 0 0 0 0 0 07. 2 0 1 1 1 08. 2 2 2 2 2 08. 0 0 0 0 0 09. 0 0 0 0 0 09. 0 0 0 0 0 10. 0 0 0 0 0 10. 0 0 0 0 0 11. 0 0 0 0 0 11. 2 0 0 1 2 12. 0 0 0 0 0 12. 0 0 0 0 0 13. 0 0 0 0 0 13. 2 0 0 1 1 14. 0 0 0 0 0 14. 0 0 0 0 0 15. 0 0 0 0 0 15. 0 0 0 0 0

Table No. 76. The assessment of score of Pidaka on the basis of affected

place before & after the treatment and in all three follow ups



FU-1 FU-2 FU-3 01. 6 2 2 2 2 01. 6 2 2 2 4 02. 4 0 0 0 0 02. 4 2 2 2 2 03. 4 0 0 0 0 03. 4 1 1 1 2 04. 6 2 2 2 2 04. 4 2 2 2 2 05. 6 2 2 2 2 05. 6 2 3 4 4 06. 4 0 1 3 3 06. 4 0 0 0 2 07. 4 0 1 1 1 07. 6 2 3 4 4 08. 6 0 0 0 1 08. 4 2 4 4 4 09. 6 1 2 2 2 09. 4 2 2 2 2 10. 6 2 2 2 2 10. 6 2 3 4 4 11. 6 2 2 2 2 11. 4 0 0 0 2 12. 4 0 0 0 0 12. 6 2 3 4 4 13. 4 0 0 0 0 13. 6 1 1 1 1 14. 4 0 2 2 3 14. 4 0 0 0 2 15. 4 0 1 1 1 15. 6 3 3 3 3

Table No. 77. The assessment of global acne grading system before &

after the treatment and in all three follow ups

Group A Group B

Follow Up Follow Up Sl. BT AT FU-1 FU-2 FU-3

Sl. BT AT FU-1 FU-2 FU-3

01. 2 0 0 1 1 01. 2 0 1 1 1

02. 1 0 0 0 1 02. 2 0 1 1 1

03. 1 0 0 0 1 03. 2 0 1 1 1

04. 2 0 0 0 1 04. 2 0 1 1 1

05. 3 1 1 1 1 05. 3 1 1 1 1

06. 2 0 0 0 1 06. 1 1 1 1 1

07. 3 1 1 1 1 07. 3 1 1 1 1

08. 2 0 0 0 1 08. 2 1 1 1 1

09. 2 0 0 1 1 09. 2 1 1 1 1

10. 2 0 0 0 1 10. 3 1 1 1 1

11. 3 0 0 1 1 11. 2 1 1 1 1

12. 3 1 1 1 1 12. 3 1 1 1 1

13. 1 0 0 0 1 13. 2 0 1 1 1

14. 3 1 1 1 1 14. 2 0 1 1 1

15. 3 0 0 1 1 15. 3 0 1 1 1

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