EVALUATION OF THE EFFICACY OF NIMBARAGWADDHI YOGA AND JATHIPHALADHI LEPA IN YUVANA PIDAKA

BY

V A N I T H A R

As partial fulfillment of post graduation Degree M.D.

(Ayurveda Vachaspati)

Under Rajiv Gandhi University of Health Sciences,

Bangalore, Karnata.

Guide

Prof. Dr. Vageepuram Varadhachryalu M.D (Ayu)

Professor and head of the department

Post graduation and research center

Kayachikits.

D.G Melmalagi Ayurvedic Medical College

Gadag – 582 103

Post Graduation and research center

Kayachikitsa

2004

J.S.V.V. SAMSTHE’S

SHREE AYURVEDIC MECIAL COLLEGE &

POSTGRADUVATION AND RESEARCH CENTRE GADAG, 582 103

Certificate This is to certify that R. Vanitha has worked for her thesis on the topic entitled

“Evaluation of the efficacy of Nimbaragwadadhi Yoga and jathiphalathi Lepa in Yuvana

Pidaka.

She has successfully done the work under the guidance of Dr.V. Varadacharyulu

M.D(Ayu).

I here with forward this thesis for the evaluation and adjudication.

(Dr. V. Varada Charyulu) (Dr. G.B. Patil)

Principal

Certificate

This is to certify that the thesis entitled “Evaluation of the efficacy of

nimbragwadadhiyoga and Jathi phaladhi lepa in Yuvana Pidaka” is a record of

research work conducated by R. Vanitha, under my direct supervision and guidance.

The candidate has put is sincere effort after making an intense study coupled with

theoretical and clinical observations.

This title has not formed title of degree, associate ship, fellowship and similar

other studies in this University.

I recommend and same for being submitted for evaluation to the adjudicators.

Guide

Dr. Varadacharyulu Vangeepuram M.D (Ayu),

Gold medallist,

Date: Professor and Head of department,

Place: Postgraduate studies and research center,

Kayachikitsa,

D.G. Melmalagi Ayurvedic Medical College,

Gadag – 582 103.

ACKNOWLEDGEMENT

I express my deep sense of gratitude to my respected guide prof. Dr.V.

Varadhacharyulu M.D. (Ayu) Head of Department of Kayachikitsa, D.G.M. Ayurvedic

Medical College and Post Graduate Studies and Research Center, Gadag. He has been

very kind to guide me in the preparation of thesis and for whose extraordinary efforts,

tremendous encouragement and valuable thought provoking advise me to complete this

thesis.

I am extremely thankful to Dr. G.B. Patil principal D.G.M. Ayurvedic Medical

College and Post Graduate Studies and Research Center, Gadag, for providing all

necessary facilities for this research work.

I am very much grateful to Dr.S.H. Doddamani D.D (Ayu) Lecturer P.G.

Department, D.G.M Ayurvedic Medical College, Gadag, for his valuable suggestions on

the important subjects.

I am ever thankful to Dr. R.Y. Shettar M.D (Ayu) Lecturer P.G. Department,

D.G.M. Aurvedic Medical College, Gadag, for his valuable suggestions and moral

support throughout my career.

I wish to convey thanks to my all Under Graduate professors, Assistant professors

and Lecturers of D.G.M. Ayurvedic Medical College, Gadag, for their help and

suggestions during my post graduate studies.

________________________The Effect of Eladi Churna in Amlapita

‘Hyperchlorhydiria”

I sincerely thanks to my beloved seniors Dr. Anil Kumar Bacha,

Dr. B.M. Mukkipatil, Dr. S. Hombal, Dr. yashoda. M, Dr. S.S Hiremath, Dr.A.S. Patil,

Dr. Irranna.K, Dr. C.V. Rajeshekar, Dr. J.I.Hiremath, Dr. Shyal, Dr.R.D. Suresh, Dr.

S.K.Tiwar, Dr. yashmin, ApP, Dr G.S. hadimani, Dr. Srinivas Reddy, Dr. BG. Swamy,

Dr. Seetaram Prasad and Dr. G.S. Hiremeath, for their deep co-operation and

involvement in the P.G. study.

I am also thankful to all my post graduate colleagues Dr, shyju.O, Dr.

Shankargouda, Dr.C. hanmantagouda, Dr. V.V. Purad, for their constant co-operation and

help in the P.G study.

I am ever thankful Dr. m.S. Daniganda m.s. for their encouragement and help

throughout my career.

I wish to convey my thanks to beloved librarian Shri.V.M.Mundinamani and

Mr.S.B.Sureban for supplying me essential references in the study. I am thankful to Mr.

Basawaraj. S. Tippanagoundar, Lab. Technician, who extended his co-operation in

investigations.

I thanks to Mr.P.M. Nada kumar for his help in the statistical evaluate.

I am highly indebated to my beloved parents Sri Narayan Kulkarni, Smt.

Sindhumati, Brothers, Sister, Sisters-in-Law, Brother-in-Law and my all other family

members for their love and affection rendered throughout my career.

Thanks to all physicians, house-surgeons, hospital staff, nurses and non teaching

staff for their timely assistance in completion of this work.

Let me express my thanks to all patients, those are on the trial for their consent for

enrolling in this clinical study and obedience to advices.

Vivekanad.N.Kalkarni

_________________________The Effect of Eladi churna in Amlapitta

“Hyperchlorhydria”

CONTENTS

PART – I INTRODUCTION

PART – II LITERARY REVIEW

HISTORICAL

DERIVATIO AND DEFINITION

MODERN VIEW

SHREERA

NIDANA

CHIKITSA

PART – III DRUG REVIEW

MATERIAL AND METHODS

MASTER CHARTS

OBSERVATION AND RESULT

PART – IV DISCUSSION

PROPOSALS FOR FUTURE

STUDY CONCLUSION

SUMMARY

REFERENCES

BIBLIOGRAPHY

APPENDIX

List of Photographs

Photo – 1 Strucure of Gastric mucosa

Photo – 2 Ela (Elettaria cardomomum)

Photo – 3 Vamshalochana (Bambusa arundinacca)

Photo - 4 Twak (Cinnamomum Zeylenicum)

Photo - 5 Amalaki (Embica officinalis)

Photo - 6 Haritaki (Taminalia chebula)

Photo - 7 Pippali moola (piper longum)

Photo - 8 Seta chandana (Santalum album)

Photo - 9 Teja patra (Cinnamomum tamala)

Photo - 10 Akarakara (Anacyclus pyrethrum)

Photo - 11 Sharkar (Sugar cady)

Photo - 12 Instrument used in F.T.M

Photo - 13 Gastric juice collection (Supine position)

Photo - 14Gastric juice collection(Sitting position)

List of Master charts

Chart No. – 1 Demographic data of “Evaluation of the efficacy of Eladi Chuma in

Amlapitta (Hyperchlorhdria)”

Chart No. – 2 Chief complaints of “Evaluation of the efficacy of Eladi Chuma in

Amlapitta (Hyperchiorhydria)”

Chart No. – 3 Adhoga Amlapitta lakshanas of “Evaluation of the efficacy of Eladi

Chuma in Amlapitta (Hyperchiorhydria)”

Chart No. – 4 Uradwaga Amlapitta lakshanas of “Evaluatio of the efficacy of Eladi

Chuma in Amlapitta (Hyperchiorhydria)”

Chart No. – 5 Vataja, Pittaja Amlapitta lakshanas of “ Evaluatio of the efficacy of Eladi

Chuma in Amlapitta(Hyperchlorhydria)”

Chart No. – 6 Kaphaja Amlapitta lakshanas of “Evaluation of efficacy of Eladi Chuma in

Amlapitta(hyperchlorhydria)”

Chart No. – 7 Vata kaphaja and Kapha pittaja Amlapitta lakshanas of “Evaluatio of the

efficacy of Eladi churna in Amlapitta (Hyperchlorthydria)”

Chart No. – 8 Nidhana of of “Evaluation of the efficacy of Eladi churna in Amlapitta

(Hyperchlorhydria)”

Chart No. – 9 Subjective parameters of “Evaluatio of the efficacy of Eladi Chuma in

Amlapitta (Hyperchlorthydria)”

Chart No. – 10 Objective parameters of “Evaluation of the efficacy of Eladi Chuma in

Amlapitta (hyperchlorhydria)”

Chart No. – 11 Assessment of subjective parameter of “Evaluation of the efficacy of Eladi

Chuma in Amlapitta (Hyperchlorhydria)’

Chart No. – 12 Statical Assessment of Objective parameters of “Evaluation of the

efficacy of Eladi Chuma in Amlapitta (Hyperchlorhydria)”

List of Tables

Table No – 1 - Samanya lakshna of the Amlapitta according to various Acharysas.

Table No – 2 - Vishista Lakshana of the Amlapitta according to Various Acharyas.

Table No – 3 - Table Showing types of Amlapitta

Table No – 4 - Table Showing Vikalpa samprapti of Amlapitta.

Table No – 5 - Table Showing Vikalpa samprapti in relation to samanya laxanas.

Table No – 6 - Table Showing Upashaya of the Amlapitta

Table No – 7 - Table Showing Differential diagnosis of Pittaja shoola and Amlapitta

Table No – 8 - Table Showing Differential diagnosis Parinama shoola and Amlapitta

Table No – 9 - Table Showing Differential diagnosis of Annadrava shoola and Amlapitta

Table No – 10 - Table Showing Age and sex incidence

Table No – 11 - Table Showing Religion incidence

Table No – 12 - Table Showing Occupational incidence

Table No – 13 - Table Showing Economical status incidence

Table No – 14 - Table Showing Diet habits

Table No – 15 -Table Showing Chief Complaints

Table No – 16 -Table Showing Associated complaints

Table No – 17 Table Showing Crocity of disease

Table No – 18 Table Showing Incidence of different types of Amlapitta

Table No – 19 Table Showing The over all assessment of therapeutic responses.

List of Graphs (Figures)

Fig No – 1 - Schematic representation of Amlapitta according to Kriyakala.

Fig No – 2 - Schematic representation of Samprapati of Amlapitta.

Fig No – 3 - Graph shows the Age and sex incidence.

Fig No – 4 - Graph shows the religion incidence.

Fig No – 5 - Graph shows the occupational incidence.

Fig No – 6 - Graph shows the Economical incidence.

Fig No – 7 - Graph shows the diet habits incidence.

Fig No – 8 - Graph shows the chief complaint incidence.

Fig No – 9 - Graph shows the associated complaints

Fig No – 10 - Graph shows the cronicity incidence.

Fig No – 11 - Graph shows the incidence of different types of Amlapitta.

Fig No – 12 - Graph shows the over all assessment of therapeutic responses.

LITERARY REVIEW

The term yuvana pidaka comprises of two words.

1. Yuvana 2. Pidaka

Yuvana: The word is pulliga in gender. The word ‘yuvana’ is derived form the root YU-KANIL-KHAL. Ref: Sabda kalpa druma. The word indicates the age factor of a person. The age factor that is stipulated to say the person as yuva is between seventeen and thirty years. Ref: Su. Sam. Sutrasthana 35/35 According to sir Monier Monier Williams yuvana means young, youthful adult. Taruna, Yuvavastha are the synonyms given to the word. Ref: Sabda Kalpa Druma. Pidaka:

The work pidaka is derived form the root PEED-KHAL-TAP dhatus. The work is defined as

“PEEDAYATEETI PIDAKA”

‘SPOTAKA VISHESHAHA PIDAKA’

Ref: Sabda kalpa druma by Raja Radha Kanta Deva.

According to sir monier Monier Williams Saskrit – English dictionary pidaka menas small boil, pimple or pustule.

Pitaka, pidika, pitika are the synonyms for pidaka. By keeping the above two words in view the yuvana pidaka is defined as follows.

SHALAMALI KANTAKA PRAKYAHA KAPHA MARUTA SHONITAIHI JAYANTE PIDAKA YUNAM VAKTRE YA MKHA DOOSHIKA

Meaning of which conveys as follows.

The pidaka in the shape of shalmali kantaka (Spine of Indian red silk tree) produced due to the vitiation of kapha, vata and Rakta in youth age on the face causing disfiguration is called as yuvana pidaka. Ref: su: Sam. Nidana Sthna 13/36

Tarunya pidaka, Mukha Dooshika are the synonyms for yuvana pidaka.

The equivalent terminology for yuvana pidaka is Acne. The derivation of the term Acne is obscure and it has been imaginatively attributed to a copist’s error for the error for the grrek word AKME. Ref: Mackenna R.M.B (1957) Lancet I. 169. The Greek work AKME means peak or prime of life. It also means the period of great intensity of any symptom, sign or process. Ref: Stedman’s medical dictionary. The work Acne has been applied, with a variety of qualifying adjectives, to many eruptions on the basis of an assumed aetiological relationship or a rough physical or morophological similarity to the acne. Here, in this context, yuvana pidaka which is natural occurs in the adolescent perod in the shape of comedones (Shalmali kantakas (or) Dark horny follicular plugs) can be exactly compared with Acne vulgaris. Acne vulgaris is simple acne which is uncomplicated. The Acne vulgaris is of two types on the basis of its scar formation.

1. Acne atrophica in which lesions leave a slight amount of scarring, and 2. Acne hypertrophica which leaves on healing conspicuous scars.

Acne vulgaris is also of two types according to the eruption of pidaka. 1. Acne papulosa: It is a type of acne vulgaris is in which papule lesions are

predominate. 2. Acne pustulosa: In which the pustular lesions are predominate.

Ref: 1. Text book of Dermatology by sir Arthur Rook 2. Stedman’s Medical dictionary.

Some of the varieties of Acne of qualifying adjectives are listed here for information. 1. Acne agminata: an eruption of small dusty, reddish papule on the face, becaming

pustular and followed by slight scarring. The term suggested by crocker for tuberculosis cutes follicularis disseminata.

2. Ace albida : milium

3. Acne artificialis: This acne is produced by external irritants, such as tar or drugs internally administred, such as Lodine.

4. Acne Cachecticorum: Simple acne occurring in the subjects of Anemia; characterized by large, soft, purulent, ulcerative, cystic and scared lesions.

5. Acne Ciliaris: Follicular popules and pustules on the face edges of the eye lids.

6. Acne Conglobata: Severe cystic acne; characterized by cystic lesions, crusts, sinuses and scars.

7. Acne Cornea: Acne Keratosa

8. Acne decalvans: A rare type of pustular folliculitis of the scalp productive of scars of and subsequent alopecia.

9. Acne erythematosa: Acne rosacea: Acne of cheeks and more associated with papules, pustules, dilated blood vessels in the nasolabial folds and dilated follicles.

10. Acne exulcerans serpigino’sa na’si : It is granulosis rubra nasi. 11. Acne frontalis: Acne of the fore head.

12. Acne generalis: lesions involving the face, chest and back. 13. Acne indurate: Deeply seated acne with large papules and pustules, large scars and

hypertraophic scars.

14. Acne Keloid: dermatitis papillaris capillitii; Folliculities keloidalis; A chronic eruption of fibruous papules which develop at the site of follicular lesions usually on the back of the neck at the hair line.

15. Acne Keratosa: It is an eruption of papules consisting of horny plugs projecting from the hair follicle accompanied by inflammation.

16. Acne neonatorum: Acne of infants (of rare condition ) on the fore head and cheeks. 17. Acne punctata: It is a condition resubling choleracne where black central

comedones present in all the lesions.

18. Acne simplex: It is the name given to simple acne. It is also includes Acne vulgris.

19. Acne Syphilitica: Pustular syphilis.

20. Acne tarsi: Follicular eruptions involving Sabaceous glands of eye lids. 21. Acne telangiectodes: An acneiform eruption associated with tuberculosis.

22. Acne urticata: An acneiform lesions beginning as small urticarial wheals and followed by slight scarring.

23. Acne Varioloformis: A phogenic infection involving follicles occurring chiefly on the forehead and temples leaving scarring after involution.

24. Bromide acne: Follicular eruption of face or chest due to Bromide ingestion. 25. Halogen acne: This acne occurs due to the halogens viz., florine, Bromine, Iodine

Chlorine and Astatine.

26. Cystic acne: Cysts containing pus and sebum produced due to folluculties. And etc.

Regional Names: 1. Assam : Salamana

2. Bengal : Bahija phora

3. Dogr. : Muhasika

4. Gujarathi : Khila

5. Hindi : Muhasa

6. Kannada : Modave

7. Malayalam : Mukhakkuru

8. Mra. : Murum, Tarunya pidika

9. Oriya : Vayas vrana

10. Panjabi : kila

11. Tamil : Mugapparu

12. Telugu : motimalu

13. English : pimples

14. Greek : Akme

15. Medical term : Acne

16. Sanskrit : Yuvana pidaka

Mukhadooshika Tarunya Pidaka

INTRODUCTION

Recent trends of researches in various fields of science and technology have covered

different areas of studies for human welfare and scientific advancements which also

involve multi dimensional approaches in medical sciences with basic support of

biological and pharmacological investigations. In the series of efforts for achievement in

solving medical and health problems, cosmetology is newer field of research and

scientific interest which is gaining importance. Therefore, the present study has been

undertaken to examine the potentials in Ayurveda in the field of cosmetology and special

attention has been paid to indicate phytodrugs possessing utility in cosmetic field.

Yuvuna pidaka is a common complex, fascinating malady of either sex in the teenagers, It is an extremely common complaint with 70% of the population and cilinically evident at some point during adolescenece or early adult life. The advent of new and potent therapeutic agents for yuvana pidka has proved insignificant and our inability to treat yuvana pidaka with tropical therapy alone. This common problem turns into cosmetic problem and results in emotional upset. Patients with yuvana pidaka are often depressed and may need counseling and family support. Yuvana Pidaka is one of the diseases mentioned under kshudra Rogas. An equivalent terminology in modern medicine in Acne vulgaris. It is also mentioned as Mukha dooshika in ayurvedic classics as it decreases the complexion and smoothness of the face. So a person affected with yuvana pidaka feels like looking ugly, prone to inferiorty complex and loses the degree of confidence. This disease is viewed as a burning cosmetic problem than a medical one. Even though beauty is skin deep, yet its significance in modern present society. The vast turnover of the beauty aid products is itself a quite example for this serious issue. Therefore Yuvana pidaka requires special attention in the above view and the present study is designed with both internal and external administration of selection of the topic ‘EVALUATION OF THE EFFICAACY OF NIMBARAGWADADHI YOGA AND HATHIPHALADHI LEPA IN YUVANA PIDAKA. The observations on contribution of indigenous medical science provides valuable material for multi-disciplinary studies and bio-chemical, biological and pharmacological investigations on phytoagents. Clinical assessment and detailed screening of drugs may yield vital results for finding out promising remedies for problems of gerontological field attracting scientific world-wide attention.

SHAREERA VIVECHANA

(ANATOMY AND PHYSIOLOGY)

Yuvana pidaka (Acne vulgaris) is the disease of the skin involving the pilosebaceous glands of the integument. It is necessary to go through the pre-requisite knowledge of the disease before proceeding into study of the disease. Shareera is the base on which the subject of medicine stands. The detailed knowledge of Anatomy and physiology is always important to know the pathogenesis of the disease without which the treatment is not successful.

Here, in this context the primary knowledge of shareera of the skin is dealt. According to Ayurvedic doctrines the twak is a matruja bhava and is the upadhatu of mamsa dhatu. Twak is one of the seats of gnanendriyas. Akasha and vayu are indriyadravyas and Sparsha is the indriyartha. Bhrajaka pitta is located in Twak. According to charaka and vagbhata the twak consists of six layers. But according to Sushruta twak is of seven layers. Here Charaka and Vagbhata didn’t mention the seventh layer-Mamsadhara layer. Vagbhata says Twak is a derivative of Raktha, during its course of paka by dhatooshma. According to sushruta, during the process of parinama of sukrashonita for the formation of garbha, twak etc., are formed just like the cream of milk is formed during boiling.

Table showing the layers of the twak mentioned by different authors is shown here. Sl.

no Sushruta Charaka Vagbhata modern

1. Avabhasini Udakadhara Udakadhara * Stratum Corneum

2. Lohitha Asrugdhara Asrugdhara * Stratum lucidum

3. Swetha * * * Stratum granulosum

4. Tamra * * * Stratum Malphighii

5. Vedini * * + Papillary layer

6. Rohini * Pranadhara + Reticular layer

7. Mamsadhara

-

-

+ Subcutaneous

Tissue & muscles

* : Indicates that acharyas mentioned the layer but not with special -

name

- : Indicates not mentioned

. : Indicates the part of Enpidermis

+ : Indicates the part of Dermis

According to modern, the skin is an anatomically and physiologically specialized

boundary lamina which is of major importance in the life of an individual.

The skin is adopted to serve many different roles since it is the major interface

between the body and its environment. It minimizes, within limits, the potentially

injurious effects of mechanical, osmotic, chemical, thermal and photic environmental

stress: it provides a barrier to invasion by micro organisms and it limits and regulates the

exchange of heat with the environment by special neurovascular mechanisms. The skin

is a major sensory surface. And it provides a sureface for the conversion of precursor

compounds into vitamin D by the action of ultraviolet light. Like this there are so many

functions are being done by the skin.

The Structure of the skin: The skin is composed of two layers of distinctive structure,

properties and embryological origin.

The dermis or corium, a connective tissue layer of mesenchymal origin, which is

covered by the epidermis, and epithelial layer derived from embryonic ectoderm. Deep

to the dermis lies a superficial fascia, hypodermis or subcutaneous layer which inturn is

bound to the underlaying tissues by a dense fibrous deep fascia corresponding to the

epimysium of muscle blocks or periosteum or perichondrium of the bony or cartilaginous

surface.

The primary barrier to mechanical damage, desiccation and microbial invasion is

the epidermis, particularly the outer horny layers which are highly impermeable to water

and chemicals rather inert. The epidermis, moreover, has a high capacity of regeneration

after damage. The epidermis also generates the appendages of the skin, that is hairs,

nails, sudorific (sweat) and sebaceous glands.

The dermis, in contrast gives the skin considerable mechanical strength by virtue

of the high proportion of collagen fibers intermingled with fibres of elastin and in the

various cellular components, provides a reservoir of defensive and regenerative elements

capable of combating infection and repairing deep wounds.

The vascular supply of the epidermis is limited entirely to the dermis, and

therefore the epidermis relies for its supply of nutrients and metabolic exchange generally

on diffusion to and from the capillaries of the most superficial regions of the dermis.

Deep to the dermis lie the subcutaneous tissue layers of the superficial fascia.

The disease, yuvana pidaka is a disease of Roma Koopas. So it is worth to study

the structure of hairs which are the appendages of the skin. The appendages also include

nails and glands.

The hair are found on nearly every part of the surface of the body, but are absent

from the palms of the hands, the soles of the feet, the dossal surface of the distal

phalanges, the umbilicus the glans penis, the innersurface of the prepuce, Labia majora

and minora. They vary much in length, thickness & colour in different parts of the body

and in different races of mankind.

A hair consists of a root (Roma Koopa), the part of implanted in the skin and a

shaft (Scapus), the portion projecting from the surface.

The root (Radix) of the hair has a proximal enlargement, the bulb, which is set in

an invagination of the epidermis and superficial portion of the corium, called the hair

follicle. The hair follicle commences on the surface of the skin with a funner – shaped

opening, and passes inwards in an oblique or curved dilated at its deep extremity, where

it corresponds with the hair bulb. The ducts of one or more sebaceous glands open into

the follicle near the skin surface. At the bottom of the each hair follicle ther is a small

conical vascular eminence or papilla, similar in every respect to those found upon the

surface of the skin.

The hair follicle consists of two coats – an outer dermal and an inner epidermal

coats.

The growth of the hair occurs at the hair bulb where the cells capping the papilla

proliferate and form the germinal matrix of the hair. The duration of a single hair varies

form about four months (eye lashes, axillary hair) to about four years (scalp hair), after

which it is shed and is replaced by the sprouting of new cells from the germinal matrix

after a period of rest. Greying or whitening of hair is due to the collection of minute air

bubbles in the cortex (and sometimes in medulla also ) of the shaft and to loss of pigment

– melanin formation by cells in the germinal matrix.

Minute bundles of nonstriated muscular fibres, called arrectores pilorum are

connected with the hair follicles. These are responsible for Gooseskin when the fibres

are contracted due to the exposure to cold or in emotional reactions.

The sebaceous gland is situated in the angle which the arrector pili muscle forms

with the superficial portion of the hair follicle, and contraction of the muscle tus tends to

squeeze the sebaceous secretion out from the duct of the gland. The arrector pili muscles

are supplied by sympathetic nerves.

The Sebaceous glands are small, sacculated and lodged in the substance of the

dermis. They occur in most parts of the dermis, but are especially abundant in the scalp

and face; they are also very numerous around the apertures of the ear, nose, mouth, anus,

but are abscent in the palms and soles.

Each gland consists of a single duct, relatively capcious, which emerges from a

cluster of oval or piriform alveoli, usually from two to five, but in some instances as may

as twenty in number. Each alveolus is composed of a basement membrane, enclosing a

number of epithelial cells. The outer or marginal cells are small and polyhedral and

continous with the cells lining the duct. The remainder of the alveolus is filled with

larger cells containg fact, but in cavity filled with their debris and mass of fatty matter,

which contitute the Sebum cutaneum. As the sebaceous gland produce their secretion by

complete fatty degeneration of their central cells they are classed as holocrine glands. As

the central cells disintegrate, they are replaced by proliferation of marginal cells. The

ducts open most frequently into the hair follicles. But occasionally upon the general

surface, as in the labis minora, glands penis and the free margins of the lips. On the nose

and face the glands are of large size, distinctly lobulated, and often become much

enlarged from the accumulation of pent-up secretion. Sebum acts as a natural lubricant

of the hair and skin, protecting skin form the effects of moisture or desiccation and hairs

form becoming brittle; It is also has some bactericidal action. The secretory activity of

the sebaceous glands doesn’t appear to be under nervous control. It is stimulated by

hormonal action, particularly androgens.

Sweat glands or Sudoriferous glands occur in almost every part of the skin, and

have been classified into two types eccrine and apocrine glands.

Eccrine glands are numerous and almost found in every part of the skin. Each

consists of a single tube, the deep part of which is coiled into and oval or spherical part or

duct, traverses the dermis and epidermis and opens on the surface of the skin by an

infundibular aperture.

The size of the sweat glands varies. They are especially large in those regions

where the amount of perspiration is great, as in axilla & groins.

Their number varies. They are very plentiful on the plams of the hands and on the

soles of the feet.

Apocrine glands ocfure in the axilla, eyelids, areola and nipple of the breast.

They are larger than eccrine glands and produce a thicker secretion.

Eccrine sweat glands are concerned in the temperature control mechanism by

surface evaporation of the sweat. These are supplied by sympathetic nerves, though these

fibres are cholenergic in nature, and no sweating occurs in a denervated area of skin.

Rarely, sweat glands may be congenitally absent.

Apocrine glands are under dual autonomic control, but do not respond markedly

to temparature changes, so that strictly speaking they should not be classified under sweat

glands at all.

N I D A N A

(AETIOLOGY)

The potentiality of a factor to induce the mechanism of pathogenesis and termination into a status of disease is called as nidana. The whole process is meticulously managed by the said causative factor-Nidana involving all pathological elements. While treating diseases our classics gave the highest importance to nidana. They said avoiding the aetiological factors is the first and foremost thing to be adopted in the management of a disease. The knowledge of nidana (aetiology) helps to the great extent in the prevention of disease. The information regarding the exact nidana of yuvana pidak ais not available in the Ayurvedic literature. Every author included yuvana pidaka under kshudra rogas because the aetiology, pathogenesis and treatment are of minor importance. An attempt to search the setilogical factors of yuvana pidaka and a study of nidana is made here.

The information regarding the nidana of yuvana pidaka is indirect and scattered. According to madhukosha commentary on madhava Nidhana, yuvana pidaka occurs due to swabhava. Ref: Ma. Ni: 55/33. The recent studies in modern medicine also support the statement of Madhava Keera. It is told, that the importance of genetic factors in determining the susceptibility to acne was suggested. Ref: Hamilton J.B. et al (1964) J. Clini. Endocr. Metab: 23;267 A survey revealed the genetic factors play a role in the production, the clinical pattern, the distribution of the lesions and the duration of susceptibility. The mode of inheritance is unknown, but is assumed to be multifactorial. The association of very severe acne with the xyy syndome has been recorded.

Ref : Voorhaes J.J. et al (1972)

Archs. Derm: 105,913

Sushruta and Vagbhata said yuvana pidaka occurs due to yuvavastha which

indirectly refers to the factors or elements participate in the culmination of yuvavastha.

Yuvana pidaka occurs as a result of sukra dhatu mala.

Ref: sha. Sam. 1/5/14. It is supported by the deeper studies done in modern science. The androgens are responsible for the grown of person which are very essential during puberty and adolescence. The endocrine factors have very essential role to play in the production of acne. The research studies revealed that the acne doesn’t develop in castrates and overctomy before puberty or in ovarian agenesis. This reveals the factors i.e., androgens,

which are responsible for a person, during puberty and adolescence, have prime role to play. These are natural and essential and hence cann’t be avoided.

Ref : Hamilton J.B. 1941

J. clin. Endocr. Metab. I ,570

A study on premenstrual exacerbation of acne is not adequantely explained.

There is a steady decrease in sebum excretion during the first half of the menstrual cycle;

in luteal phase the excretion rate increases and to fall again premenstrually.

Ref : Burton J. C et al (1973) Derm –vener: 53-81. The yuvana pidaka is produced due to the vitiation of kapha and vata.

Ref : Su.Sam. Ni: 13/36 Ma.Ni: 55/33.

This is to understand that the nidana, is responsible for the vitiation of kapha as well as vata causes yuvana pidaka. Vagbhata says the medas encapsulated eruptions of face in youngsters are called as yuvana pidaka. Hence the medas play an important role in the formatio nof yuvana pidaka. Ref: Ast. Sang. Uttara 36/7 It is wise to consider her the nidana responsible for the vitiation of medodhatu. Medodhatu is vitiated by kapha prakopaka nidana. Yuvavastha itself is kapha kala and hence there are chances of vitiation of medas naturally also. Medovaha srotas which seats in medodhatu also vitiated due to medodusti. It is also necessary to consider the nidana responsible for medovaha srota dusti in the causation of yuvana pidaka. The modovaha stoats is vitiated by Avyaama, Divaswapana and excessive medya consuption (Fatty diet). Ref: Cha. Vi: 5/16 Her the kapha prakopaka ahara which is of Guru, Manda, Snigdha and Seeta in character, is considered along with medya ahara as nidama of yuvana pidaka. The role of dietary factors in acne are convinced of their importance. And believe that in some individuals certain fats-notable chocolates, seets, Nuts, meat and perhaps, cheese and highly seasoned foods will provoke exacerbations. In a invertigation it has been show to increase the sebum production in obese subjects. Ref: Hagerman. G. (1967)

Derm. Wschr. 153,13. The participation of vayu in the productionof yuvana pidaka comes next to kapha. The vayu and kapha are vitiated by Seeta guna of the dravya or climate. The studies in modern science also say that in temperate climates acne is usually at its worst during the colder months of the year.

The vata also is vitiated by Fret, Anger, etc.

Ref: ma. Ni: 21/1 These factors come under psychological factors. Critical and objective evaluation suggests that emotional stress plays a minor role in the pathogenesis of acne in general \, but in many cases exacerbations of existing lesions can be convincingly related to stressful episodes.

Ref: Lucas. C. J. (1961)

Br. Med. J. ii 354

Yuvana pidak occurs as a complication to Nasya Karma also. When the person talks loudly, laughs loudly, goes out in cold climate etc., immediately after the procedure. Probable the Nasya karma induces a change in the circulatory mechanism related to the face. The abrupt change associated with prohitary action may create a pathological sequece in the production of yuvana pidaka. Even it could induce a reverse mechanism of beaking down the pathogenesis when followed according to the rules and regulations of the Nasya procedure. According to Sushruta the disease ocfurs due to the vitiation of Rakta along with kapha and vayu. Ref: Su. Sam. Ni: 13/36. Her Rakta dhatu is vitiated either by kapha or vata. Sometimes the Rakta dhatu is vitiated by Raktaja krimis alone resulting in the production of yuvana pidaka. This statement is supported in modern science also. Corynebacterium acne and staphalococcus epidermis are very regularly present in acne lesions. The bacteria play a role in causing inflammation resulting pain and in complicating the lesions.

Ref: Marple. R. R et al. ( 1974)

J. invest. Derm. 62,326.

Sebaceous gland activity also plays a role in the production of acne. By taking the above aetiology into consideration it can be classified under six groups.

1. Swabhava 2. Age factors 3. Dietic factors 4. Extra –dietic factors 5. Psychological factors 6. Complication of Nasya karma

SAMPRAPTI (PATHOGENESIS) Due to the said Nidana the kapha and Vata are vitiated. The vitiated doshas causes agnimandhya and lead to ajeerna at respective leverls of dhatus and bhootagni. As a result Ama related to dosha and dooshya is produced The vitiated vata also causes shaithilyata of Roma koopas. Here the climate and psychological factors cause shaithilyata due to the frequent contraction and relaxation of erector pilorum muscles which attached to the Roma koop. As the Roma Koopas are the final ending points of all dhamaness and as they are minute the shaithilyata occurs first at this level.

The increased kapha vitiates medodhatu and Raktadhatu. The medovaha srotas also is vitiated by its own nidana or due to the vitaiated meda. These vitiated doshas enter into the Rasayanees and travel all over the body. Sanchari doshas, in the process of population move towards Shaithilyatwa of twakgata Roma kupas and get lodged there. This process is called as Schana samshraya and exhibits poorva roopas. But in this process the doshas and dooshyas are of low intensity and so the manifestation of the prodromal symptoms is negligiable and exhibits poorva roopas. But in this process the doshas and dushyas are of low intensity and so the manifestation of the prodromal symptoms is negligible and may not be noticed by the subject also. The lodged doshas at Roma koopas causes pidaka. This stage is called vyakti in which the signs and symptoms are exhibited through which it is diagnosed as yuvana pidaka. According to modern science the pathogenesis and histopathology of acne is explained as follows. The earliest detechable change is keratinization of the duct of the Sebaceous gland. In the beard area, where the pilosebaceous canal is divided into two channels, the sebaceous channel fills with keratin. On the trunk, where the pilosebaceous canal has a single channel the keratin appears as a peripilar sheath. An inflammatory infiltrate forms in the dermis at the level of the sebaceous duct, and an abscess may develop within the lumen of the follicle. The neck of the follicle becomes distended and may rupture to the surface or into the dermis, where the sebum and keratin produce a severe inflammatory reaction which may destroy the lower part of the follicle, leaving a blind sac containing horny material, in which further inflammatory changes are unusual. Bacterial activity plays a part in enhancing the inflammatory Changes. The pilosebaceous follicle is commonly obstructed by inspissated material consisting of lipid and keratin, the degree of obstruction bearing some relationship to the severity of the acne. The studies revealed the level of sebum production is higher in acne subjects than in controls. The horny plug obstructing the upper follicle projects as a comedo or the obstruction may be below the visible level. Retention of sebum and inflammatory changes combine to produce an oedematous paple or pustule.

Ref: 1. Text book of Dermatology by Sir Arthur Rook 2. Holmes R.L. et. Al (1972) by br. J. Derm 87,143 3. Pochi. P.E. & strauss J.S. (1967) Archs. Derm. 95,47

Samprapti Ghataka Vivechana 1. Doshas : Kapha and vata

2. Dushyas : Twak(Rasa), Raktha and Medas

3. Agni and Ama : Jataragni and dhatwagni Jaya Ama

4. Srotas : Medo vaha srotas

5. Dusti Prakara : Sanga

6. Udbhava sthana : Amashaya

7. Roga marga : Bahya

8. Adhistana : Twak gata Roma Koopas

9. Sanchara Sthana : Throught the body

10. Vyakta sthana : Mukha

POORVA ROOPA AND ROOPA

(SYMPTOMATOLOGY)

Symptomatology of particular disease helps in the diagnosis of the disease. Symptomatology includes objective and subjective features called as signs and symptoms. Acharya Sushruta explaind the igns of the disease where as Vagbhata explained the signs as well as symptoms of the disease to some extent. Yuvana pidaka is a disease of young people. So the age factor, here, also plays an important role in the diagnosis of the disease along with signs and symptoms of the disease. Pidaka of youngsters’ face in the shape of shalmali kantaka (spines of Indian red silk tree) is called as yuvana pidaka which disfigures the face and so called Mukha dooshika.

Ref : Su.Ni: 13/36

Vagbhata explained the same as Sushruta. But he added a little more information apart form Sushruta’s details. The pidaka contains encapsulated medas in it which is explained as sebum by modern science and these pidaka are solid in nature and gives slight pain.

Ref: Ast. Snag. Uttara 36/7. The other authors followed Sushruta’s statements only.

Acne vulgaris is a disease of inflammation of pilosebaceous gland. The characteristic lesions of acne are comedo, a dark horny follicular plug; small papules with or without the evident of inflammatory changes; pustules which may surmount papules or develop independently, superficially placed at follicular orifices; and nodules, which may exceed 2 cm. In diameter and may slowly resolve or break down and discharge. True acne occurs only on the face and neck, on the upper arms and on the trunk to the level of waist. The periorbital skin is never involved. The earliest lesion occurs on the forehead or chin or in the nasolobial furrow.

The exact distribution of acne in every person is poorly explained. SYMPTOMATOLOGY OF YUVANA PIDAKA

S.no

Laxanas

Cha

raka

Sus

hrut

a

Vag

bhat

a

Mad

ava

Nid

ana

Bha

va

Pra

kash

a

Sha

rngi

ha

ra s

amhi

ta

1. Shalmalikantaka Sadhrusha - + + + + +

2. Medas encapsulated Pidaka - - + - - -

3. Sarujah - - + - - -

4. Ghanah - - + - - -

5. Occurs on the face - + + + + +

6. Occurs in Yuvavastha - + + + + +

7. Mukhadooshika - + + + + +

SAPEKSHA NIDANA

(DIFFERENTIAL DIAGNOSIS)

Yuvana pidaka is one of the diseases where pidaka is the prominent feature. And hence the differential diagnosis is necessary in the diagnosis of the disease without which the treatment becomes aimless.

Pidaka, as one of the lakshanas, occurs in the following diseases. 1. Yuvana pidaka 2. Prameha pidakas 3. yava Prakyeya 4. Antralagi 5. aParimandala 6. Katchoo and aPama 7. Valmeeka 8. Visrpa 9. Kaksha 10. Gardhabhika 11. pashana Gardhabha 12. Jala Gardhabha 13. Gandha 14. Kusta 15. Agnirohini 16. Spota.

But in the diagnosis of the yuvana pidaka, the shape, contents and place of pidaka take the prime role. In yuvana pidaka the pidakas are in the shape of shalmali kantaka, which is an unique feature of the yuvana pidaka. And the another special feature of the yuvana pidaka. And the another special feature of pidaka in yuvana pidaka is containing medas inside. These features of pidaka are not found in other pidakas. Pidakas can occur on any part of the body. But in the case of Yuvana pidaka it occurs chiefly on the face and only in Yuvavastha.

Ref: Ma. Ni. 55/33 Madhukosha Commentary

The pidaka of yuvana pidaka causes slight pain and the pidaka are solid in consistency. All the above said features together are absent in all the other pidakas. Apart from that there are different features which are typical to the pidakas and also they are associated with different conditions of disease. Therefore yuvana pidaka can be differentiated by its typical presentation only.

UPADRAVA AND SADHYASADHYATA

(COMPLICAITONS AND PROGNOSIS)

Yuvan pidaka is a kshudra roga in which the aetiologyl, pathogenesis and treatment are of minor significance. And hence the complications of yuvana pidaka are not delt in classics. Yuvana pidaka is also tarmed as Mukha dooshika (which disfigures the face). This is due to the formation of scars which is a complication of Acne. Acne atrophica and acne hypertraphca are the two stages of acne vulgaris, where the former leaves no scars and the later leaves scars. Ancne hypertrophica will be the lattercondition of acne atrophica if not treated properly during its course.

Acne may become an abscess if secondary infection is associated. The prognosis of yuvana pidaka is indirectly explained.

According to Charaka, a disease can be easily curble if it occurs in young sters with less symptomatology and naturally.

Ref : Cha. Su. 10/11. The Yuvana pidaka occurs neither in balyavastha nor in vrudhavastha. It occurs in yuvavastha only. The signs and symptoms, aetiology are being very less, the yuvana pidaka is included under kshudra rogas. Yuvana pidaka occurs naturally during yuvanavastha.

All these statements make up to declare that the yuvana pidaka is sukha Sadhya. CHIKITSA VIVECHANA

(PRINCIPLES OF MANAGEMENT)

According to Charaka, the principles of management is classified under three headings. 1. Daiva Vyapashraya 2. Satvavajaya and 3. Yukti Vyapashraya

There are no references regarding Daiva Vyapashraya and Satvavajaya Chiktsas to Yuvana pidaka. The Yojana of Oushadha, adhara and vihara according to disease is called yukti vyapashraya chikitsa. This can be again classified into three groups.

1. Antahparimarjana 2. Bahiparimarjana and 3. Shastrapranidhana

Antahparimarjana includes the administration of internal medication of eliminate the morbid factors. Even panchakarma procedure come under this group. In Ayurvedic literate the shamanoushadis for the treatment of yuvana pidaka are mentioned in the form of mukha lepa. Vamana and Nasya Karma are told as the panchakarma procedures in the treatment of yuvan pidak, which come under Anahparimarjana chikitsa. Bahiparimarjana includes snehana, swedana, abhyanga, parishek, pitau, sirobastic, lepa, anjana etc.

In the treatment of yuvana pidaka mukalepas, Abhyanga, are explained. Ref: Y.R. : Kshudra roga chikitsa

Among the bahiparimarjana chikitsas mentioned the mukha lepas takes the important place. All the authors mentioned mukha lepas in detail in the treatment of yuvana pidaka. In modern science also the external applications in the treatment of acne vulgaris play a prime role and the internal medication is of minor importance unless it is complicated with secondary infection. Shastrapranidhana chikitsa comprises of various surgical measures. In the treatment of yuvana pidaka siravyadha in lalata pradesha is mentioned which comes under this group. In modern science the removal of contents from the cystic acne is advised which comes under this group.

Some of the much lepas mentioned in our taxts are given here under. 1. Vacha, Lodhra, Dhanyaka in equal quatities with milk.

Ref: Su.Sam. Chi : 20/37

B.P. Madhyama khanda: 61/34 Sha. Sam. 11/11 Y.R Kshudra rogadhyaya: Chakradatta 55/42

2. Kustumburu + Vacha + Lodhra + Kusta with milk Ref: Su. Sam. Chi 20/37

3. Vacha + Lodhra + Saidhava Lavana with water or milk. Ref: Su. Sam. Chi.: 20/37

Ast, Hr. Uttara 32/3 BP 61/35 Ast. Sang. Uttara 37/5 Sha. Sam 11/11

4. Vata Patra + Narikela Majjeerasa (milk like extraction prepared by grinding and squeezing the endocarp of fresh coconut) Ref: Ast. Hr. 32/3

Ast. Sang. Uttara: 37/5 5. Vacha + Lodhra + Dhaniya + Gorochana + Mareecha with water ( Anukta

paribhasha) Ref: BP Madhyama khand 61/34

Sha. Sam. 11/11 Y.R. Kshudra Rogadhyaya C.D, 55/42

6. Shalmali Kantaka Choorna with mailk Ref: Bp 61/36, Madhyama Khanda.

Y.R :ksh. Adhy. 7. Matulunga + Vata Patra + Sarpi + Shilajit with Goshakrut rasa.

Ref: Sha. Sam. 11/10

Y.R. : Ksh. Aday 8. Arkaksheera + Haridhra, after mardhana is advised as mukha lepa.

Ref: Sha: sam. 11/13

Y.R. : Ksh. Adhy 9. Jateephala + Chandana + Mareecha with water (Anukta paribhasha)

Ref: Y.R. Ksh. Adhy.

Slno. Of

Mukha

Lepa

Su.sam Ast.Hr Ast.Sang B.P Sha.sam Y.R C.D

1. + - - + + + +

2. + - - - - - -

3. + + + + + - -

4. - + + - - - -

5. - - - + + - +

6. - - - + - + -

7. - - - - + + -

8. - - - - + + -

9. - - - - - + -

Table Showing the Treatment of yuvana Pidaka mentioned by different Texts

Cha

.sam

Su.

sam

Ast

.Hr

Ast

. San

B.P

Sha

.Sam

Y.R

C.D

B.R

1. Mukha Lepa - + + + + + + + +

2. Vamana - + + + - - - + -

3. Nasya karma - - + + - - - - -

4. Abhyanga - - - - - - + + -

5. Siravyadha - - + - - - + + -

PATHYAPATHYA

(DIET AND REGIMEN)

Pathyapathya should be followed according to the dosha, dooshya and avastha of the diseases.

Ref: R. Kshudra roga Chikitsa. In yuvana pidaka the nidana which is discussed should be avoided, as general rule. In yuvana pidaka kapha prakopaka ahara & vihara is always better to avoid. With all considerations of Nidana Samprapti and Chickitsa the following list of pathyapathyas can be considered. Pathyas

Ahara : Purana shastika shali, Godhuma, Tikta shakas like patola, Nimba

etc., Dhanyaka, Mareecha, Hingu, Lasuna, All green vegetables &

Carrots

Vihara (Extra dietetics): Normal exercises

exposure to evening sun-light, washing the face regularly with

tepid water.

Apathyas

Ahara (Dietetics) : Madhura Rasa padarthas (Sweats especially chocolates, nuts) Medya padarthas (Fats and fatty acids, meat, oils etc.) Dhadhi, ice creams. Vihara

: Divaswapana Avyayama Using greasy cosmetics Squeezing the lesions.

DISCUSSION The observations made in this study for the sake of discussion are based on:

1. Complete case history of the patient. 2. The incidence of associated signs and symptoms and their response to the

management. 3. Improvement in the regression and recurrence of yuvana pidaka recorded by the

careful general observation and examination of the patients. 4. Case study made in the previous chapter in the form of tables.

Age:

Yuvana pidaka, its maximum incidence was found in the age group of 16-20. 20 patients out of 35 were in this group. 8patients each from the age groups of 21-25 and 7 patients from the age group of 26-30. Yuvana pidaka is considered as a disease of young people. In the observation the patients were seen between the age group of 16-35. As per the “table showing the age of the patients and their first occurrence of Yuvana pidaka”, the statistics reveal the first incidence was observed between the 18-23 years of age. The total number of cases were 43 out of 54 in the group. 3 cases coming within 18 years of age included 1 case at the age of 16 and 2 cases at the age of 17. The remaining 8 cases were between 24-30 year of age. This clearly speaks yuvana pidaka occurs more in the early part of yuvavastha. Nindana:

“The table showing the incidence of nidana in yuvana pidaka patients” reveal the presence of yuvavastha in all the cases. Atimedya Bhakshana was divided into two groups, one for vegitarian food habit patients and two for non-vegitarian food habit patients. 20 patients out of 35 wre found that they were habituated in eating more sweets. 24 more fatty diet. Avyayama was found in 17 patients out 35 and Divaswapana in 15 patients. Psychological factor and premenstrual exacerbations in female patients were also considerable. The combination of all types of Nidana was found in some patients who came with severe Yuvana pidaka. The incidence of yuvan pidaka was high in Non-vegitarians than, in vegetarians. This probably due to the non-vegitarians who consume moe of fatty food, i.e Medya Ahara. Sex:

Considering the “table showing the sex incidence of yuvana pidaka” 22 patients were males and 13 patients were females. Yuvana pidaka was observed in both the sexes almost in equal percentage i.e., 53.7% of males and 46.3% of females. There is no sex difference in the incidence of yuvana pidaka. But during observation of the patients it was found the more severe form of yuvana pidaka was found in males.

Results: There was 35 cases out of which cured were 12 34-28, improved were 20 57-14 and not – improved were 38.57 The percentage speaks by itself that the Mukha lepa combined with internal modification provides grater cure and appreciable improvement. A prolong use of both internal and external medication will be very effective. Considering the duration of illness, cases falling within 3 years of duration could be managed easily as such in group- ‘B’. 13 cases had a duration of only 1 year, Even the improvement in this group in seen in the same duration. Cases which had duration of more than 3 years had a picture of improvement only. This is due to the effect of combined therapy, which again speaks of the effectiveness of the therapy.

If the duration is less the therapy will be more effective.

MATERIAL AND METHODS Criteria for selection of the patients: For the purpose of study and clinical trials 35 patients diagnosed as yuvana pidaka were selected from OPD of Sri DGM Ayurveda medical College & P.G center the patents were selected on random basis irrespective of their age, sex, caste, duration of the complaints, food habits and occupation. All the care fulfilled the diagnostics parameters. Criteria for the diagnosis of the disease Patients who complained pidaka (eruptions) over face, neck and back in yuvartha were diagnostic as yuvana pidaka. Criteria for the selection to of the drug Most of the Ayurvadic clinics gave muc importance to mukha lepa. The Mukha lepa is prepared by mixing Ththiphzla, Manicha and Rakhaethdna and made into cream bore. Internal medication in prepared by making power of Niba twak, twaksara, Beeja, Prtra Pushphs, Tnikatn, triphala, anidra and ayurveda. This chorma is made into copsyle of 500mg. Criteria for usage of medicine:

Internal medicine : the Dose advisal in 29m I day. External: The parents be applied on the overweight and wasted in the moving Duration of the Treatment The Duration of the broatment in 21 days and trelowap of 1 month. The results were asured of the 1 month no interval was advised during their period.

Creteria for the annecment of the treatment Diagnosis of the disease was made according to symptomatology of the diasese And hence the same was taken for the asserment of the rg. Doubt 68 The results of the treatment, after months were assessed in terms of cured, improved and not improved. Cured: Complete relief form the signs and symptoms during the treatment and non-recurrence of the diseases is considered as cured. Improved: Complete relief from the signs and symptoms during the treatment and recurrence after stopping the treatment. Not – improved: Continuation of signs and symptoms or slight improvement with recurrence as before treatment, is considered as not-improved. General Rules: 1. The dosage of internal medication was altered according to the severity of the disease and age of the patients. 2. The duration available for the study was only tow years and hence recurrence criteria is limited within the period.

CASSIA FISTULA, LINN.

Sans – Nripadruma Arahbhada; Arakvadam; Rajavraksha; Suvarnaka. Eng. – Indian laburnum; pudding Pipe tree; Purging Cassia. Hind.- Sonhali; Amulthu. Gwalior & Duk – Amaltas; Girmalah; Kirvali. Ben. – Bundarlati; Sanalu; Soondali; Sondal. Guj. – Garmala. Mah – Bahava. Tel- Kondrakay; Rachlachettu; Aragvadhmu; Koelapenna; Relagujju. Tam.-Konai; Irjviruttam; Konraikkai; Sarakkonnai or Sarokkonnoi. Mal.-Konna. Con.-Kakkaemara. Kon.-Kakkayi. Sinb- Ahalla. Arab.-Kahayar-shambar.

Habitat.- common throughout India and Burma. Part Used.- Pulp. Rot-bark, flowers, pods, leaves and root. Constituents.- By steam – distilling the finely powdered fruit, a dark-yellow volatile oil with honey-like odour is obtained. Water which distils over with the oil contains normal butyric acid. Pulp consists of suga, gum, astringent matter, gltem, colouring matter and water. Action.- Pulp. Root-bark, seeds and leaves posses purgative properties. Root acts as purgative tonic and febrifuge. Fruit is cathartic. Action & uses in Ayurveda .- Madura rasam, seetha veeryam, pitta, pitta-haram, guru , mild laxative, in jwaram, diseases of the heart, raktapittam, udhardham, soolam. Uses.-Pulp of pods is an agreeable laxative, safe for children and pregnant women. It is best used combined with other purgatives as a confection or electuary as by itself it reauires to be taken in dient in the confection of senna. Cassia pulp is also employed in the essence of coffee. A confection of the pulp in 2 to 4 drachm doses is a mild purgative producing I or 2 soft motions; and is given in cases of diabetes, Gulkband of which it forms an ingredient is a cooling laxative especially for delicate women; dose is half an ounce with warm milk taken at bed time. Externally the pulp is considered to be a good application for gout, rheumatism, snake bite, etc, The pulp of the ripe pod mixed with tamarind pulp taken at bed time acts on the bowels mildly causing one or two soft motions the following morning. In the flatulent colic of children it is commonly applied round the pavel to produce motions. Flowers in docoction are given in stomach affections. Externally the leaves ground into a paste are applied to ringworm; bark and leaves mixed and rubbed with oil are applied to pustules, rigworm, chilblains, insect bites, facial paralysis and rheumatism. From 5 to 7 of the powdered seeds are prescribed as an emetic. Root is useful in fever, hear-diseases. Retained excreations, biliousness etc.

CURCUMA LONGA, LINN.

Sans.- Rajani; Gauri; Varnavat; haridna; Nisha. Eng.-Saffron; Turmeric. Hind., Duk. & Punj.- Haldi. Kash.- Lindar. Ben.-halud. Mab. & Kon. – Guj.-Halder; Halada. Panj.- halja. Pers.-Serd Chubah; Zard-chobah; Daraserda. Arab.-Zirsud; Uruk-es-suff; Kurkum. Tel.-Pasupu; haridra. Tam. & mal.-majal. Can.-haldi, Arasina. Sinb.-Haradul; Khaka. Burm.-Tanum, Malaya.- kooneit. Fr.-Curvcuma long. Habitat.- Extensively cultivated all over India. In Bombay presidency there are two varieties (i) with hard rich-coloured oval rhizomes, chiefly used in dyeing, known as ‘lakhandi balad’; and the other with softer, larger, lighter-coloured long rhizomes which are usually used for eating.

Parts Used.-An essential oil I P.c. resin, an alkaloid, cur-cumin-the yellow

colouring matter, turmeric oil or turmerol. Turmeric oil is a thick, yellow, viscid oil.

Curry powder owes its aromatic taste and smell to this oil. “Turmeric Oil obtained by

distilling in steam turmeric grown in the Chittoor district of Madras Presidency was

examine. The yield of the oil obtained was 5.8%. turmeric oil though examined several

times since 1868, the constituents recorded in literature were: - d-a phellandrene and an

alcohol called turmerol of formaula CI3HI80 or CI4H2o0. A Systematic examination of

the oil the revealed that the oil did not contain any phenols, aldehydes or ketones.

Caproic acid C6Hio02 (o.I%) was fond to be present as free acid while valeric C5Hio02

(O.I%) as a combined acid. The oil was distilled at 20m.m into various fractions ranging

between 700 to I800 C. The lower fractions contained d-sabinene CroHI6 (2,o%),d-a-

phellandrene CroHI6 (4%), Cineol CroHI8o (3.0%) and d-Borneol CrohI7OH (2.5%).

The middle fractions were sesquiterpene hydrocarbons mainly zingiberene

Cr5H24 (30.5%) while the higher fractions were mixtures of the sesquiterpene

hydrocarbon and sesquiterpene alchol CI5H260 (50.5%). Considerable changes in

optical rotations in the fractions of the whole oil were observed form time to time.”

Formation of Curcumone form Turmerol:-

A sesquiterpene alcohol Cr5H260 has been isolated and purified. The pure alcohol has the following constants: Boiling point I63.40/II m.m., d 300 0.9506; and n 300 I 5I5I. Turmerol is a monocyclic tertiary sesquiterpene alcohol of formala CI5H260. The body to which the formula CI3HI280 or CI4H200 was assigned might have been a mixture of the alcohol CI5H260 and the hydrocarbon CI5H24. Rupe in 1909 found that the fractin 1580.I62/II m.m on treatment with alkali yielded a ketone-curcumone CI3HI80 which formula was later modified by him as Cr2Hr60 . Its structure as 2-methyl-2-p-toyl-methyl ethyl ketone CH3C6H4 CH(CH3). CH2C0.CH3 was finally confirmed by Rupe’s synthesis in 1924. It has been shown that the original oil does not contain the ketone but it is formed by the action of alkali on the alcoholic constituent”turmerol” CI5H260. Turmerol on dehydrogenation with sulper and selenium gave neither cadalin nor eudalin. During catalytic reduction with platinum black and hydrogen, termerod was converted into a saturated alcohol CI5H3o0 showing the presence of two double bonds. The alcohol onoxidatin with dilute nitric acid yielded p-tluic.p-toluic, terephthalic and oxale acids. On oxidation with aqueous KMn04 as well as with powdered KMn04 in acetone solution, turmerol gave an acid of melting point 420-430, equivalent 178 and molecular formula CIIHI402 perhaps identical with the acid obtained by Rupe by oxidation of curcumone. Curcumic acid CIIHI402 melting at 420-430 has the structural formula as p-methyl-

3methyl-hydrocinnamic acid CH3C6H4CH (CH3). CH2COOH. (N.C. Kelkar, Indian Institute of Science, Bangalore). Action: - Aromatic, stimulant, tonic and carminative. Internaliy juice is anthelmintic. Action & Uses in Ayurveda :- katu tikta rasam, veeryam, ruksham, varnyam, in prameham, pandu, rakta-dosham, krimi, vranam, pinasam. (Therapeutic Notes).

Preparations.-powder, Paste Ointment, Oil Lotion, inhalant and Confection. Uses.- Rbizomas are boiled dried and made into powder, which gives a yhellow colour and which is employed largely as a colouring ‘agent and as condiment entering largely into the composition of Indian pickles and curry powders. Juice of the fresh rhizome is applied to recent wounds, bruises and leech-bites. Internally it is used as an anthelmintic. Root is usefully administered in intermittent fevers. In doses of 15 to 20 grains twice a day it is given for flatulence, dyspepsia and weak state of the stomach; it is used both externally and internally in skin diseases due to impurity of the blood. A paste of turmeric and the leaves of justicia adhatoda with cow’s urine is rubbed on the skin in prurigo (Chakradatta). Several other combinations of the sort are in vogue, such as turmeric and nim leaves, turmeric and the ashes of the plantain tree, etc. Turmeric is also given internally with cow’s urine in prurigo and eczema. Mixed with gingelly oil it is applied to the body to prevent skin eruptions. Turmeric paste mixed with a little lime and saltpeter and applied hot is a popular application to sprains, bruises, wounds, and inflammatory troubles of the joints. In small-pox and chken-pox a coating of turmeric powder or thin paste is applied to facilitate he process of scabbing, and decation of turmeric (I ounce of the bruised noot to 20 ounces of water) is applied as a lotion to relieve the burning in catarrhal and purulent opthalmia popularly known as “country sore eye”, and conjunctivitis. A piece of rag soaked in it, and kept constantly over the affected eye relieves the burning and moderates the urgency of the symptom. Its powder is sprinkled on ulcers to stimulate them to healthy action. “ Tubers sold in the market for dietary purposes are boiled, and are on no account used for dyeing. Turmeric for dyeing is sold separately and Indian women use it to smear their hands and faces with, and is called in Tamil ‘Kappumanjal’ – Manual of jail Industries (1931, Madras). Ghee mixed with powdered turmeric, is given to relieve cough. A paste of turmuric alone or combined with the pulp of neem leaves is used in ringworm, obstinate itching, eczema and other parasitic skin diseases. In piles an ointment made of turmeric, hemp leaves, onions, and warm mustard or linseed oil gives great relief when the piles are painful and protruding also effective in eczema. Itches, etc. In pemphigus and shingles, the part first smeared with a thick coating of mustard oil and then dusted on with turmeric powder is cured with 3 or 4 days. In catarrh and coryza the inbalation of the fumes of the burning turmeric from the nostrils causes a copious mucous discharge and gives instant relief; the fumes are also used to relieve hysterical fits. The inhalation is taken at night and no fluid is allowed for some hours afterwards. Smoke produced by sprinkling powdered turmeric over burnt charcoal will relieve scorpion sting when the part affected is exposed to the smoke for a few minutes. Turmuric and alum powder in the proportion of 1 to 20 is blown into the ear n chronic otorrhoea. With borax as pate it is applied to reduce indolent swellings. It is given in urinary diseases. Milk boiled with turmeric rhizome added to it, and then sweetened with sugar is a popular remedy for cold. Internally turmeric is given in affections of the liver and in jaundice. Following powder is a good digestive:-Take of turmeric, long pepper, ginger, Cardamoms, ten grains each in powder and black pepper

powder five grins. Mix well and make and compound powder. Following confection is highly recommended in obstinate skin complaints. – Haridrakbanda.-Take or turmeric 64 tolas, clacified butter 48 tolas, milk 16 seers; sugar 12 tolas and boil them together over a gentle fire in an earthern pot. Then add black pepper, long pepper, ginger, cinnamon, cardamom, tejapatra, baberang seeds, root of Ipomea, Turpethum, the three myrobalans, flowers of Mesua ferea, tubers of Cyperus rotundas and prepared iron, each 8 tols in fine powder and prepare a confection. Dose:-one tola every morning in praurigo, boils urticaria and chronic skin eruptions-(Bhaishajyratnavali). A cure is effected in 7 days . Tests-Good turmeric should be of a reddish orange apperarance when broken or cut in two and should also have a moist feeling. MELIA AZADIRACHTA See Azadirachta Indica. (N.O:- Melianceae) Sans.-Ravipriy; Vembaka; Vranashodhakari; Nimba; Arishta; Pichumanthah. Eng.-Neem or magrosa Tree; Indian Lilac. Fr.-Azadirae d’Inde; Margousier. Ger.-IndischerZedrach. Hind., Duk., Punj.&Ben.-Nim or Nimb; Nimga-chh. Guj.-Libma. Mah.-Kadhunimba. Bom.-Nim; Balnimb; Tel.-vepa. Kahibevu. Kon.-Beva-rooku. Pers.-Neem. Sinh.-Kohumba. Burm.-Tamabin; Kamakha. Malay.-Dawoon Nambu; Baypay.

Habitat.-Indigenous to and cultivated nearly all over India and in Burma. Parts used:- Every par of the plant-bark, root-bark, young fruit, nut or seed, flowers, leaves gum and toddy or sap. “Bark and leaves are of particular interest form medicinal pints of view”. Constituents.- “The bark exudes a clean bright ambercoloured gum which is collected in small tears or fragments. It contains a bitter alkaloid named “margosine” in long white needles, as a double salt of margosine and soda-a neutral, amorphous resin believed to reside in the inner bark or liber. Leaves contain a small quantity of bitter substances of similar character but much more soluble in water. This substances also contained in the bark is a hydrate of the resin which it closely resembles in its properties. Seeds contain about 10 to 31 p.c. of a yellow bitter fixe oil which is extracted by boiling or by pressure. “The oil is deep yellow in colour and has a 0.9235 at 15.50 c ; at about 100 to 70C, if congealed without losing its transparency; the oil contained free and volatile fatty acids. After standing for about 36 hours, the freshly expressed oil deposited a white sediment which on microscopical examination was found to be amorphous in character. The colour reactions of the margosa oil were not characteristic. The volatile fatty acids probably consist of a mixture of stearic and oleic acids with a small amount of lauric acid. Action & Uses in Ayurveda .- Tikta rasam, katu vipakam, seetha veeryam, pitta kapha haram, lagu, grahi, in srameam, trishna, kasam, jwaram, aruchi, krimi, vranam, chardhi, kushtam, premeham. Leaves: In krimi, pitam, visham, arochakam, kushtam. Fruits:-Bedhanam, snigdam, ushana veeryam, lagu, in kushtam, gumam, arsa, krimi, premeham, and in chronic fevers.- (Therapeutic Notes).

EMBLICA OFFICINALIS. See Phyllanthus emblica. (NO.- Euphorbiaceae) sans.-Dhatri-phala; Amraphalam; Amalakam; Sriphalam; Amalaki; Vayastha. Eng.-Embic Myrobalam; Indian gooseberry. Ger.-gebrauchlicher, Amlabaum. Fr.-Phyllanthe Embic, Hind- amla; Aoula; Aura; Amlika; Anvurab. Bom.-Amla; Avalkati. Ben.-Amlaki; Amla. Mab. & Gwalior.-Avla; (Seed) Avalkati. Te,.-Neli; Usrikeyi; Amalakamu; Usiri. Tam.-Toppi; Nellikkai. Mal.& can.-Nellikai. Sinb.-nelli; Nelika. Biirm.-zip. Ambala; Amla. Kash.-Aonla. Arab.-Amlaj. Pers- Amla; Amulh; Amial. Assam. Amluki. Nepal.- amla. U.p.- Amla; asula. Uriya.- Amlaki. Santal.-meral.

Habitat.- The deccan, the sea-cot districts and Kashmir. Parts Used.- Dried fruit, the nut or seed, leaves, root, bark and flowers. Ripe fruit used generally fresh, dry also used. Action. – Fresh fruit is refrigerant, diuretic and laxative. Green fruit is exceedingly acid. Fruit is also carminative and stomzchic. Dried fruit is sour and astringent. Flowers are cooling and aperient. Bark is astringent. Action & Uses in Ayurveda .- Resa, all except lavana, kashayam dominate, seetha veeryam, mathura vipakam, tridosha, haram, rasayanam, increases sukram. (Therapeutic Notes). Indications.- Rakta-pittam, pramcham, vata-raktam, giddiness, vertigo. External use:- In mental disorders as paste and tailam to head. Tara-dravam. (Therapeutic Notes). Preparations.- Decoction and infusion of leaves and seeds; a liquor, a fixed and an essential oil; confection; powder; paste and pickles. An astringent extract equal to catechu is prepared form the root by decoction and evaporation.

TERMINALIA BELERICA. Roxb.

(No.:- Coberaceae)

Sans. – vibhitaka; vibhitaki; vipitakaha; Anilaghnaka; Aksh; bahira; Karshapalah; kaligrvamah; Bhata-vasah. Eng. – Beleric myrobalas. Hind.-Bhaira; Bahera; Bhera; sagona; Bharla; Buhura. Ben.-bohera; baheri; Bhairah; Buhuru; boyra. Punj.-Bahira; Bahera; Birha; Bayran. Bom.-Behara; Behaira; Behada; Behds; bherdha; Balra; bahuda; Yella; Gting; Yel; Behda; Bherdha; Mah.- bherda; Bacheda; Bahera; Sagwan; Beda; yehcla behada. Guj.-berag. Tam.-Tani; Tani; Kattu-elupay; Tanrk-kay; Tandi-tonda; Chattau-elup; Tamkai; Vallaimurdu; Tanioi; Tankrikkai. Tel.-Tani; Tandi; Tandhikaya; Thandra; Thana; tadi; Kattu-olupoe, Tandrakaya; bahadraha Mal.-Tennikai; Tanni. Cun.-Tankrikai; Tari; Shanti-marakon.- Goting. Arab.- baleela.

Hbitat.- A tree common in Indian forests and plins” Parts Used – Fruits.

Constituents.-Beleric myrobalans consist of gallo-tannie acid, colouring matter. Resins, and a greenish yellow oil 25p.c

Action.-Astringet. Tonic, expectors and laxative.

Action & Uses in Ayurveda .- Rasam, kashayam, mathura vipaka, ‘ishna veeruyam, pitta kapha haram, good for vision, hair. Internally for kasam, krimi, swarbhan-gam, asmari. Externally antiseptic, lotion, Paste for pitta swellings, eye diseases.- ( Therapeutic Notes). TERMINALIA CHEBULA.Retz., T reticulata. (N.O :- Combretaceae). Sans.-Pathya; suddha; Bhisnak-priya: haritaki; Abhaya; Vayastha; Amritha; haimayathi; Vijaya; Jivanthi. Eng.-Myrobalam. Chebulic Myrobalam; Ink nut; Indian gall-nut; Gallnut. Fr. – Badamier Chebule. Ger.-Respiger Myrobalanenbaum. Hind.-Harara; har; Pile-har; Balhar; Zangihar; kalehas (fruit); hana (dye), Punj.- har; Harrar; Hurch; halela (tree); Har. Arab.- Halilaja; Hallela. Pers.-halila hazards. Sind.-Imachi. Hin.&Dui.-Pile-hara; Harda. Ben.-Hora; Hari-taki. Punj.&kash.-Zard Halela. Guj.- Himaja; Pilo-harde: kabuli-hards. Mah.-Hirada. Bom.-Hirda; Harda: Hirada; Bala-hirade; Harle; Pilo – harle;Hardi. Te.-karakkaya: karaka: karaka: karakai (dye): kadukar; karka (tree); Pinda-karakkay(fruit); Tam.-Kadookai; baduk-kai (mature); Pinchu-kadukkai (immature); Kada-kai; Kaduk-kay(tree); Kaduk-kay-pinji (fruit; kadukkai-pon (thses are gall-like excrescenses on the leaves and young branches of T.chebula): Mal.- Kadukkal. Can.- Anilayakayi; Alate-huvru (Poo-flowers): Alale or Hirade (dye) Fruit): Sinh.-Aralu. Malay.- Bush Kaduka. Habitat.-This tree is wild in the forest of northern India, central provinces and Bengal. Common in Madras. Mysore and in the southern parts of the Bombay presidency. In general. Myrobalans are oval in shape and about two laches long, and are of a dull yellow colour. There are 4 varieties: (1) Survari harade, which are large, dense and heavy about 2 inches long. Yellowish-brow; when cut it contains yellowish or darkish brown, pulp and stone. (2) Rangariharade these are smaller, less wrinkled and less furrowed than the above variety; in length about an inch; the epidermis is yellow; when cut it presents a yellow dried pulp and a stone. The pulp is less astringent than that of Survari harade. (3) bala harade are smaller than the above two varieties. Their colour is deep brown or black: highly wrinkled, dark or brown epidermis. Their pulp in dark all homogenous; there is no stone. (4) Java harade: these are the smallest of all. Other characters are similar to those of Bala harade. Parts Used.-Dried fruits: immature fruits; mature fruits myrobalans and galls; mostly the outer skin of the fruits. “Two varieties are used in Unani. Viz-(1) Halilard (Maju): (2) Halila kabli (Surat). Besides Halila Siah (Pinju).”-(Therapeutic Notes) Constituents.- Myrobalans contain astringent principles: tannin (tannic acid) 45 p.c., and a large amount of gallic acid, incilage, a brownish yellow colouring matter, chebulinic acid which when heated in water splits up into tannic and gallic acids. Aciton.-Myrobalans are a safe and effective purgative (gentle laxative), astringent and alternative. Unripe fruits are more purgative and the ripe are astringent Rangari harade are alternative, stomachie, laxative and tonic. Survari harade is a valuable purgative. Bala harade is a mild and safe aperient and antibilious, though astringent, Ripe fruit is considered as purgative removing bile and phlegm, and to adjust bile. Action and Uses Ayurveda and Siddha.-Rasa-all except lavana, ushna veeryam, tridosha haram, mathura vipaka, medyam, rasayanam, lagu, brahmanam, laxative, ayushyam. In swasam, kasa, prameham, archas, sopham, kushtam, grahani,udaram, hridrogam. Externally, in veta swelling eye diseases, skin diseases.-(Therapeutic Notes)

PIPER CUBEBA,Linn – See Cubeba officinalies PIPER LONGAUM, LINN. Chavica roxburgii. (N.O:- Piperaceae) Sans.-Pippali; Trikana; Tikshnatandula; Maghadhi; vsai-dehikana; (root):- Pippili-moolam; Granthikam. Eng.-Dried chatkins; long-pepper. Hind.-pimpli; Pipal; Pipli;(root) pipli-mool. Ben.-Pili; Pepul. Guj.-Pipara; Pipli; Pipal. Mah.-Mohi; Pimpli; Pipli. Duk.-Pipaliana. Arab.Darfilfil; (root) Fil-fila-daraz; Fil-fila-moya. Pers.-Maghzpipal; Pipli; Filfildray; Pipal. Tel.-Pippali-katte; Peppelu Pippallu(Berries); Pipili; Modi (root). Tam.-Pipli; Tippali; (berries) Tipplilli; (root) modi mal.- Tippli. Can.-Hippali; Yippali. Kon.-Hipli. Sinh.-Tippili. Bom.-Pipli. Punj.-Pipal; Darfilfil. Malay.- Landa; Mula-gu. Burm.-Peikchin. Sind.-fill; fildray. Santal.-Ralli. Nepal-Pipla-mol. Habitant.-This plant is indigenous to North – Eastern and Southern India and Ceylon, and cultivated in Eastern Bengal. Parts Used.- Immature berries ( i.e dried unripe fruits or fruiting spikes ) dried in the sun, and stems (roots). Constituents.- Resin, volvatile oil, starch, gum, fatty oil, inorganic matter and an alkaloid, piperine 1 to 2 p.c. Action .- Infusion is stimulant, carminative alternative tonic more powerful than black pepper; also aphrodisiac, diureue, vermifuge and emmenagogue. Externally, rebefacient. Root is stimulat. “First fruits are said to be ‘mathura-paka’, guru, katu rasam, seetha veeryam; melt kapham”.- (Therapeutic Notes) Action & Uses in ayuveda.- katu rasam, mathura vipakam, ushna veeryam, vatha kapha haram, lagu, snigda, rasayanam, vrishyam, clears ulcers, stimulate agni, in swasam, kasam, gulmam, soolam, etc.,(Berries). Root:-as above, pittakaram, in udaram, krimi, anacham, pleeham, etc.

1929 PIPER NIGRUM. LINN.

(N.O:-Piperaceae).

Sans.-marcham; Maricha; Hapusha; Krishnam; Ooshnam; Valliyam. Eng.-Black-pepper; Decorticated pepper; Common pepper. Fr.-poivre. Ger.-Schwartze pfeffer. Hind.-Gulmirch; kalimirich. Duk. & Ben.-Kalimirich. Punj.-Gol-mirich; Golmorich; Habus. Afgh.-March. Sind.- Gulmirien. Arab.- Filfiluswud; fil-fila-siah. Pers.-pilpil. Kash.-Martz. Ben.-Vellajun. Bom. & Mah.-Kala-miri. Guj.-kalomirich. Tel.-Miriyalu; Miryala-tige. Tam.-milagu. Mal.-Kuru-mulaka; Kuru-milagu. Can.-Volloy-menasu. Kon.-Miri. Sinh.-Kalu-miris. Burm.-Sa-yo-mai; Navukon. Malay.- ladahitam. Habitat.- This pernnial climbing shrub is indigenous to Malabar and Travancore coasts, i.e., western coast of India.

Part Used.- Dried unripe fruit-black pepper. Consituents:- A volatile alkaloid piperine or pipirine 5 to 9 p.c., Piperidine or Piperidin 5 p.c a balsamic volatile essential oil 1 to 2 p.c., fat 7.p.c masocarp contains chavichi, a balsamic volatile oil, starch, lignin, gum, fat1 p.c proteids 7 p.c. and ash containing organic matter 5 p.c Chavicin is a soluble pungent concrete resin; it contains very little piperline and no voltile oil. Piperine crystallizes in flat, foursided glassy prisms insoluble in water.

Action.- Black pepper is acrid, pungent, hot, carminative, also used as antiperiodic, Externally it is rubefacient and stimulant to the skin, and resolvet. On the mucous membrane of the urethra it acts like cubebs; Piperine is a mild antipyretic and antiperiodic. Action & Uses in Ayurveda.- Katu rasam, katu vipaka, ushna veeryam, vata kapha haram, pitta-haram, tikshnam, ruksham, lagu dipanam, in swasam, soolam krimi, hicca, in eye diseases white pepper paste.- (Therapeutie Notes) ZINZIBER OFFICINALE

(SCITAMINACEAE)

sans:srangavera;sringa-beram;(dried)-sunta; Nagara; Nagaram;Visoushada;Maha-

oushadam; Mahaushada;(fresh)-Ardhrakam;Katu-patram;Mihijam.Eng:Ginger. Fr.-

Gingembre. Ger.-Ingwer. Arab.&Per.-zanjabil. Hnid. Duk., Ben. & Punj. (dried):-

Sonth; (fresh) Adrak; Ada; Adi. Ben.-Ada. Kash.-Sonth; (fresh) Adrak; Ada; Adi. Ben.-

Ada. Kash.-Sho-out. Bom. & Guj.-Adu. Kon. & Mah.-(dried):-Sunt; (fresh): - Ala;

Alem. Tel.-(dried):-Sont; (fresh):- Allam. Tam.-(dried):-Shukhu; chukku. (fresh):-Inji.

Mal.-Chukka. Can.-(fresh):-Hashi-shunti; (dried):-Vona-Shunti. Kon.-(dried):- Soonti;

(fresh):-alen. Sinth.-Inguru. Burm.-(fresh:-Gin-sin; (dried):- Ginsi-kyaw. Malay.-

Hulya-kring.

Habitat.- Ginger is cultivated in many part of India; on a large scale in the warm,

moist regions chiefly in Madras, Cochin and Travancore, and to a somewhat less extent

in Begal and the Punjap.

Constituents.- “India ginger contains an aromatic volatile oil, 1 to 5 p.c. of light-

yellow colour having a characteristic odour and containing camphene, phellandene,

zingiberine, cineol and borneol; gingerol a yellow pungent body; an oleoresin-“Gingerin”

the avitve principle , other resings and starch; k-oxalate. The essential oil and resin, to

which ginger owes its pungent flavour, occur just beneath the skin or epidermis. The

pungent priciples of ginger are not vilatile in steam to any appreciable extent and are,

therefore not found in the volatile oil. It has, however, been isolated and been named

‘gingeroal’, but its true chemical nature has not yet been finally settld”.- (Chopra).

Action.- Aromatic, crminative, stimulant to the gastrointestinal tract, and

stomachiec, also sialagogue and digestive; Externally, a locl stimulant and rebefacient.

Action and Uses in Ayurveda.- Katu rasam, ushna veeryam, vata-kapha-haram,

katu vipaka, lagu, snigdam, pachanam, ruchyam, vrishyam, swaryam, vibhanada haram,

in grahani, agnimathyam, amavatham, chardhi swasam, soolam,arsas anaham, hrith,

udhara rogam, externally in kapha, swellings, headache.-(Therapeutic Notes)

PTEROCARPUS SANTALINUS, Linn.

P. Lignum

(N.O.- Papilionaceae)

Sans. Hind. Ben. Mah. & Can.-Rakta-chanda. Eng.-RedSanders or Red Sandalwood.

Fr.-Santal Rouge. Ger.-Dunkelrothe Flugal-frucht. Hind.-lalchandana. Pers.-Sandale

surkh. Guj & Bom..-Ratanili. Tel.-Rakta gandhamu; Erra-gandamu. Tam.-Shen-

chandanam. Mal.-Chan-chandanam. Kon.-Rachandana.

Habitat.- This small tree is generally met with in the forest of Southern India.

Parts Used.- Wood

Constituents.- Santalin or santalic acid, a cryialline red principle; santal pterocarpin, a

white crystalline insoluble substance; homopterocarphin with the same general

properties, but more soluble in carbon bisulphide; glucoside and colouring matter.

Action .- Mildly astringent, cooling and tonic.

Uses.- Wood rubbed on a piece of stone with water forms an excellent cooling

application and purifier of skin after bating like white sandalwood.

MYRISTICA FRAGRANS, Houtt

M. officinalis, Linn. & Mart., M. aoschata;

M. aromatica.

(N.o: Myristicaceae)

Sans.-Jati-phalam; malathi-phalam. Eng.-Nutmet. Fr.-Muscadier; Musque. Ger.-Achter

muscatnussbaum. Hind. Duk. & Ben.-Jayphal; jaiphal; Jaepatre. Kash.-Zafal. Bom.

Punj. Guj. & Mah.-Jayiphal; javantri. Tel.-Jaajikaya. Tam.- Jadikkay; Jathikai. Mal.-

Jatika. Can.-jajikai. Kon.-jaiphal. Sinh.-Jadika. Buram.-zadi-phu. Malay.-Bush-pala.

Pers. & Arab. –Sauz-Bawwa; Zanza-bawawa.

Sans.-Jatipatiri (arillus). Eng.-Mace. Fr.-Macis. Hind. Can. Tel. Mah. & Guj.-Jaepatri.

Ben.-Jotri. Punj.-jauntari. Kash.-Jowwatri. Bom.-jawantri. Tam. 7 mal.-jadi-pattiri.

Sindh.-Vasavasi. Burm.- Zadi-phu-apoen. Malay.- Bunga-pala. Arab. & Pers.-

Bazabaza.

Habitat.- Nutmeg tree is indigenous to the Malay peninsula and Penang. It has been

successfully cultivated in Madras and Southern India (Nilgiri Hills and Malabar Coast).

Seeds are the nutmegs of commerce, and the arillus surrounding the seed within the outer

shell constitutes, when dried, the product known as mace.

Parts Used.- Dried seed (deprived of testa), nutmeg(B.P.) arillus surrounding the seed,

mace and wood.

Constituents.- Kernal (nutmeg) contains a volatile oil 2.8 pc., a fixed oil, proteids, fate,

starch, mucilage and ash. Mce (arillus)contains a volatile oil 8 to 17 p.c., (identical with

that obtained for the Kernal, a fixed oil, resin, fat, sugar, destrin and muscilge, . The

fixed oil which is called “butter of nutmeg” consists of myristin and myristic acid, and a

portion of the essential oil. Essential oil contins myristicene and myristicol. Essantial oil

of mace is of a yellowis colour with the odour of mace and consist of macene.

Action.-Nutmeg is aromtatic, stimulant and carminative; in large doses, narcotic.

Concrete oil is used as a rubefacient; volatile oil is stimulant, aperient and carminative.

Mace is carminative and aphrodisiae. Mahomedan writers describe nutmeg as

stimulating, intoxicating, digestive, tonic and aph-rodisiac. Wood is astringent. “Dr.

Osiander descrbies nutmeg as an antipyretic, and Dr.Paracelsus, Lonicerus and Mathiolus

describe them as a gastric tonic. The content of an ethereal oil, 6-10%, in combination

with myristicine gives the nutmeg a tonicising action on the stomach; its effect on the

mucous membrane of the uninary passages is irritative, which may account for its use as

an aphrodisiac and abortifacient.- (Dr. Kober). In large doses, nutmeg oil has a narcotic

action and produces nausea, somnolence and headaches.- 9Dr.Marfori-bachem). Dr,

Paracelsus, Lonicerus and mathiolus, used nutmegs with a constipating action; also as a

diuretic against gastric catarrh and cardiac fibrillation. Dr. Osiander found nutments

useful against the vomiting of pregnancy.”

Action & Uses in Ayurveda.- Tikta rasam, ushanam, kapha-vata-haram, lagu, rochanum,

dipanam, gradi, swryam, in foul month, krini, kasam, chardhi, swasam, sosham,

hridrogam, imorteney. (Therapeutic Notes).

Mace:- mathura rasam, kattu rasam, ushna veeryam, kapha haram, lagu, ruchi varna

karam, in kasam, swasam, chridhi, thrishna, krimi, visham.

Preparations.- Past, powder, pills, Confections, Expressed oil and Decoction of wood.

Graph Showing the Results

0

10

20

30

40

Cured

Improved

Improved

Results

34.28

8.5757.14

1 2 3

TABLE SHOWING THE INCIDENCE OF NIDANA

IN YUVANA PIDAKA PATIENTS IN THE STUDY

SL.

No. Nidana No. of Patients Percentage

1. Yuvavastha 35 100%

2. Atimedya] Sweets

Bhakshana] Meat

20

24

57.15

68.5

3. Avyayama 17 48.5

4. Divaswapna 11 31.42

5. Psychological factors 16 45.71

6. Premenstrual exacerbations in Female patients 10 28.57

7. History of Nasya Karma -- 0%

Note : For the assessment of psychological factors like mental stress and strain, the patients were interrogated with great difficulty and delicacy and recorded for the study.

TABLE SHOWING THE REPORTED CASES OF

YUVANA PIDAKA IN DIFFERENT AGE GROUPS

Sl.

No. Age Group No. of Patients Percentage

1. 0 – 15 - -

2. 16 – 20 20 57.1

3. 21 – 35 8 22.8

4. 26 – 30 7 20.1

5. 31 – 35 - -

6. 36 – 40 - -

7. Above 40 - -

TABLE SHOWING THE FIRST INCIDENCE OF YUVANA PIDAKA

IN DIFFERENT AGE GROUPS OF THE REPORTED CASES

Sl.

No. Age Group No. of Patients Percentage

1. 0 – 15 -- --

2. 16 – 20 20 57.1

3. 21 – 35 10 28.5

4. 26 – 30 5 14.4

5. 31 – 35 -- --

6. 36 – 40 -- --

7. Above 40 -- --

Note: The age of every patient, in this table, is considered in which the first occurrence of the disease was observed. It was calculated by deducting the duration of sickness from the present age of the patient.

TABLE SHOWING FOOD HABIT INCIDENCE

OF YUVANA PIDAKA

Sl.

No. Food Habit No. of Patients Percentage

1. Vegetarian 11 31.4

2. Non-Vegitarian 24 68.6

TABLE SHOWING THE SEX INCIDENCE

OF YUVANA PIDAKA

Sl.

No. Sex No. of Patients Percentage

1. Male 22 62.9

2. Female 13 37.1

Table showing the Results

Sl.no Result No. of patients Percentage

1. Cured 12 35.28

2. Improved 20 57.14

3. Not – Improved 03 8.57

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE KARNATAKA, BANGALORE PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the candidate and address (in block letters)

: R. VANITHA No. 6, New State Bank Colony,

West Tambaram, Chennai – 600 045

Tamilnadu

2. Name of the institute : Sri D.G. Melmalagi Ayurvedic Medical College,

Post graduation & Research Center, Gadag -

582103

3. Course of study and subject : Ayurveda Vachaspathi M. D. (KAYACHIKITSA)

4. Date of admission : September2001

5. Title of the topic : Evaluation of the efficacy of Nimbaragwadhadi

yoga and Kustumburu lepam with Pratimarsha

Nasya in Yuvana pidaka (Acne) 6. Brief resume of intended work

6.1. Need for the study

Yuvana Pidaka i.e. a common Complex, fascinating malady of either sex in the

teenagers. It is an extremely common complaint with 70% the population and is clinically

evident at some point during adolescence or early adult life. Out of only 10-20% request

medical attention for the problem1. The advent of new and potent therapeutic agents for

acne has proved insignificant and in our ability to treat acne with topical therapy alone. This

common problem turns into cosmetic problem and results in emotional upset. Patients with

acne are often depressed and may need sympathetic counseling and support2. Therefore,

the present study is designed with both internal and external administration of Ayurvedic

drugs to correct this cosmetic disorder 12-13.

6.2. Review of Literature:

Pidakas resembling the thorns of Shalmali with pain are called as Yavana pidaka3. It can

be correlated with Acne vulgaris explained by modern scholars. Acne vulgaris is a clinical

condition of open and closed comedones, inflammatory papules, pustules, cyst nodules and

often scars 4.

Madhavakara uses the synonym Mukhadushika 5. It is also explained that it is a natural

process of adolescence. Madhava and Susruta described this disease is manifested due to

vitiation of Kapha Vata Doshas and Rakta dhathu6. Vagbhata trace only Vata and Kapha as

causative factors with out considering Rakta7.

Ayurveda classical texts like Yogaratnakara, Bhaisajyaratnavali, Susruta samhita,

Sahasrayoga etc. give immense importance to the external applications for this problem.

"Nimbaragwadhadi yoga"8 internally and "Kustumburu lepam"9 externally with Pratimarsha

Nasya 10 in Yuvana pidaka (Acne) are classical formulations extracted from Susruta samhita.

As the main Doshas are Vata, Kapha and Rakta, it is necessary for internal medicine for

radical cure. Therefore the internal medicine "Nimbaragwadhadi yoga", which is explained in

the treatment of Padminikantaka 11, a similar complaint occurring on the face is selected

from Susruta samhita.

6.3. Objectives of the study

1. To evaluate the efficacy of "Nimbaragwadhadi yoga" internally and "Kustumburu lepam"

externally with Pratimarsha Nasya in Yuvana pidaka (Acne).

2. To evaluate the efficacy of "Nimbaragwadhadi yoga" internally and "Kustumburu lepam"

externally with Pratimarsha Nasya in androgens which cause Acne.

7. Material and methods

7.1. Source of data

a) Literary: Literary aspects of the study will be collected from standard Ayurvedic texts,

Modern books, Magazines and journals.

b) Drug: Nimbaragwadha yoga and Kustumburu lepam 14

The ingredients of Nimbaragwadha yoga and Kustumburu lepam are properly

identified. The Good manufacturing procedures are followed for the preparation. The

combination and proportion of Nimbaragwadha yoga and Kustumburu lepam is as

follows.

Nimbaragwadha yoga and Taila (for Pratimarsha Nasya)

Nimba (Melia azadirachta Linn.) 1 Part

Aragwadha (Cassia fistula, Linn) 1 Part

Kustumburu lepam

Kustumburu (Coriandrum sativum, Linn) 1 Part

Vacha (Acorus calamus, Linn) 1 Part

Lodhra (Symplocos racemosa, Roxb) 1 Part

Kusta (Saussurea lappa, Clarke) 1 Part

c) Patients: Patients with Yavani Pidika will be selected from O.P.D. of Post Graduation and

Research center of Sri D.G.M. Ayurvedic medical college & Hospital, Gadag by preset

inclusion and exclusion criteria.

7.2. Method of collection of data

a) Study design: Prospective open clinical trial

b) Sample size: A minimum of 30 patients

c) Exclusion criteria:

1. Patients below the age of 10 years and above the age of 30 years, pregnant and

lactating women will be excluded from the study.

2. The patients having diabetes mellitus and other systemic diseases will be

excluded.

3. The patients with concomitant therapy will be excluded.

4. Patients using Glucocarticoids and anti-epileptic drugs are excluded.

d) Inclusion criteria

1. The patients are selected with pidaka between the age groups of 10 to 30 years

2. The patients are selected irrespective of Sex and race based on the clinical signs

& symptoms other than that of exclusive criteria,

e) Posology:

2 gm/24 hours in divided dose or 33mg/Kg-body weight in divided dose orally

f) Study duration: 21 days

g) Assessment of result

The results will be assessed by subjective as well as objective parameters.

7.3. Investigation

1. Hb%

2. Differential count

3. Androgens i.e. Testosterone

7.4. Ethical clearance : Obtained

8. List of references

1. Manual of Dermatology by Philadehphia W. D. Samdos 1991

2. The look you like by Schoent and Lazar, pp 253-272

3. Astanga Sangraha, Uttarasthana 36/5, translated by, Prof. K. R. Srikanta Murthy pp 316 4. Manual of Skin disease by Gordon C. Saucer John C. Hall, pp126-135

5. Madhava Nidana, Kshudraroga Nidana, 55 chapter.

6. Susruta Samhita Nidana 13th chapter.

7. Astanga Sangraha uttara sthana, 36/ 5

8. Susruta samhita Chikitsa 20/37

9. Susruta samhita Chikitsa 20/39

10. Astanga Hridaya uttara 32/4

11. Susruta samhita Chikitsa 20/38

12. B. V. Parmar – Study of Yuvanapidika with special reference to the concept of

pathopysiology and its principles of management – Gujarat Ayurveda University,

Jamnagar.

13. D. P. Singh – Role of certain Indigenous drugs on Yuvana pidaka – Gujarat Ayurveda

University, Jamnagar.

14. Indian Materia Medica by A. K. Nadkarni, 3rd revised edition, published by Popular

Prakashan, Bombay, 1976,

EVALUATION OF THE EFFICACY OF

NIMBARAGWADADHI YOGA AND JATHIPHALADHI LEPA

IN YAUVANPIDAKA

- By -

Dr. Vanitha. R.

GuideDr. Vangipuram Varadacharyulu

M. D. (Ayu), (Osm)

Professor and Head of the department,Kayachikitsa.

Post graduation studies and research.

D.G.Melmalagi Ayurvedic Medical CollegeGadag- 582103.

Introduction

01. Recent trends of researches in various fields were carried for human welfare.02. This involve multi-dimensional approaches in medical sciences with basic support of biological and pharmacological investigations. 03. In the series cosmetology is newer field of research and scientific interest which is gaining importance. 04. Therefore, the present study has been undertaken to examine the potentials in Ayurveda in the field of cosmetology.

05. Yuvana pidaka is a common complex, fascinating malady of either sex in the teenagers.06. It is an extremely common complaint with 70%of the population and clinically evident at some point during adolescence or early adult life.07. Yuvana Pidaka is one of the diseases mentioned under kshudra Rogas and mentioned as Mukha dooshika as it decreases the complexion and smoothness of the face.08. This disease is viewed as a burning cosmetic problem than a medical one.09. An equivalent terminology in modern medicine in Acne vulgaris.

Historical review

Sushruta Samhita Nidanasthana 1336.Sushruta Samhita Chikitsasthana 2037.Ashtanga Sangraha Uttarasthana 367.Ashtanga HridayaUttarasthana31/5 & 32/3.Madhava Nidana 55/33.Bhavaprakasha Madhyama khanda 31/32-35.Yoga RatnakaraBasava Rajeeyam 22nd Chapter. Sharangadhara Samhita Uttarakhanda 11/11 & 15.Chakradatta Chikitsa prakaranam 55/41-43.Ananga Ranga 8/91-93.

Literary meaningThe term yuvana pidaka comprises of two words.

01. Yuvana 02. Pidaka

Yuvana

The word indicates the age factor of a person.

The age factor that is stipulated to say the person as yuvana is between seventeen and thirty years2.

According to sir Monier Monier Williams yuvana means young, youthful adult.

Taruna, Yuvavastha are the synonyms given to the word3.

Pidaka

The word is defined as

“PEEDAYATEETI PIDAKA”

‘SPOTAKA VISHESHAHA PIDAKA4’

Pidaka menas small boil, pimple or pustule5.

Pitaka, pidika, pitika are the synonyms for pidaka.

By keeping the above two words in view the yuvana pidaka is defined as follows.

SHALAMALI KANTAKA PRAKYAHA

KAPHA MARUTA SHONITAIHI

JAYANTE PIDAKA YUNAM VAKTRE

YA MKHA DOOSHIKA

The pidaka in the shape of shalmali kantaka (Spine of Indian red silk tree) produced due to the vitiation of kapha,vata and Rakta in youth age on the face causing disfiguration is called as yuvana pidaka6.

Tarunya pidaka, Mukha Dooshika are the synonyms for yuvana pidaka.

Regional namesAssam : SalamanaBengal : Bahija phoraDogr. : MuhasikaGujarathi : KhilaHindi : MuhasaKannada : ModaveMalayalam : MukhakkuruMarathi : Murum, Tarunya pidikaOriya : Vayas vranaPunjabi : KilaTamil : MugapparuTelugu : MotimaluEnglish : PimplesGreek : AkmeMedical term : Acne Sanskrit : Yuvana pidaka, Mukhadooshika, Tarunya ,

Pidaka

Table Showing the layers of twak

+ Subcutaneous

--Mamsadhara7

+ Reticular layer

Pranadhara*Rohini6

+ Papillary layer

**Vedini5

# StratumMalphighii

**Tamra4

# Stratumgranulosum

**Swetha 3

# Stratumlucidum

Asrugdhara

AsrugdharaLohitha 2

# StratumCorneum

Udakadhara

UdakadharaAvabhasini1

ModernVagbhatCharakaSushrutaSl.

Description of Twak stara

Subcutaneous tissue & muscle

Reticular layer

Papillary layer

Malphigian layer

Stratum granulosum

Stratum lucidum

Horney layerAs per Dr. Chunekar

Mamsadhara, Bhagandara, Arshas, Vidhradhi 2 yava

Rohini, Grandhi, Apachi, Arbuda, Shleepada, Gandamala 1 yava

Vedini, Kushta, Visarpa 1/5th

Taamra, Kilasa, kushta, 1/18th

Seta, Charmadala, Ajagallika, Masaka, 1/12th

Lohita, Tilakaalakam, Nyachha, Vyanga, 1/16th

Avabhasnisiddha

Sushruta

Superficial deep fasci

Stratum reticulum

Stratum papillae

Malphigian layer

Stratum granulosum

Stratum lucidum

Stratum corneum

Modern Nomenclatur

e

Mamsa dhatuRohiniVediniTaamraSwetaLohita Ashrugdhara

Avabhasini

Udakadhara

Paarishadilya Nomenclatur

e

-Shashti Praana

Panchami , Alagi, Vidhradhi

Chaturthi Sarva kushta

Tritiya sidhma Kilasa

Dwithiya Ashruk

Pradhama

Udaka

Vriddha Vagbhat

-Shashti Arumshika

Panchami Alagi, Vidhradhi

Chaturthi Dadru kushta

Tritiya sidhama

Kilasa

Dwithiya

Ashrgdhara

Pradhama

Udakadhara

Charaka

SapatiniShashtiPanchamiChaturthaTritiyaDwithiyaPradhamaName of the Author

Yuvana Pidaka is the disease of Romakoopa. (a) An increase in sebum secretion(b) Thickening of the keratin lining of the sebaceous duct, to produce black heads or comedones. Thecolour of the black heads is due to melanin, not dirt. (c) An increase in fatty acids(d) Inflammation around the sebaceous glands; probably as a result of the release of bacterial enzymes.

Changes in the skin

Nidana

All types of Nidanas can be divided into 6 types –SwabhavaAge factorDietic factorsExtra-dietic factorsPsychological factorsComplication of Nasya karma

SampraptiNidana sevana

Kapaha & Vata dosha pradhana vikriti

Agnimandya

Ama

Dosha-Dushya Sammoorchhana

Development of pidakas at Twakghata roma kupas

Yuvana pidaka.

Samprapti Ghatakas۵ Doshas : Kapha and vata۵ Dushyas : Twak(Rasa), Raktha and

Medas۵ Agni and Ama : Jataragni and dhatwagni

janya Ama۵ Srotas : Medo vaha srotas۵ Dusti Prakara : Sanga۵ Udbhava sthana : Amashaya۵ Roga marga : Bahya۵ Adhistana : Twak gata Roma Koopas۵ Sanchara Sthana : Through out the body۵ Vyakta sthana : Mukha

RoopaSharangadhara

Bhavprakasha

Bhask.Vag.S.S.C.S.LaxanaSl.

+++++-Mukhadooshika7

+++++-Occurs inYuvavastha

6

+++++-Occurs on the face

5

---+--Ghanah4

---+--Sarujah3

---+--MedasencapsulatedPidaka

2

+++++-Shalmalikantaka Sadhrusha

1

Sapeksha Nidana

Yuvana pidaka

Prameha pidakas

Yava Prakyaya

Antralagi

Parimandala

Katchoo and Pama

Valmeeka

Visarpa

Kaksha

Gardhabhika

Pashana Gardhabha

Jala Gardhabha

Gandha

Kusta

Agnirohini

Spota.

Sadhyasadhyatwam

Yuvana pidaka which appears in certain conditions is said to be sukha sadhya, viz.

Yuvana avastha

Less symptoms

No longer duration

Upadrava

The Yuvana pidakas causes fomation of scar which is complication in cosmicological aspect.

Apart from these patient is not developing any severe forms of systemic disorders.

Chikitsa vivechana

According to Ayurvedic line of management is of three types –

Daiva Vyapashraya

Satwavajaya

Yukti Vyapashraya

Yukti Vyapashraya chikitsa

This is of three types –

@ Antaparimarjana

@ Bahiparimarjana

@ Shastrapranidhana

Treatment of Yuvana Pidaka by Different authors

-++---+--Siravyadha5

-++------Abhyanga4

-----++--Nasya karma

3

-+---+++-Vamana2

++++++++-Mukha lepa

1

BRCD

YRShSBPASAHrSSCS

TreatmentSl.

MUKHA LEPAS : -

I. Vacha, Lodhra, Dhanyaka in equal quantities with milk.

II. Kustumburu + Vacha + Lodhra + Kusta with milk.

III. Vacha + Lodhra + Saidhava Lavana with water or milk.

IV. Vata Patra + Narikela Majjeerasa (milk like extraction prepared by grinding and squeezing the endocarp of fresh coconut).

Mukha Lepas : -

V. Vacha + Lodhra + Dhaniya + Gorochana +Mareecha with water ( Anukta paribhasha)6

Shalmali Kantaka Choorna with mailk.

VI. Matulunga + Vata Patra + Sarpi + Shilajit withGoshakrut rasa.

VII. Arkaksheera + Haridhra, after mardhana is advised as mukha lepa.

VIII. Jateephala + Chandana + Mareecha with water (Anukta paribhasha).

Pathyapathya

Pathya can be prescribed into 2 parts –

Ahara : Purana shastika shali, Godhuma,

Tikta shakas like patola, Nimba etc.,

Dhanyaka, Mareecha, Hingu, Lasuna, All green vegetables & Carrots.

Vihara : Normal exercises

Exposure to evening sun-light

Washing the face regularly with tepid water.

Pathyapathya

Apathya can be prescribed into 2 parts –

Ahara : Madhura rasa padarthas (Sweets especially chocolates, nuts, etc).

Medya padarthas (Fats and Fatty acids, Meat, Oils, etc.).

Dadhi.

Ice creams.

Vihara : Divaswapnas

Avyayama.

Using greasy cosmetics.

Squeezing the lesions.

Criteria for Selection of the Patients : -

35 patients diagnosed as yuvana pidaka were selected from OPD of Sri DGM Ayurveda medical College & P.G center for present clinical trail.

The patients were selected on random basis irrespective of their age, sex, caste, duration of the complaints, food habits and occupation.

Criteria for diagnosis of the Disease : -

Patients who complained pidaka (eruptions) over face, neck and back in yuvavastha were diagnosed as yuvana pidaka.

Disease assessment gradings –

Gr. I – ComedoneGr. II – Comedone & PapulesGr. III – Comedone, Papules, Pustules and cystGr. IV – Wide spread involvement of face and

upper half of the body.

Trail Drugs

FOR INTERNAL MEDICATION

Nimbaragwadadhi yoga

• Nimba (Panchanga)

• Aragwadha

• Triphala

• Haridra

FOR EXTERNAL APPLICATION

Jathiphaladhi Lepa

• Jathiphala

• Maricha

• Raktachandana

Ref. Sahastrayoga (kushta Prakaranam)

Ref. Yogaratnakara

Criteria for selection of Drugs : -All the drugs were selected rationally on the

basis of their properties. The formulation of Nimbaragwadadhi yoga

was prepared as per the sentence of Sahastra Yoga. The formulation of Jathiphaladi Lepa was

prepared as per the sentence of Yogaratnakara.

Posology –Internal Medicines – (Nimbaragwadadhi Yoga) 2 gms / day. [Each capsule was of 500 mg.]External Application – (Jathiphaladi Lepa) Applied on face overnight & washed in the morning.

Treatment Protocol –

Study duration – 21 days.Follow-up – 1 month.

General Rules –

1. The dosage of internal medication was altered according to the severity of the disease and age of the patients.

2. The duration available for the study was only two years and hence recurrence criteria is limited within the period.

Result Assessment Criterias : -The results were assessed after a month in terms of

cured, improved and not improved.

Cured : Complete relief form the signs and symptoms during the treatment and non-recurrence of the disease is considered as cured.

Improved : Complete relief from the signs and symptoms during the treatment and recurrence after stopping the treatment.

Not – improved : Continuation of signs and symptoms or slight improvement with recurrence as before treatment, is considered as not-improved.

Incidence of Nidana Sevana

48.5%-History of Nasya karma7

28.57%10Premenstrual exacerbations in Female patients

6

45.71%16Psychological factors5

31.42%11Divaswapna4

48.5%17Avyayama3

57.15%

68.5%

20

24

Atimedya Sweets

Bhakshana] Meat2

100%35Yuvavastha1

%No. of Pts. NidanaSl

Graph Showing the incidence of nidana

35

2024

1711

1610

0

10

20

30

40

a b c d e f g

Nidanas

No. o

f Pt.'

s

Series1

Distribution of Patients by Age

--Above 407

--36 – 406

--31 – 355

20.1%726 – 304

22.8%821 – 353

57.1%2016 – 20 2

--0 – 15 1

%No. of Pt.’sAge groupSl.

0

20

10

5

0 0 0

0

5

10

15

20

No.of

Pt.'s

0 – 15 16 – 20 21 – 35 26 – 30 31 – 35 36 – 40 Above40

Age groups

Distribution of patients by Age incidence

No. of Pt.'s

Distribution of Pt.’s showing the first incidence of Yuvana Pidaka

--Above 407

--36 – 406

--31 – 355

14.4%526 – 304

28.5%1021 – 353

57.1%2016 – 20 2

--0 – 15 1

%No. of Pt.’sAge groupSl.

Distribution of Pt.’s showing food habit

68.6%24Non-vegetarian2

31.4%11Vegetarian1

%No. of Pt.’sFood habitSl.

Distribution of Pt.’s by sex incidence

37.1%13Female2

62.9%22Male1

%No. of Pt.’sSexSl.

Overall Result

8.57%03Not-improved3

57.14%20Improved2

35.29%12Cured1

%No. of Pt.’sResultSl.

Overall result of the therapy

Cured34%

Improved57%

Not – Improved

9%

Cured Improved Not – Improved

DISCUSSION ON DEMOGRAPHIC DATAS –01. Age –

As per the “table showing the age of the patients and their first occurrence of Yuvana pidaka”, the statistics reveal the first incidence was observed between the 18-23 years of age.

This clearly speaks yuvana pidaka occurs more in the early part of yuvavastha.

02. Sex –Yuvana pidaka was observed in both the sexes almost

in equal percentage i.e., 53.7% of males and 46.3% of females. There is no sex difference in the incidence ofyuvana pidaka.

But during observation of the patients it was found the more severe form of yuvana pidaka was found in males.

DISCUSSION ON DEMOGRAPHIC DATAS –

03. Food habits –The incidence of yuvan pidaka was high in Non-

vegetarians than, in vegetarians. This is probably due to the non-vegetarians who

consume more of fatty food, i.e Medhya Ahara.

04. Nidana –The combination of all types of Nidana was found in

some patients who came with severe Yuvana pidaka.

DISCUSSION ON RESULTS –There was 35 cases out of which cured were

12(34.28%), improved were 20(57.14%) and not improved were 3(8.57%).

The percentage speaks by itself that the Mukha lepacombined with internal modification provides grater cure and appreciable improvement. A prolonge use of both internal and external medication will be very effective.

Considering the duration, if the duration is less the therapy will be more effective.

LIMITATION OF STUDY

Sample size is small to generalize the result.Long standing use of the medications should be studied on large sample size to find out the statistical & potentiality of the drug. Drug being a compound formation is difficult to drawits mode of action regarding rationality.Samples were selected incidentally.

Conclusion

Based on literature & observations of present clinical study we can draw following conclusions –The Yuvana pidaka is common skin problem troubling predominantly in the teenage. In our classical it is considered as Kshudra roga, but even though 70% of the population is complaining of Yuvana Pidaka.

This disease is appearing as a cosmetic problem rather than a systemic disease.

This will not produce any severe systemic complications but, due to ugly look a patient gets discouraged.

Application of both internal & external medicaments gives better results than individual one.