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“COMPARATIVE CLINICAL STUDY ON EFFECT OFVAMANA FOLLOWED BY LEPA AND ONLY LEPA IN    YOUVANA PIDAKA (ACNE VULGARIS)”       ...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,                 BANGALORE, KARNATAKA.              DECLARATION BY THE CANDIDAT...
DEPARTMENT OF POSTGRADUATE STUDIES IN                         PANCHAKARMA     N.K.J.A.M.C., P.G. RESEARCH CENTER, BIDAR.  ...
DEPARTMENT OF POSTGRADUATE STUDIES IN                        PANCHAKARMA     N.K.J.A.M.C., P.G. RESEARCH CENTER, BIDAR.   ...
DEPARTMENT OF POSTGRADUATE STUDIES IN                         PANCHAKARMA     N.K.J.A.M.C., P.G. RESEARCH CENTER, BIDAR.  ...
COPY RIGHT            DECLARATION BY THE CANDIDATE           I hereby declare that the Rajiv Gandhi University ofHealth Sc...
ACKNOWLEDGEMENT      “Love is the only inspiration.” Along with the divine blessings ofLord Manjunatheshwar and Lord Dhanw...
I express my obligation and heartfelt thanks to my teachers        Dr. Anand Jabshetty M.S. (Ortho) Asst. Prof. BIMS, Bida...
ABBREVIATIONSAH    – Ashtanga HridayaAS    – Ashtanga SangrahaCS    – Charaka SamhitaBV    – BhavaprakashaMN    – Madhava ...
ABSTRACTBackground and Objectives         Acne   vulgaris   is   a   chronic   inflammatory   disease   of   thepilosebace...
Results     Overall effect of the treatment in Gr. A was –     Moderate improvement was found in 05 patients (33.33%)     ...
CONTENTS    Chapters                                            Page No.01) Introduction                                  ...
LIST OF TABLESSL.                               TABLE                             Pg.01.   Layers of the skin according to...
26.   Distribution of patients according to Marital Status                9227.   Distribution of patients according to Di...
56.   The “t” test result showing the difference between the          117      means of samples before and after the treat...
66a. The percentage of improvement in individual parameters of     Youvana pidika after the treatment and Third follow up6...
LIST OF GRAPHSSL.                              TABLE                           Pg.01. Age-wise distribution of the patient...
26. Relation with menses-wise distribution of the patients        10727. Type of Vedana-wise distribution of the patients ...
LIST OF FLOW CHARTS, FIGURES & PHOTOGRAPHSSl.                              Table                           Pg.            ...
INTRODUCTION      Ayurveda, the holistic healing Shastra, deals with the concept ofindividual approach. The preventive and...
Acne    vulgaris   is   a   chronic   inflammatory   disease   of   thepilosebaceous units of the skin in certain body par...
Looking into above facts there is a need of treatment which canprevent complications of the disease as well as reduces the...
OBJECTIVES OF THE STUDY      Vamana is one of the major procedures in Panchakarma. This isa Shodhana procedure which has g...
HISTORICAL REVIEW      Youvana Pidaka is a common condition observed in day to daylife. But, detail explanation about its ...
TWAK SHAREERA        Youvana Pidaka is a skin disease. For better understanding ofetiopathogenesis, normal structure of th...
Table No. 01. Layers of the skin according to various authors.SL.         SS             CS            AD        ShS      ...
The first layer Avabhasini is mentioned as Udakadhara both inCharaka Samhita and Astanga Sangraha. This layer is so named ...
NIRUKTI      The word Youvana Pidaka contains two terms. Viz.      Youvana + Pidaka = Youvana Pidaka.      Where, Youvana ...
“Tachcha Panchadashadoordhwamuchyate” |            “Kaishoram Panchadashat Youvanantu Tataha Param”|Pidaka is derived from...
Meanings of the above mentioned synonyms are as follows –      Mukhadooshika – The condition which spoils the face of an  ...
Pidaka is one of the Raktaja Vikara. The causes of Raktaprakopaare Krodha, Shoka, Bhaya, Aayasa, Vidagda Ahara Sevana,Mait...
Brief description of Youvana Pidaka is available in all the Samhitas,and they have mentioned Kapha, Vata, Rakta, as the ca...
Table No. 04. Viharaja Nidana of Youvana Pidaka DOSHA                           VIHARAJA NIDANAVataja      Anashana, Visha...
Sharangdhara has accepted Mukha Snigdhata and Youvana Pidakaas Mala of Shukra Dhatu. As mentioned earlier most of the clas...
On the basis of the above Samprapti Ghataka following sketch ofSamprapti of Youvana Pidaka may be constructed.Flow   chart...
Flow chart No. 03. Summarized Samprapti of Mookhadooshika                                        NidanaDosha Prakopaka    ...
PURVA RUPA (PREMONITORY SYMPTOMS)        The Poorvaroopa of Kshudra Rogas is not mentioned in classics.While    commenting...
The references of the above mentioned signs and symptoms are asfollow –   1. Shalmali Kantaka Sadrusha Pidaka31,32,33,34,3...
03. Saruja      Saruja means with pain. The eruptions are painful and the pain maybe mild or sub-acute in nature. It may a...
TREATMENT OF YOUVANA PIDAKA      Dozens of remedies are mentioned in classics for this condition. Themanagement of Youvana...
Local Management       As per the disease pathology concern local therapies like facialmassage, application of various med...
Washing the face with Varunadi Kwata and Lepa prepared out to      Vatapatra,      Malathi,   Raktachandana,   Kusta,    a...
Line of treatment prescribed by various Acharyas can besummarized as follows –      Sushruta Samhita         : Vamana, Lep...
LEPA      The external application of a paste prepared from the drugs isknown as Lepa. It is used to improve the skin heal...
Alepa – Midway between Pralepa and Pradeha is Alepa. It is of      medium character and it normalizes the Rakta and Pitta....
Nirvaapana Lepa – This is meant for Pitta Dosha, Pittaja andVishaja Shotha, burning caused by Agni and Ksharadagdha. In th...
Apart from these, 3 more types of Lepa are explained by Vagbhataand Sharngdhara are as follows –     Doshaghna – The Lepa,...
Lepa drug should not be reused.    Fresh Lepa should not be applied over previous one.    Lepa should not be applied at ni...
LEPA KARMA PROCEDURE      This can be subdivided into 3 types. Viz. –      Poorvakarma      Pradhanakarma      Paschyata K...
PASCHAT KARMA OF LEPA20      Mukha Prakshalana with Jala after wetting the lepa with water.      Abhyanga to faceUTILITY O...
MUKHA LEPA ACCORDING TO SEASON      In classics, various Lepa are advised according to various seasons.Table No. 09. Types...
CONTRA-INDICATIONS OF MUKHA LEPA26     Peenasa                               Arochaka     Ajeerna                         ...
VAMANA      This is one of prime procedure in Panchakarma. It occupies the firstplace among Panchkarma. It is the best Sho...
INDICATIONS OF VAMANA      When Doshas are accumulated in large quantity (Bahu), Vamana is      advised.2      More specif...
VAMANA POORVAKARMA      In this category, one has to fulfill the prerequisites required forconducting the Vamana procedure...
Table No. 10. Process of Vamana & effect of Vamaka Dravya on the body9SL.   SYMPTOMS         CHANGES               MECHANI...
Table No. 11. The criteria for the evaluation of Shuddhi. 10VAMANA           AVARA               MADHYAMA                 ...
SAMSARJANA KRAMA        After Vamana, the diet regimen should be planned according to thetype of Shuddhi obtained.Table No...
ANATOMY OF SKINIntroduction      The skin is the largest organ of the body covering all living tissues inthe body. It is m...
Epidermis      In the word epidermis, "epi" comes from the Greek meaning "over"or "upon," is the outermost layer of the sk...
DERMIS      The dermis is the layer of skin beneath the epidermis that consists ofconnective tissue. It cushions the body ...
Thermo-regulation – The skin contains a blood supply far greaterthan its requirements which allows precise control of ener...
Cosmetics should be used carefully because these may cause       allergic reactions. Each season requires suitable clothin...
The sebaceous glands open into the neck of the hair follicle bymeans of a duct. In some areas like face, lips, nipple, gla...
ACNE VULGARIS      Acne is commonly known as Acne vulgaris. It is a chronicinflammatory dermatological condition affects n...
After the age of 35 years acne resolves very slowly. At 40 years ofage lesions are found in 1% of males and 5% of females....
The most important androgen is testosterone, which affects the face,pubic area and armpits. The excessive secretion of tes...
Excessive intake of Bromides and iodides in the form of tonic,medicines or diet causes acne. When these salts are disconti...
Acne may relate to severe increased anger or anxiety. The stressescauses excess secretion of androgens and subsequently le...
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COMPARATIVE CLINICAL STUDY ON EFFECT OF VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN YOUVANA PIDAKA (ACNE VULGARIS), Anil S. Managuli, DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA, N.K.J. AYURVEDIC MEDICAL COLLEGE &
P. G. RESEARCH CENTER, GUMPA, BIDAR

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  1. 1. “COMPARATIVE CLINICAL STUDY ON EFFECT OFVAMANA FOLLOWED BY LEPA AND ONLY LEPA IN YOUVANA PIDAKA (ACNE VULGARIS)” – By – Anil S. Managuli Dissertation submitted to theRajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfillment of the requirement for the degree of Ayurveda Vachaspati (Doctor of Medicine) In Panchakarma Under the guidance of Dr. Sanghamitra Patnaik M.D. (Ayu) Associate Professor & H. O. D. Department of P.G. Studies in Panchakarma Under the Co-guidance of Dr. Anilkumar Baccha M.D. (Ayu) Asst. Professor Department of Kayachikitsa DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA N.K.J. AYURVEDIC MEDICAL COLLEGE &P. G. RESEARCH CENTER, GUMPA, BIDAR – 585 403. 2009.
  2. 2. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled“COMPARATIVE CLINICAL STUDY ON EFFECT OFVAMANA FOLLOWED BY LEPA AND ONLY LEPA INYOUVANA PIDAKA (ACNE VULGARIS)” is a bonafide andgenuine research work carried out by me under the guidance ofDr. Sanghamitra Patnaik M.D. (Ayu) Associate Professor Department ofP.G. Studies in Panchakarma and under the co-guidance ofDr. Anilkumar Baccha M.D.(Ayu). Asst. Professor, Department ofKayachikitsa N.K.J. Ayurvedic Medical College & P. G. ResearchCenter, Gumpa, Bidar.Date : Signature of the CandidatePlace: BIDAR. (Anil S. Managuli)
  3. 3. DEPARTMENT OF POSTGRADUATE STUDIES IN PANCHAKARMA N.K.J.A.M.C., P.G. RESEARCH CENTER, BIDAR. (Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka) CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled“COMPARATIVE CLINICAL STUDY ON EFFECT OFVAMANA FOLLOWED BY LEPA AND ONLY LEPA INYOUVANA PIDAKA (ACNE VULGARIS)” is a bonafideresearch work done by the “Anil S. Managuli” in partial fulfillment ofthe requirement for the degree of Ayurveda Vachaspati M. D. (Ayu) Signature of the GuideDate : Dr. Sanghamitra PatnaikPlace: BIDAR. M.D. (Ayu) Associate Professor Dept. of P.G. Studies in Panchakarma N.K.J.A.M.C., P.G. Research Center, Bidar.
  4. 4. DEPARTMENT OF POSTGRADUATE STUDIES IN PANCHAKARMA N.K.J.A.M.C., P.G. RESEARCH CENTER, BIDAR. (Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka) CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled“COMPARATIVE CLINICAL STUDY ON EFFECT OFVAMANA FOLLOWED BY LEPA AND ONLY LEPA INYOUVANA PIDAKA (ACNE VULGARIS)” is a bonafideresearch work done by the “Anil S. Managuli” in partial fulfillment ofthe requirement for the degree of Ayurveda Vachaspati M. D. (Ayu) Signature of the Co-GuideDate : Dr. Anilkumar BacchaPlace: BIDAR. M.D. (Ayu) Asst. Professor, Department of Kayachikitsa N.K.J.A.M.C., P.G. Research Center, Bidar.
  5. 5. DEPARTMENT OF POSTGRADUATE STUDIES IN PANCHAKARMA N.K.J.A.M.C., P.G. RESEARCH CENTER, BIDAR. (Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka) ENDORSEMENT BY THE H.O.D. & PRINCIPAL This is to certify that the dissertation entitled“COMPARATIVE CLINICAL STUDY ON EFFECT OFVAMANA FOLLOWED BY LEPA AND ONLY LEPA INYOUVANA PIDAKA (ACNE VULGARIS)” is a bonafideresearch work done by the “Anil S. Managuli” under the guidance ofDr. Sanghamitra Patnaik M.D. (Ayu) Associate Professor & H. O. D.Department of P.G. Studies in Panchakarma N. K. J. AyurvedicMedical College & P. G. Research Center, Gumpa, Bidar. H. O. D. PRINCIPALDr. Sanghamitra Patnaik Dr. K. V. L. N. Acharyulu M.D. (Ayu) M.D. (Ayu)Department of P.G. Studies Principal & Deanin Panchakarma N. K. J. Ayurvedic Medical College & P. G. Research Center, Bidar.Date : Place: BIDAR.
  6. 6. COPY RIGHT DECLARATION BY THE CANDIDATE I hereby declare that the Rajiv Gandhi University ofHealth Sciences, Bangalore, Karnataka shall have the rights topreserve, use and disseminate this dissertation in print or electronicformat for academic / research purpose.Date : Signature of the CandidatePlace: BIDAR. (Anil S. Managuli) © Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
  7. 7. ACKNOWLEDGEMENT “Love is the only inspiration.” Along with the divine blessings ofLord Manjunatheshwar and Lord Dhanwantari, this work carries somememories to express gratitude and record some distinguishedpersonalities with whom I had inspired during the course of this thesis. It is an inexplicable pleasure, sincere and respectful regards to Pujya Shri. Shri. Siddharudha Mahaswamiji, Siddharudha Math,Gumpa, Bidar. My vocabulary falls short of suitable words to express my reconditesense of indebtedness – Dr. K. V. L. N. Acharuyulu M.D. (Ayu) Principal & Dean Dr. P. V. Sauvnur M.D. (Ayu) Vice-Principal Dr. V. S. Patil M.D. (Ayu) Medical Advisor Dr. Sanghamitra Patnaik, M.D. (Ayu) Guide & H. O. D. Dr. Anilkumar Bacha M.D. (Ayu) N. K. J. A. M. C., P. G. Research Center, Bidar. It is beyond the reach of my language to inscribe the profoundrespect and devotion towards affectionate to Dr. Harini C. M.D.(Ayu), Asst. Prof. PG Dept. Of Panchakarma Dr. Manikrao Kulkarni M.D.(Ayu), Lecturer, PG Dept. Of Panchakarma Dr. Nagesh Gandagi, M.D. (Ayu) Lecturer, Dept. of Kayachikitsa Dr. Deepali Sherikar M.D.(Ayu), Lecturer, Dept. Of Kayachikitsa Dr. Sanjeev Kadalewad M.D.(Ayu), Lecturer, Dept. Of Kayachikitsa Dr. Ratnakar L. V. M.S.(Ayu), Prof. & HOD PG Dept. Of Prasutitantra Dr. Bandeppa Sangolagi, M.D. (Ayu) Asst. Prof. Dept. of Rasashastra Dr. Praveen Shimpi M.D. (Ayu) Asst. Prof. Dept. of Rasashastra Dr. Chandrakant Halli M.D. (Ayu) Asst. Prof, PG Dept. of Shalyatantra Dr. Divyadarshan Shelly M.D. (Ayu) RMO & Lecturer Dept. of Shareera Rachana N.K.J.A.M.C., & P.G. Research Center, Bidar.
  8. 8. I express my obligation and heartfelt thanks to my teachers Dr. Anand Jabshetty M.S. (Ortho) Asst. Prof. BIMS, Bidar. Dr. Vijaykumar Kote M.D.DVD Dermatologist, Asst. Prof. BIMS, Bidar. Dr. Sipra Sasmal M.D. (Ayu) C.C.R.A.S., Bhuvaneshwar. Dr. Mallikarjun Malipatil M.Pharma., Ph. D. Professor Dept. Of Pharmacognosy, Karnataka College of Pharmacy I acknowledge technical and non-technical staff members of ourinstitute who have helped me – Shri. Rajakumar Kadam, (Lib.) Smt.Sakubai, Shri. Rajkumar, Shri. Kanteppa, Shri. Basavaraj, Smt.Parvathi, Smt. Guramma, Smt. Padmavati, Mr. Jagadish, Mr. Santosh,Shri. Mohan Reddy, at N. K. J. A. M. C., P. G. Research Center, Bidar. I wish to express thanks to my friends, seniors, juniors & colleagues.Special thanks to Dr. K.P. Namboothiri, Dr. Girish, Dr. Pradeep, Dr.Gourish, Dr. Mahesh, Dr. Vivek, Dr. Prashant, Dr. Omprakash, Dr.Siddharam, Dr. Santosh, Dr. Shankar, Dr. Satish, Dr. Jyoti Dr. Raju,and Dr. Muralikrishna As I recall my parents Shri. Shivaputra B. Managuli and Smt.Sushila who advised me to enter in this noble profession. The truth dawnson me that the language of words suffers very stringent limitation. I havenot been able to find words enough to express my sentiments, love,respect and gratitude for them. I must record the occasion to show love and gratitude towards myyounger brother Mr. Sunil & Shri. Umesh Patil & Smt. Sunita whoinspired and blessed me to achieve this milestone in my life along withtheir timely help in many ways like moral support, financial assistance, etc. I acknowledge my patients for their wholehearted consent toparticipate in this clinical trial. I thank my patients who exhibited high levelof patience and subjected themselves for cooperating with me in everystage of my clinical work. Lastly I express my thanks to all the persons who have helped medirectly and indirectly with apologies for my inability to specify themindividually. I did this work as a partial fulfillment of Post graduationdegree, but dedicate to forthcoming researchers of Ayurveda.DATE : (Anil S. Managuli)PLACE : BIDAR.
  9. 9. ABBREVIATIONSAH – Ashtanga HridayaAS – Ashtanga SangrahaCS – Charaka SamhitaBV – BhavaprakashaMN – Madhava NidanaShS – Sharangadhara SamhitaSS – Sushruta SamhitaYR – Yoga RatnakaraAD – ArundattaGr – GroupBT – Before Treatment (Day 0)AT – After treatment (Day 7)FU1 – 1st Follow up (45 Days after treatment)FU2 – 2nd Follow up (75 Days after treatment)FU3 – 3rd Follow up (105 Days after treatment)NI – No improvementMiR – Mild reliefMoR – Moderate reliefMrR – Marked reliefCR – Complete relief
  10. 10. ABSTRACTBackground and Objectives Acne vulgaris is a chronic inflammatory disease of thepilosebaceous units of the skin of certain body parts with formation of apapules / pustules eruption commonly known as pimples. The classicaldescription of Youvana Pidaka resembles with this. Objective of the present study was to evaluate and compare theeffect of Vamana with Lepa and only Lepa in Youvana Pidaka (Acnevulgaris).Methods 30 patients filling the inclusion criteria of Youvana Pidaka wererandomly selected and divided into 2 groups. In Gr. A the patients weresubjected for Vamana with Kritavedhana followed by Manjishta MadhuLepa. In Gr. B the patients were subjected for Manjishta Madhu Lepa. Source of the data – Patients were selected from OPD and IPD ofPG Department of Panchakarma, N.K.J.A.M.C., P. G. Research Center,Bidar. Clinical signs and symptoms were given suitable self formulatedscores according to its severity. Patients were assessed based on pre andpost data gathered through pre-designed research proforma. The results having ‘p’ value less than <0.05 was considered to bestatistically significant in this study.
  11. 11. Results Overall effect of the treatment in Gr. A was – Moderate improvement was found in 05 patients (33.33%) Marked improvement was found in 08 patients (53.33%) Complete relief was found in 02 patients (13.33%) Overall effect of the treatment in Gr. B was – Moderate relief was found in 09 patients (60%) Marked improvement was found in 06 patients (40%)Interpretation and conclusion Manjishtha-Madhu Lepa was found effective in the management of Youvana Pidaka All the patients were responded to the given treatment without any complications In most of the cases complete relief was found in pain, burning sensation, number of Pidaka, dryness of the face, score of the Pidaka on the basis of affected place and global acne grading system after the treatment Manjistha-Madhu Lepa is an efficacious, cost effective, safe and better drug in the management of Youvana Pidaka (Acne vulgaris) The effect of Lepa followed by Vamana was better than only Lepa prescribed to the patient The result obtained in Gr. A were better than in Gr. B after treatment as well as during subsequent follow ups with minimal recurrenceKEY WORDS – Youvana Pidaka, Vamana, Lepa, Kritavedhana, Majishtha, Madhu.
  12. 12. CONTENTS Chapters Page No.01) Introduction 01 – 0302) Objectives 0403) Review of literature 05 – 72 Ayurvedic review 05 – 39 Modern review – Shareera and Disease review 40 – 72 Drug review 73 – 0004) Methodology 00 – 8605) Observations & Results 87 – 14006) Discussion 141 – 17307) Conclusion 174 – 17508) Summary 176 – 17809) Bibliography i – xviii10) Annexure xix – xxxiv
  13. 13. LIST OF TABLESSL. TABLE Pg.01. Layers of the skin according to various authors 0702. Explanation of Twacha According to Sushruta 0803. Aharaja Nidana of Youvana Pidaka 1304. Viharaja Nidana of Youvana Pidaka 1405. Manasika Nidana of Youvana Pidaka 1406. Anya Karana of Youvana Pidaka 1407. Sign & Symptoms of Youvana Pidaka according to various 18 authors08. Quantity of Sneha Dravya in Lepa formulation 3109. Types of Lepa according to various seasons 3210. Process of Vamana and effect of Vamaka Dravya 3711. The criteria for the evaluation of Shuddhi 3812. Samsarjana Krama on Various days 3913. Differential Diagnosis on Acne Vulgaris 6813a. Prescription guidelines for systemic antibiotics 7013b. Adverse reactions associated with oral antibiotic usage 7014. Drugs used during clinical study 7315. Properties of Drugs used during clinical study 7416. Karma & indication of Drugs used during clinical study 7517. Preparation of Peyadi Samsarjana Krama 7817a. Procedure of Conducting the Vamana 7918. Distribution of patients registered in trial Groups 8719. Distribution of patients according to Age 8820. Distribution of patients according to Sex 8821. Distribution of patients according to Religion 8822. Distribution of patients according to Education 9023. Distribution of patients according to Occupation 9024. Distribution of patients according to Socio-Economic Status 9025. Distribution of patients according to Habitat 92
  14. 14. 26. Distribution of patients according to Marital Status 9227. Distribution of patients according to Dietary Habits 9228. Distribution of patients according to Prakriti 9429. Distribution of patients according to Satwa 9430. Distribution of patients according to Desha 9431. Distribution of patients according to Vyayama Shakti 9632. Distribution of patients according to Satmya 9633. Distribution of patients according to Divaswapna 9634. Distribution of patients according to Agni 9735. Distribution of patients according to Ahara Nidana Specification 9936. Distribution of patients according to Vihara Nidana Specification 10037. Distribution of patients according to Site of Pidaka 10138. Distribution of patients according to Chronicity 10139. Distribution of patients according to Varna of Patient 10340. Distribution of patients according to Shotha of Pidaka 10341. Distribution of patients according to Onset of Pidaka 10342. Distribution of patients according to aggravation of Pidaka 105 in Season43. Distribution of patients according to Family history of acne 10644. Distribution of patients according to Relation with 106 Rajopravrutti45. Distribution of patients according to Type of Vedana 10846. Distribution of patients according to Number of Pidaka 10847. Distribution of patients according to Density of Pidaka 10848. Distribution of patients according to Nature of Pidaka 11049. Distribution of patients according to Area Affected 11050. Distribution of patients according to Size of Pidaka 11151. Distribution of patients according to Number of scars 11152. Distribution of patients according to Pain 11253. Distribution of patients according to Burning Sensation 11254. Distribution of patients according to Use of cosmetics 11555. Distribution of patients according to Dosha Pradhanata 115
  15. 15. 56. The “t” test result showing the difference between the 117 means of samples before and after the treatment in reduction of severity of pain in both the groups57. The “t” test result showing the difference between the 119 means of samples before and after the treatment in reduction of severity of burning sensation in both the groups58. The “t” test result showing the difference between the 121 means of samples before and after the treatment in reduction of severity of number of Pidaka in both the groups59. The “t” test result showing the difference between the 124 means of samples before and after the treatment in reduction of severity of size of Pidaka in both the groups60. The “t” test result showing the difference between the 126 means of samples before and after the treatment in reduction of severity of number of scar in both the groups.61. The “t” test result showing the difference between the 128 means of samples before and after the treatment in reduction of severity of oiliness of the face in both the groups62. The “t” test result showing the difference between the 131 means of samples before and after the treatment in reduction of severity of dryness of the face in both the groups63. The “t” test result showing the difference between the 133 means of samples before and after the treatment in reduction of severity of score of the Pidaka on the basis of affected place in both the groups64. The “t” test result showing the difference between the 135 means of samples before and after the treatment in reduction of severity of score of the Pidaka on the basis of Global Acne Grading System place in both the groups65. The % of improvement in Individual Symptoms of Youvana 138 Pidaka After treatment & 3rd Follow up66. The over all Response of the Therapy 139
  16. 16. 66a. The percentage of improvement in individual parameters of Youvana pidika after the treatment and Third follow up66b. The over all improvement in both groups after treatment in all the parameters 67. Master Chart Showing Demographic Data of patients in – group B. 68. Master Chart Showing Demographic Data of patients in – group B 69. The assessment of Pain before & after the treatment and in xxx all three follow ups 70. The assessment of burning sensation before & after the xxx treatment and in all three follow ups 71. The assessment of number of Pidaka before & after the xxxi treatment and in all three follow ups 72. The assessment of size of Pidaka before & after the xxxi treatment and in all three follow ups 73. The assessment of number of scars before & after the xxxii treatment and in all three follow ups 74. The assessment of oiliness of the face before & after the xxxii treatment and in all three follow ups 75. The assessment of dryness of face before & after the xxxiii treatment and in all three follow ups 76. The assessment of score of Pidaka on the basis of affected xxxiii place before & after the treatment and in all three follow ups 77. The assessment of global acne grading system before & xxxiv after the treatment and in all three follow ups
  17. 17. LIST OF GRAPHSSL. TABLE Pg.01. Age-wise distribution of the patients 8902. Sex-wise distribution of the patients 8903. Religion-wise distribution of patients 8904. Educational status-wise distribution of the patients 9105. Occupation-wise distribution of the patients 9106. Socio-Economic status-wise distribution of the patients 9107. Habitat-wise distribution of the patients 9308. Marital status-wise distribution of the patients 9309. Dietary habits-wise distribution of the patients 9310. Prakriti-wise distribution of the patients 9511. Satwa-wise distribution of the patients 9512. Desha-wise distribution of the patients 9513. Vyayama Shakti-wise distribution of the patients 9714. Satmya-wise distribution of the patients 9715. Divaswapna-wise distribution of the patients 9816. Agni-wise distribution of the patients 9817. Ahara specific Nidana wise distribution of the patients 10218. Vihara specific Nidana wise distribution of the patients 10219. Site of Pidaka-wise distribution of the patients 10220. Chronicity-wise distribution of the patients 10421. Varna of patient-wise distribution of the patients 10422. Shotha of Pidaka-wise distribution of the patients 10423. Onset of Pidaka-wise distribution of the patients 10524. Aggravation of Pidaka in Season-wise distribution of the 107 patients25. Family history of Pidaka-wise distribution of the patients 107
  18. 18. 26. Relation with menses-wise distribution of the patients 10727. Type of Vedana-wise distribution of the patients 10928. Number of Pidaka-wise distribution of the patients 10929. Density of Pidaka-wise distribution of the patients 10930. Nature of Pidaka-wise distribution of the patients 11331. Area of Pidaka involved-wise distribution of the patients 11332. Size of Pidaka-wise distribution of the patients 11333. Number of scars-wise distribution of the patients 11434. Pain-wise distribution of the patients 11435. Burning Sensation-wise distribution of the patients 11436. Use of Cosmetics-wise distribution of the patients 11637. Dosha Pradhanata-wise distribution of the patients 11638. % of Reduction in mean score in Pain of Pidaka 12339. % of Reduction in mean score in Burning sensation 12340. % of Reduction in mean score in Number of Pidakas 12341. % of Reduction in mean score in Size of Pidakas 13042. % of Reduction in mean score in Number of Scars 13043. % of Reduction in mean score in Oiliness of the face 13044. % of Reduction in mean score in Dryness of the face 13745. % of Reduction in mean score in Score of Pidaka on the 137 basis of Affected area46. % of Reduction in mean score in Acne Global Grading 137 Sysem47. Results obtained After treatment & 3rd Follow up in Group A 13948. Results obtained After treatment & 3rd Follow up in Group B 14049. Over All improvement in Group A 14050. Over All improvement in Group B 140
  19. 19. LIST OF FLOW CHARTS, FIGURES & PHOTOGRAPHSSl. Table Pg. FLOW CHARTS01. Samprapti of Youvana Pidaka according to 16 Sharangadhara02. Samprapti of Youvana Pidaka according to Vagbhata & 16 Sushruta03. Summerized Samprapti of Youvana Pidaka 1704. The Procedure of Lepa in detail 3005. Pathological Consequences in Acne Vulgaris 53 PHOTOGRAPHS05. Ghrita, Tila Taila, Yashtimadhu Kwatha Churna06. Madhu, Ksheera, Yashtimadhu Phanta07. Kritavedhana and Kritavedhana Churna08. Dried Kritavedhana, Kritavedhana soaked in Yashtimadhu Phanta, Kritavedhana ready for usage during Vaman09. Saindhava Lavana, Manjishta, Manjishta-Madhu Paste ready for application10. Saindhava Jala, Trikatu Churna, Snehapana with Moorcchita Ghrita11. Sarvanga Abhyanga with Moorcchita Tila Taila12. Sarvanga Bashpaswedana, Aakantha Pana, Patient during Vamana procedure13. Mukha Prakshalana, Dhoomapana, Containts of the vomitus14. Anatomy of Skin and Pathogenesis of Acne vulgaris15. Pathogenesis and Clinical presentation of Acne vulgaris16. Group – A – Vamana followed with Manjishta Madhu Lepa – Before, During and After the treatment17. Group – A – Vamana followed with Manjishta Madhu Lepa – Before and After the treatment18. Group – B – Only Manjishta Madhu Lepa – Before, During and After the treatment
  20. 20. INTRODUCTION Ayurveda, the holistic healing Shastra, deals with the concept ofindividual approach. The preventive and curative aspects1 of individual liferelated entities are summed up in eight branches of Ayurveda.2 Panchakarma is developing as an emerging individual specialty fieldof research in Ayurveda. It has become the sole attraction of the Ayurvedictreatment. All most all specialties require the Panchakarma procedures,hence gained much popularity. It is the natural instinct of mankind to have a healthy and glamorousskin with attractive personality. But very few are blessed with naturallyperfect skin. People always have great concern about their health andbeauty (i.e. good looking). Thus, health and beauty are the two faces ofsingle coin.3 Face is the index of body & mind. Youvana Pidika is a most commonanomaly, usually self limiting, found in teenagers and young adults.4 Thisresults in disfigurement of facial skin leads to feeling of inferiority complexand sometimes depression, isolation from society, suicidal tendency, etc.5It is produced due to combine association of vitiated of Vata, Pitta, KaphaDoshas along with Rakta as dushya.6 It is explained under the concept ofKshudraroga.7
  21. 21. Acne vulgaris is a chronic inflammatory disease of thepilosebaceous units of the skin in certain body parts with formation of apapules / pustular eruption commonly known as pimples.8 The classicaldescription of Youvana Pidaka resembles with this. It commonly affects the skin of face involving forehead, cheeks,nose, and chin. It rarely affects neck, chest, shoulder, back. It is closelyrelated to the hormonal changes at puberty.9 Nearly 8 out of 10adolescents suffers from acne vulgaris. Majority of patients recovers with20-25 years, although 10-20% of adults may experience its severe forms.10In women, it rarely lasts beyond the early 30’s and normally it is worsebefore each menstrual period.11 Various systems of medicines come up with various remedies andtherapeutic procedures stating from simple topical applications till theextensive management like use of X-ray, antibiotics, multivitamins,hormones, corticosteroids, etc. In spite of their therapeutic values, theseprocedures posses temporary relief, limitation and several health hazardson body.12 Cosmetology is branch of medicine which is coming up with thevarious methods to preserve and to restoring bodily beauty. Variouschemical and cosmetic agents are taken into practice which has gottemporary effect. Some of the chemicals used in the practice ofCosmetology produces severe allergic reactions in few people.
  22. 22. Looking into above facts there is a need of treatment which canprevent complications of the disease as well as reduces the recurrenceeffectively. In classics dozens of topical applications are explained for thiscondition. Among that Manjishta-Madhu13 external application wasselected for the present clinical study. Vamana is the treatment of choice for Kustha’s which produces inUrdhvanganga Shareera. Sushruta14 praised utility of Vamana as a bestremedy, capable of alleviating the pathogenesis of Youvana Pidikaefficiently. So an effort was made to study the comparative efficacy of Vamanafollowed by Manjishtha Lepa & only Manjishtha-Madhu Lepa in themanagement of Youvana Pidika. 30 patients were randomly selected and subjected into 2 groups. Group A – 15 patients were subjected for Classical Vamana followed with Manjishta-Madhu Lepa. Group B – 15 patients were subjected for Manjishta-Madhu Lepa alone. During the duration of study the patients were assessed on the basisof pre and post treatment with pre-designed research profile and selfdesigned severity grading. The data was collected as pre treatment (Day 0– BT), after treatment (Day 30 – AT), first follow up (Day 45 – FU1 fromAT), second follow up (Day 75 – FU2 from AT), third follow up (Day 105 –FU3 from AT).
  23. 23. OBJECTIVES OF THE STUDY Vamana is one of the major procedures in Panchakarma. This isa Shodhana procedure which has got effect all over the body with longterm results. Lepa is local treatment procedure in which the medication ismade into a paste form and applied over the desired site with particularthickness and removed after specified time. The present study was undertaken in 2 groups with a course ofVamana followed by Lepa and Lepa alone in cases of Youvana Pidaka(Acne vulgaris). The samples were collected from OPD and IPD ofDepartment of P.G. Studies in Panchakarma, N. K. J. A. M. C. & P. G.Research Center, Bidar with following objectives – Evaluate the effect of Manjishta-Madhu Lepa in Youvana Pidaka Evaluate the additional effect of Vamana with Kritavedhana followed by Manjishtha-Madhu Lepa in Youvana Pidaka Compare the effect of only Lepa over the Vamana followed by Lepa in Youvana Pidaka
  24. 24. HISTORICAL REVIEW Youvana Pidaka is a common condition observed in day to daylife. But, detail explanation about its aetiopathogenesis is not mentioned inclassics. Numbers of remedies are explained in all most all treatises andeven in traditional practice.PRE-VEDIC AND VEDIK ERA The Vedik literature was the treasure of knowledge in those days. Ithas briefed all the life related sciences in it. But the word Youvana Pidakaor Youvana Pidaka and its independent explanation is not found in preVedic or Vedic period. Reference of the term Youvana Pidaka is found in Purana Kala,Bhauddha Kala and Adhunika Kala.SAMHITA PERIOD (BRIHAT TRAYEES) Though the Samhita period was the important period for thedocumentation of the clinical experiences of the sages, Sushruta was thefirst to describe about Youvana Pidaka in the context of Kshudraroga. Explanation about the condition is not found in Charaka.LAGHU TRAYEES After Sushruta, later texts have included the Youvana Pidaka in theirliterature. The texts like Madhava Nidana, Sharangdhara, Vangasena,Gadanigraha, Chakradatta, Basavarajeeyam, etc have briefed the aetio-pathology of the disease and explained several treatment modalities forthe same.ADHUNIKA KALA Youvan Pidika described in later texts like Rasakamdhenu,Yogaratnakara, Bhaishajya Ratnavali, Arkaprakasha, Brihat RasarajaSundara, etc.
  25. 25. TWAK SHAREERA Youvana Pidaka is a skin disease. For better understanding ofetiopathogenesis, normal structure of the skin should be considered.FORMATION OF TWACHA According to Sushruta, Twak has developed after the fertilization ofthe ovum. At the time of fertilization Shukra, Shonita and Soul becomeunited for the manifestation of Garbha. Its growth is rapid and nourished byTridosha. Seven folds of the layers of the skin are formed in the embryoduring the first and second trimester of pregnancy, similar to as milk getsits cream over the surface during boiling.01 Twacha is derived out of Panchamahabhoota. Vayu Mahabhutapredominance creates tactile sensation. Bhrajaka Pitta helps in absorptionand metabolism. Topical medicaments give luster and complexion to thebody. Sweda is the Mala of Meda Dhatu. Charaka says, that 10 Anjali ofSweda is formed in a healthy individual. Twak is included under BahyaRogamarga. Twak is formed by the Paka of Rakta Dhatu by its Dhatvagni thus;Twak is also called as “Rakta Santanika”. Vagbhata mentions that the skinis fully developed during 6th month of intrauterine life.
  26. 26. Table No. 01. Layers of the skin according to various authors.SL. SS CS AD ShS Bh01. Avabhasini Udakadhara Bhasini Avabhasini Udakdhara02. Lohita Asrukdhara Lohita Lohita Asrikdhara03. Shweta 3rd Shweta Shweta 3rd04. Tamra 4th Tamra Tamra 4th05. Vedini 5th Vedini Vedini 5th06. Rohini 6th Rohini Rohini 6th07. Mamsadhara – – Mamsadhara Sthula According to Sushruta and Vagbhata02 there are 7 layers of Twakwhereas, Charaka considered only 6 layers in Twak. Sushruta has given specific name for each layer. Whereas, Charakahas mentioned only the first two layers and numbered the others referringthem by the disease to which they are prone. Vagbhata has given specific names to the first two layers and thelast one and the rest were numbered according to the diseases afflictingthem. Ashtanga Sangraha follows the verse of Sushruta but used differentnames for some layers. e.g. Avabhasini and Lohita have been replacedwith Bhasini and Lohini respectively. The names for the other four layersare same as that of Sushruta.
  27. 27. The first layer Avabhasini is mentioned as Udakadhara both inCharaka Samhita and Astanga Sangraha. This layer is so named becauseit provides protection against the loss of fluids. The total thickness of the skin is 3½ Vreehi (approximately 0.7 to0.12mm). This varies in palm, sole and other Mamsala Pradesha but not inLalata Pradhesha.Skin layers according to Sushruta03Table No. 02. Explanation of Twacha according to Sushruta. Sl. NAME FUNCTION Thickness DISEASES in Vreehi01. Avabhasini Reflects Varna 1/18th Sidhma, Elucidate Chhaya Padmini, & Prabha Kantaka02. Lohita – 1/16th Tilakalaka, Nyaccha, Vyanga03. Shweta – 1/12th Charmadala, Ajagallika, Mashaka04. Tamra – 1/8th Kilasa & Kushta05. Vedini – 1/5th Kushta & Visarpa06. Rohini – 1 Granthi, Apachi, Arbda, Shleepada & Galaganda07. Mamsadara – 2 Bhagandara, Vidradhi & Arshas
  28. 28. NIRUKTI The word Youvana Pidaka contains two terms. Viz. Youvana + Pidaka = Youvana Pidaka. Where, Youvana referes to the incidence of the condition typicallyduring adulthood. Pidaka refers to the formation of eruptions. Combinely, it can be taken as the condition which typically observedduring adulthood in the form of eruptions over the face. The word Mukhadooshika contains two terms. Viz. Mukha + Dooshika = Mukhadooshika. Where, Mukha refers to face Dooshika refers to spoiler Combinely, it can be taken as the condition which disfigures or spoilsthe face.01VYUTPATTI It is a feminine gender and derived as Youvano Vyutpatti: Youvanam ( ) Pidika Vyutpatti: | – ( ) = or circular swelling. From the above two it is clear that the circular swelling like Pinda(papule, pustule, nodule, etc) occurring on the face in youth is YouvanaPidika. “ ” It means that, which disfigures the face along with discoloration isknown as Mukhadooshika. Mukhadooshika = Mukhagata Kshudraroga Bhede.02 The Mukha Twak undergo Paka.03 The term “Youvana” is derived from04 “Youvanavasthayam” |
  29. 29. “Tachcha Panchadashadoordhwamuchyate” | “Kaishoram Panchadashat Youvanantu Tataha Param”|Pidaka is derived from “Peedayati Iti Pidakaha”| “Yasya Pittam Prakupitam Twachi Rakte Avatishtate | “Shotham Saragam Janayet Pidaka Tasya Jayate” ||05 The aggravated Pitta located in the Tvaka and Rakta causes redswelling which is known as Pidaka. “Pidakayam Cha Sthiro Jneya Ata Eva Pidaka Sampraptau”| The lesion, which is neither spreading nor stable in nature, is calledPidaka.06 “Youvana” means Youth, Youthfulness, Puberty and Manhood.07 Pidaka means Kantaka that which occurs on the face of youth (YuvaKali Mukhajata Pidakayam).08SYNONYMS The synonyms were used to describe the nature of the condition andhighlight various facts of Youvana Pidaka. 1. Mukhadooshika09 2. Tarunya Pidaka10 3. Youvana Pidaka11 4. Varandaka12 5. Ananadooshika13 6. Vayasphoda14
  30. 30. Meanings of the above mentioned synonyms are as follows – Mukhadooshika – The condition which spoils the face of an individual. Tarunya Pidaka – The condition which disturbs in adulthood. Youvana Pidaka – The condition which disturbs in early adulthood. Varandaka – The condition which appears along with the growing age. Ananadooshika – The condition which disturbs the face. Vayasphoda – The eruption of the follicles or papule with the growing age.NIDANA Youvana Pidaka is explained in the context of Kshudra Roga.Hence, direct reference regarding detail etiopathological factors is notfound. Following are some of the Nidana that are explained during theexplanation of the condition as well as some of the cross referencesmentioned in the context of Kushta and other skin diseases. Mala of Shukra Dhatu is Youvana Pidaka. So Shukra Vriddhi can be taken a cause for Youvana Pidaka.15 Youvana Pidaka occurs because of its Swabhava.16 All three Doshas are involved in the manifestation of Youvana Pidaka and even it occurs due to its Swabhava.17 Youvana Pidaka is having Kapha, Vata and Rakta as Dooshya. Hence we consider general causes of vitiation of Vata, Kapha and Rakta as Nidana factors for Youvana Pidaka.18,19, 20,21,22,23
  31. 31. Pidaka is one of the Raktaja Vikara. The causes of Raktaprakopaare Krodha, Shoka, Bhaya, Aayasa, Vidagda Ahara Sevana,Maithuna, excessive intake of Katurasa, Amlarasa, Lavanarasa,Teekshna, Ushna, Laghu, Vidahi Ahara, excess intake of Tila Taila,Pinyaka, Kulatta, Sarshapa, Atasibeeja, Haritashaka, Mamsa ofGodha Matsya, Aja, Avika, Dadhi, Takra, Sura and Amlaphala.24Apart from these, intake of Drava, Snigdha, Guru Ahara,Divasvapna, Krodha, excess Atapa Sevana, intake ofViruddhashana and excess Parishrama causes Rakta Prakopa.25Excess intake of Teekshna, Ushna, Madya, Lavana, Kshara, Amla,Katu Rasa, Kulattha, Tilataila, Moolaka, Harita Shaka, Jalaja andAnupa Mamsa, Dadhi, Amlamastu, Sura, Souvira, indulgence inincompetent food (Viruddha Ahara), Paryushita Ahara, consumptionof excess food, day sleep immediately after consumption of Snigdha,Drava and Guru Ahara, excess exposure to sunlight, fire, excess ofanger, suppression of Chhardi and if non implementation ofRaktamookshana during Sharad ritu causes Pidaka in general.26According to Charaka foods and activities, which have similarproperty to that of Dooshya causes Srotodushti, so here RaktaPrakopaka Aahara and viharas causes the Youvana Pidaka.27Svabhava is bound to human body by invisible factors, is alsoanother factor for Youvana Pidaka.28,29
  32. 32. Brief description of Youvana Pidaka is available in all the Samhitas,and they have mentioned Kapha, Vata, Rakta, as the causative factors ofthe disease. Here the causes are summarized as follows – All the Nidana can be divided in following categories. Viz. 1. Ahara 2. Vihara 3. Manasika and 4. Anya KaranaTable No. 03. Aharaja Nidana of Youvana Pidaka DOSHA AHARAJA NIDANAVataja Excess intake of Katu, Tikta and Kashaya Rasas, Rooksha, Laghu Guna Aharas,Varaka(Kudhanya), Uddhalaka, Koradoosha, Shyamaka, Neevara, Mudga, Masoora, Shushka Shaka Ahara SevanaKaphaja Excess intake of Madhura, Amla & Lavana Rasas, Sheeta, Snigdha, Guru, Picchila, and Abhishyandhi Ahara Sevana. Dadhi, Dugdha, Krishara, Payasa & Ikshu Vikara, Anupa Udaka, Vasabisa, Mrunala, Kaseruka and Srungata mamsa, Madhura ValliRaktaja Excess intake of Lavana, Kshara, Katu, Amla Rasas, Jalaja, Anupa, prasaha, Bileya, Aja, Avika mamsa, Kulatta and Masha Dhanyas, Dadhi, Takra, Amlamatsu. Pradusta, Ushna, Tikshna, Madya Sura & Souviraka. Tilataila, and Atasitailas, Lashuna, Harita Shaka, Moolaka
  33. 33. Table No. 04. Viharaja Nidana of Youvana Pidaka DOSHA VIHARAJA NIDANAVataja Anashana, Vishamashana and AdhyashanaVata, Mootra, Pureesha, Shukra, Chardi etc. Vega Vidharana, Balavat Vigraha, Ativyayama and Vyavaya, Parapatana, Pradhavana, Prapeedana, Abhighata Langhana, Plavana, Tarana, Ratri Jagarana, Bharaharana. Dhatu Kshaya, Rogatikarshana, Dukha, Shyyasana, Divaswapna, Marma Bhadha, Vishamad Upachara, etc.Kaphaja Adhyashana, Prabhruti, Divaswapna, Avyayama, Alasya.Raktaja Adhika Bhojana, Ati Atapa Sevana, Chardivega Dharana. Not undergoing Raktamokshana during sharadritu, Excess exhaustion, AdyashanaTable No. 05. Manasika Nidana of Youvana Pidaka DOSHA MANASIKA NIDANAVataja Ati-Shoka, Bhaya, Chinta, Krodha and UdvegaRaktaja Ati-Shoka, Bhaya, Chinta, Krodha and UdvegaTable No. 06. Anya Karana of Youvana Pidaka DOSHA ANYA NIDANAVataja Varsha, Vata PrakritiKaphaja Vasanta, Kapha PrakritiRaktaja Sharad Ritu, Pitta PrakritiSAMPRAPTI OF YOUVANA PIDAKA Detail Samprapti of Youvana Pidaka is not mentioned in classics.Here an attempt has been made to construct its step-wise Sampraptibased on available classical references and symptomatology.
  34. 34. Sharangdhara has accepted Mukha Snigdhata and Youvana Pidakaas Mala of Shukra Dhatu. As mentioned earlier most of the classics havementioned the vitiation of Kapha and Vata Dosha and Rakta Dooshyaleading to Youvana Pidaka. Thus when Kapha and Vata get vitiated and byinvolving Rakta produce Youvana Pidaka. As Youvana Pidaka is relatedwith Shukra therefore it occurs in young person during their adult hood.SAMPRAPTI GHATAKA 1 Dosha – Kapha and Vata 2 Dooshya – Rasa, Rakta, Meda, Shukra 3 Upadhatu – Twacha 4 Mala – Sweda, Tvaksneha 5 Srotasa – Swedavaha, Raktavaha. 6 Srotodushti – Sanga 7 Agni – Dhatwagni Mandya 8 Sthana – Twak 9 Samutthana – Amashaya 10 Roga Marga – Bahya Marga 11 Udbhava sthaana – Ama-Pakvashaya 12 Sanchaara sthana – Urdhwa Shareera 13 Vyakta Sthana – Mukha
  35. 35. On the basis of the above Samprapti Ghataka following sketch ofSamprapti of Youvana Pidaka may be constructed.Flow chart No. 01. Samprapti of Youvana Pidaka according toSharangadhara. Nidana Kapha, Vata, Rakta Prakopaka Later involvement of Shukradhatvagni Excess of Shukradhatu Mala Vaktra-Snigdhata leads to YOUVANA PIDAKAFlow chart No. 02. Samprapti of Youvana Pidaka according to Vagbhata &Sushruta. Nidana sevana Kapha, Vata, Rakta, Meda Prakaopa Rasa-Raktadi Dhatvagni Vaishamya (Mainly Medo Dhatvagni Mandhya) Excess Sweda Utpatti as Mala (Sweda is Mala of Meda) Meda Sangha in Roma Kupa (Swedavaha Srotas Moola) YOUVANA PIDAKA
  36. 36. Flow chart No. 03. Summarized Samprapti of Mookhadooshika NidanaDosha Prakopaka Dushya Dourbalyakara AgnimandyakaraVata Pitta Kapha Rakta Meda Twak Sweda Ama Kha Vaigunya in Swedavaha & Raktavaha Srotas Kaphadhikya (Sebum ) Sang In Swedavaha & Raktavaha Srotas Shushakata in Kapha & meda Dosha Samurchana Pidika with Medogarbhi (Poorvaroopa) Pittaja Vataja Kaphaja (Rupavastha) Paka, Daha, Srava, Vedana,Rukshata Kandu, Snigdhata, Vaivarnya, Ushnata Krishnata Kathinata MUKHA DUSHANA VAIVARNYA VRANA VASTU (Nodule Cyst Comedon etc) (Perme of discoloration) (Scars)
  37. 37. PURVA RUPA (PREMONITORY SYMPTOMS) The Poorvaroopa of Kshudra Rogas is not mentioned in classics.While commenting on Charaka Chikitsa Vaatavyadhi Adhyaya,Chakrapaani commented that, if Poorva Roopa is not mentioned, oneshould consider the Laghu Roopa of the disease as Poorva Roopa. 30ROOPA (SIGNS AND SYMPTOMS) Signs and symptoms of Youvana Pidaka is summarized according tovarious authors as follows –Table No. 07. Signs and Symptoms of Youvana Pidaka according tovarious authors.SL. LAKSHANA SUSHRUTA VAGBHATA OTHERS 01. Shalmali Kantaka + + + Sadrusha Pidaka 02. Ruja – + – 03. Contains Meda – – + In its core 04. Ghana Shotha – + – 05. Involved Doshas Kapha, Vata Kapha, Vata, Vata, Pitta and Rakta and Rakta Kapha (SKD) 06. Site of affliction Face Face Face 07. Age of occurrence Yauvana Yauvana Yauvana
  38. 38. The references of the above mentioned signs and symptoms are asfollow – 1. Shalmali Kantaka Sadrusha Pidaka31,32,33,34,35,36,37,38,39,40 2. Contains Meda 41,42 3. In its core Ghana Shotha43,44 4. Involved Doshas – Kapha, Vata and Rakta 45,46,47,48,49,50,51,52,53 Vata, Pitta, Kapha54 5. Site of affliction – Mukha (Face)55,56,57,58,59,60,61,62,63,64 6. Age of occurrence – Youvana65,66,67,68,69,70,71,72,73,74 7. Ruja75,76DEFINITION OF YOUVANA PIDAKA The painful eruptions enclosed with Meda, similar to the thorns ofShalmali on the face during adulthood known as Youvana Pidaka. Thedetails of individual signs and symptoms are being elaborated as follows –01. Resembles with Shalmali Kantaka The eruptions are conical in shape, similar to the thorn of Shalmalitree. Shalmali Kantaka is with broad base on the trunk of the tree and withtriangular projection. Similarly, the Mookhadooshika is having broad baseinside the skin and a small triangular eruption over the skin. Here thissimily is being used to demonstrate the shape of eruption. Some believes that, Shalmali Kantaka simily is being given for thepain in Mookhadooshika. Pain experiences the pain like pricking of thethorns of Shalmali.02. Pidaka Pidaka means eruption. This disease is characterized by thepresence of multiple eruptions over the face.
  39. 39. 03. Saruja Saruja means with pain. The eruptions are painful and the pain maybe mild or sub-acute in nature. It may associate with burning sensation.04. Ghana Ghana word refers to the thick or turbid discharge. It also indicatesthe hard in appearance of Pidaka before Paka. Ghana word also can betaken as the deeply indurated eruptions over the skin. This particularfeature appears by the aggravated Kapha.05. Medogarbhata It means the eruptions are enclosed with the thick whitish cheesymaterial which is also having the qualities resembling Meda. It occurs dueto the blockage of openings of pilosebacious gland. When a gentle pressure is applied over the eruptions, it comes outwith some discharge, which is usually whitish, cheesy in appearance. Thisdischarge may vary in colour according to the dominant Dosha.06. Yuna Mukhe This condition typically observed in adulthood and with equalincidence in both sexes. The most predominant site of this disease isMukha. Here, Mukha refers to the outer parts of the face except the mouthsuch as checks, forehead, nose and chin are affected.COMPLICATIONS OF MOOKHADOOSHIKA As such there is no direct reference in classics regarding thecomplications of Youvana Pidaka except disfigurement of the face.
  40. 40. TREATMENT OF YOUVANA PIDAKA Dozens of remedies are mentioned in classics for this condition. Themanagement of Youvana Pidaka can be done in 3 ways. Medicinal management Para-surgical management Surgical managementMEDICINAL MANAGEMENT It includes two types of therapies. Viz. – Systemic therapies – This includes the utility of Panchakarma and other para-surgical procedures. Local therapies – This includes the utility of various types of procedures like Lepa, Gharshana, Swedana, etc.Systemic Management01. Vamana : It is the best procedure to subside the Kaphajaabnormalities and even in Youvana Pidaka. It is also indicated in classicsthat, when all the therapeutic management is not giving satisfactoryresults, then go for Shodhana therapies, typically Vamana. 77,78,79,80,81,82,8302. Nasya : The mediciitons are administered through nostril forthe Urdhvajatrugata Dosha Shamana which may also its influence over theYouvana Pidaka.84,8503. Virechana : This therapy is specific for Pitta Dosha, or PittaSamsarga Doshas. This procedure removes excessive Pitta throughAdhomarga. Thus, helps in Samprapti Vighatana of Youvana Pidaka.
  41. 41. Local Management As per the disease pathology concern local therapies like facialmassage, application of various medications, etc got an immediate impacton the Youvan Pidika. Various formulations are prescribed in classics forthe topical usage in the form of powder, past, oil, ghee, gel, etc. Themethod advised for the application of medication includes special regimenslike Prakshalana, Snehana, Swedana, Lepana and Gharshana.Lepa Rational combination of Varnya dravyas used in the form of externalapplication in Youvana Pidaka. It is found very efficacious when usedsimultaneously with internal administration of the Raktashodhaka,Pittarechaka drugs.86 In Youvana Pidaka use Lepa prepared out of drugs like Vacha, Lodhra, Saindhava and Sarshapa87,88,89,90,91,92,93 Dhanyaka, Vacha, Lodhra and Kusta applied over the face is also useful.94 Application of the Lepa prepared out of Lodhra, Tuvaraka95 Vatapatra, Narikelapushpa, and Shukti are useful96,97 Lepa of Lodhra, Dhanyaka, Vacha over Mukha is useful.98,99,100,101,102,103,104,105 The Lepa prepared out of Gorochana and Maricha.106,107,108,109,110 Matulungajata, Ghrita, Manashila and cow dung these formulation should be applied over the face it improves the complexion and cures the Youvana Pidaka and Nyaccha.111 Milk and Shalmali thorn. If fails then Vamana is to be done.112,113,114 Lepa prepared out of Jatipala, Chandana, Maricha115,116 Bark of Arjuna tree and milk117,118,119 Manjishta Churna with Madhu120,121,122
  42. 42. Washing the face with Varunadi Kwata and Lepa prepared out to Vatapatra, Malathi, Raktachandana, Kusta, and Lodhra, or Matulungajata, ghee, Manashila, Lodhra are applied over the face.123 Kumkumadi Taila Abyanga can also be done. 124 In all Kshudrarogas Sarpi, Nimbachurna and Parpati is to be given internaly.125 Sahacharaghrita126 Parada Bhasma can be used along with other suitable drugs or with any other Yogavahi formulations can be used to treat Kshudra Rogas.127 Haridradi Lepa can be applied for face. Manjishtadi Taila to be over the face.128 Masuradal fried with milk and applied over the face or Kaliyaka, Neelakamala, Kushta, Priyangu Pushpa with milk or Tusharahita Masoora, Yashtimadhu, Yava, Lodhra with milk or Haridra Churna with Arka Ksheera.129PARASURGICAL MANAGEMENT If the medical treatment does not give better results Raktamokshana/ Siravyadha is advised as a parasurgical procedures are advised inYouvana Pidaka.130, 131,132,133,134SURGICAL MANAGEMENT Even after para-surgical procedures, if the patient has not gotsatisfactory relief, following surgical procedures are indicated. Chhedana Agni Karma Kshara Karma
  43. 43. Line of treatment prescribed by various Acharyas can besummarized as follows – Sushruta Samhita : Vamana, Lepana Ashtanga Hridaya : Vamana, Lepana, Nasya, Siravedha Ashtanga Sangraha : Vamana, Lepana, Siravedha Chakradatta : Vamana, Lepana, Siravyadha & Abhyanjana.PATHYA AND APATHYA By considering the involved Dosha, Dooshya and AvasthaPatyaapathya have to be employed. 135,136PREVENTIVE MEASURES Mukha Prakshalana – The healthy person should wash his face and eyes with the decoction of Ksheeriya Vriksha (lactiferous trees) mixed with milk or that of Amalaka or with simple water. It alleviates shortly blue spots, dryness of face, boils, freckles and other diseases caused by Rakta and Pitta. It also makes the vision strong, light and easy.137 Abhyanga – Relieves Kapha and Vata. Restores the proper color and complexion and acts as a nutrient to Dhatu. It prevents the ageing tiredness and eyes become clear, increases the life of the person, person will get the proper sleep and skin become healthy wrinkle free.138 Udhvartana – Relieves Kapha and Medas. It stabilizes Twak and gives complexion to the skin.139 One should under go Rakta Mokshana in Sharad Ritu.140
  44. 44. LEPA The external application of a paste prepared from the drugs isknown as Lepa. It is used to improve the skin health as well as to relievethe diseases.ETYMOLOGY AND DERIVATION OF LEPA The word Lepa is derived from its root “Lip” affixed by “Vang”Pratyaya.1 Lepanam – “Lipyati, Anena iti Lepanam” It means, the one which is used for anointing is Lepa.2 Pradeha – (Pradeha + Gung) Lepa. Lepa – (Lip + Gung) smearing plastering, anointing. Lip – Smearing, anointing, plastering. Lepa – The act of smearing - anointing + plastering.DEFINITION Medicines in the form of paste used for external application areknown as Lepa.Synonyms : Lipta, Lepa or Lepana.3TYPES OF LEPA Pralepa – The paste which is cold, thin and non-drying or drying i.e. with absorbing or non-absorbing property. Pradeha – The paste which is warm or cold, thick or thin acts as non-absorbent and which is Vata and Kapha Shamaka. It cleanses, heals, and alleviates inflammatory swelling and pain.
  45. 45. Alepa – Midway between Pralepa and Pradeha is Alepa. It is of medium character and it normalizes the Rakta and Pitta. 4 Charaka has classified Lepa as follows – Kaathinyakara Pralepa – It is used in Vrana Shaithilyata and in Sukumara. It also have the property of Prasadana.5 Maardavakara Pralepa – It is used in Saruja, Kathina, Stabdha and Nirasrava Vrana.6 Ropana Pralepa – It is used as Twak Grahnanti (binding of torn skin).7 Shodhana Pralepa – It is Twak Shuddhikara.8 Twak Kaarshnyakara Lepa – It is used for Krishna Karma in the discolored skin caused by a Vrana. 9 Savarneekarana Lepa – This Lepa is used for enhancing color and complexion.10 Varnakara Lepa – To get the normal color of skin from healed Vrana this Lepa can be used.11 Roma Sanjanana Lepa – It is used for the reproduction of Roma which got destroyed by the Vrana. 12 Vagbhata13 has mentioned 10 types of Lepa based on their differentactions are as follows – Snaihika Lepa (Oliating or Lubricatory) – This is meant for Vata Dosha and is prepared with Snighda Dravya or Dravya added with more of fats.
  46. 46. Nirvaapana Lepa – This is meant for Pitta Dosha, Pittaja andVishaja Shotha, burning caused by Agni and Ksharadagdha. In thisSheeta Dravya are used.Prasaadana Lepa – This is similar to Nirvaapana Lepa and it ismeant for cleansing the vitiated blood present inside.Stambhana Lepa – Apart from having Nirvaapana Lepa property ithas the additional property of Rakta Stambhana in Raktaatipravrutti.Vilayana Lepa – It is meant for Shleshma and Medas predominantShotha which does not undergo Paka because of its Sheetata,Grathita and Rookshata.Paachana Lepa – It does the Paachana of Apakva Shotha, by usingRooksha and Ushna Dravya.Peedana Lepa – This can be made use in Sookshma Vrana byapplication of Rooksha and Picchila Dravya.Shodhana Lepa – It is indicated in Ashuddha Vrana where usingShodhana Dravya can do Shodhana.Ropana Lepa – As the name indicates it is used for Ropana ofShuddha Vrana.Savarneekarana Lepa – It is meant for bring back the normal skincolor after the ulcer has healed.
  47. 47. Apart from these, 3 more types of Lepa are explained by Vagbhataand Sharngdhara are as follows – Doshaghna – The Lepa, which alleviates the impure Doshas called as Doshaghna Lepa. Due to Prakopa of Dosha following features may appear i.e. Shotha, Shoola etc. To reduce vitiated Dosha this Lepa is useful. Its thickness is 1/4th Angula.14 for Vata and Kapha vitiation Ushna Lepa is advised. Similarly for Pitta, Sheetala Lepa is advised.15 Vishaghna – That which nullifies the poisonous effect is Vishaghna Lepa. Vitiation of Dosha may occur either due to Sthaavara or Jangama Visha Oushadhi. Lepa can be applied to suppress the effect of such Visha or there fore it is called Vishghna Lepa. Its thickness is 1/3rd Angula. 14 Vishaghna Lepa is said to be Sheetala in nature.15 Varnya – That which increases the skin color is Varnya Lepa.Many diseases like Vyanga, Pitika, etc lose normal color and complexion of the face. The Lepa used for its correction is called Varnya Lepa. It is ½ Angula in thickness.14 For Varnya purpose Sheetala Lepa is used.15GENERAL RULES AND REGULATIONS OF LEPA16 Always Lepa should be applied in the opposite direction of hair follicles. The Lepa should not be left in situ after drying. It must be removed as soon as it dries up, until the Lepa is wet, it helps to cure the disease but, as soon as they are dried they lose their potency and irritate the skin. Except in Pralepa, this is kept even after drying for Peedana action in Vrana Shotha. Lepa should be prepared freshly and used.
  48. 48. Lepa drug should not be reused. Fresh Lepa should not be applied over previous one. Lepa should not be applied at night, if applied it causes skin diseases by suppressing local temperature and also enhances the Roga Lakshana. Do not cover the Lepa with cloth because it causes retention of sweat, which in turn leads to Pidaka, Kandu etc. complications. Lepa should neither be too Snighda nor too Rooksha. Neither solid nor liquid (It should be of medium consistency.) The thickness of Pradeha should be Ardra Maheesha Charmavat like that of wet skin of the buffelow17 or 1/3rd of angula.18 Ratri Lepa is indicated in Vrana associated with Apaka shopha, Vata and Shleshma, Kshata, Raktaja Vikara and which is Ati Gambheera. If in Pittaja Shopha Vata Pitta Lakshanas are present then Shatadhouta Ghrita application is advised.19GENERAL METHOD OF LEPA FORMULATIONS Lepa can be prepared from both dry and wet drugs. The dry drugs are powdered fine individually in a Khalvayantra and mixed well if compound formulation is advised. Add required or advised liquids to prepare paste. Some of the liquids advised in classics are Goghrita, Goksheera, Gomutra, Divyajala, Madhu, Taila, Swarasa, Kashaya, etc.
  49. 49. LEPA KARMA PROCEDURE This can be subdivided into 3 types. Viz. – Poorvakarma Pradhanakarma Paschyata KarmaPoorvakarma for Mukha Lepa There is no specific reference for the Poorvaroopa of Lepa. But,Mukha Prakshalana with Luke warm water can be done as a part ofPoorvaroopa in Lepa procedure.Pradhanakarma for Mukha Lepa The procedure for Lepa application is mentioned individually inrespective contexts. The Lepa Karma used in this context is as follows –Flow chart No. 04. The procedure of Lepa in detail. Patient is advised to wash the face with luke warm water Apply the Lepa in the opposite direction of hair follicles. Apply the medicine with gentle pressure and massage. Allow the medicine to be applied for specific period, like till it gets dried. Then the applied medicine is to be removed.
  50. 50. PASCHAT KARMA OF LEPA20 Mukha Prakshalana with Jala after wetting the lepa with water. Abhyanga to faceUTILITY OF SNEHA DRAVYA IN LEPA FORMULATION The utility of Sneha Dravya in Lepa formulation according to Doshais mentioned as follows –Table No. 08. Quantity of Sneha Dravya in Lepa formulation.SL. DOSHA QUANTITY OF SNEHA DRAVYA01. Vataja Vyadhi 1/4th part of Senha Dravya02. Pittaja Vyadhi 1/6th part of Sneha Dravya03. Kaphaja Vyadhi 1/8th part of Sneha DravyaMUKHA LEPA ACCORDING TO VARIOUS KALA In Ushna Kala Lepa is applied for soothing effect and Lepa drugs should be Parama Sugandhi and Sheeta in Veerya.21 In Sheeta Kala Lepa is producing Ushnata and it will be Vata Kapha Nashaka effects.22 Vagbhata has mentioned different Dravya to be used for Mukha Lepa according to different Ritu.23
  51. 51. MUKHA LEPA ACCORDING TO SEASON In classics, various Lepa are advised according to various seasons.Table No. 09. Types of Lepa according to various seasons.SL. SEASON SPECIFIC LEPA01. Hemanta Kola Majja, Vrishanamoola and Goura Sarshapa.02. Shishira Simhimoola, Tila, Krishna, Darvi twak, Nistusha and Yava.03. Vasanta Darbhamoola, Hima Usheera, Shireesha, Mishiba and Tandula.04. Greeshma Kumuda, Utpala, Kalhara, Doorvi, Maduka and Chandana.05. Varsha Kaleeyaka, Tila. Usheera, Mamsi, Tagara and Padmaka.06. Sharad Taleesa, Gundra, Pundra, Yasti, Kashanata and Agaru.BENEFITS OF LEPA24 Mukhalepa helps to overcome the diseases like Akaala Palita(Gryaying of hair), Vyanga (Discoloured patches over face), Vali(Wrinkles), Timira and Neelika (Blur vision and Bluish discolouration),Relieves burning sensation, Itching and Pain, Makes Tvak,Mamsa andRakta Prasadana, etc. Other benefits of regular Mukha Lepa application are as follows25 Stability of the eye sight vision become clear Pleasant facial appearance Good complexion with smoothness (soft) Resembles like a fresh Lotus flower.
  52. 52. CONTRA-INDICATIONS OF MUKHA LEPA26 Peenasa Arochaka Ajeerna Datta Nasya Hanugraha Awaken at night Those for whome Snana is contraindicated are also considered asAyogya for Mukha Lepa.27 Such as – Jwara Vata Vikara Atisara Adhmana Netra Roga Peenasa Karna Roga VishaktaRESTRICTIONS AFTER MUKHA LEPA28 The person who has underwent Mukhalepa should not involving in Divasvapna Ati Bhashana Agni Sevana Atapa Sevana Ati-Shoka Krodha
  53. 53. VAMANA This is one of prime procedure in Panchakarma. It occupies the firstplace among Panchkarma. It is the best Shodhana therapy and requiresspecial care. It must be conducted under the supervision of trainedphysician. It is indicated for Kapha Shamana in Sharad Ritu for healthypersons as well as in several acute conditions of Kapha and Pitta Vikara.ETYMOLOGY OF VAMANA "Vama Udgare, Yak Set | Vamati Avamit | The root word “Vama” means “Udgare.” It is derived from the rootverb “Udgru,” conveys the exact interpretation through the meanings like –ejecting, giving out, oozing, stream, eruptations, echo & hissing sound. Butaccording to Monnier William, “Vama” refers to ejecting, spitting out,vomiting, giving out, emitting, saliva, belching, sound, etc.DEFINITION1 It is a process in which waste products i.e. vitiated Doshas areeliminated out through the upper channels i.e. through the mouth1.Chakrapani mentions that Urdhvabhaga should be considered asUrdhvamukha. Sharangadhara defines Vamana as “A process in which ApakwaPitta and Kapha are eliminated out forcefully through upper channel by theact of vomiting.” Vamana is the best treatment to eliminate out the vitiated Kaphafrom the body, thus removes all sorts of derangements regarding Kapha.SYNONYMS Vama, Vamana, Vami, Vamathu, Virechana, Vireka, Chardi,Chardana, Ullekhana, Lekhana, Shodhana, Samshodhana, Udgirana &Urdhvamukha Doshaharana.
  54. 54. INDICATIONS OF VAMANA When Doshas are accumulated in large quantity (Bahu), Vamana is advised.2 More specifically Vamana may assist the body in the following conditions. Aggravation of Kapha in its own sites or place. Kapha combined with Pitta, which is present in a small proportion. Vata or Pitta invading the sites of Kapha. Excessive increase in the levels of Kapha. Apart from these there are several diseases in which Vamana is indicated are – Peenasa, Navajwara, Kushtha, Shwasa, Kasa, Rajayakshma, Galagraha, Shleepada, Mandagni, etc.3CONTRAINDICATIONS OF VAMANA4 There are certain contra-indications for Vamana such as – Atibaala,Atividdha, Atisthula, Atikrisha, Durbala, Shranta, Pipasita, Kshudhita, etc.VAMANA INDICATED IN URDVABHAGAGATA KUSHTA5 Charaka explained that, when Doshas are in Utklishta Avastha inHridaya and Kushta is present in Urdvabhaga of Shareera then Vamanashould be advised.VAMANA AND RITU Vamana is advised in Vasanta Ritu to combat with the exaggeratedKapha.6 Vasanta Ritu comprises of two months viz. Phalguna and Chaitra.VAMANAKARMA PROCEDURE The whole process in Vamana Karma can be divided into threecategories. Viz. – Poorvakarma Pradhanakarma Paschyatakarma
  55. 55. VAMANA POORVAKARMA In this category, one has to fulfill the prerequisites required forconducting the Vamana procedure. This includes – Examination of patient in terms of Vamya / Avamya Analysis of Ashtavidha and Dashavidha Bhava Examination of the disease and status of Tridosha General physical, biochemical and instrumental examinations Collection of drugs and utensils required for Vamana7 Vamaka Drug selection and dosage fixation Preparation of Vamanopaga Dravya and set up in treatment room Preparation of the patient like – Proper concealing, Detail information Informed written and oral consent, Proper pre- medication like Deepana-Pachana, Abhyantara and Bahya Snehana, Swedana, Vishramakala, Maanasopachara, etc.VAMANA PRADHANAKARMA This is the actual act of the Vamanakarma. This includes followingprocedure, which are to be done carefully and with caution.8 Viz. – Examination and monitoring of vitals Guiding and monitoring the procedure of Vamanakarma Administration of Yavagu Administration of Aakanthapana Dravya like milk / Ilkshu Rasa Administration of suitable Vamaka Dravya and in required quantity Waiting for Swa-pravrita Vega for 1 Muhurta (48 minutes)
  56. 56. Table No. 10. Process of Vamana & effect of Vamaka Dravya on the body9SL. SYMPTOMS CHANGES MECHANISM OF VAMANA APPEARED IN DOSHA01. Appearance Doshas are Due to Ushna, Teekshna and Vyavayi of Sweating liquefied properties, the Doshas are starts on Forehead melting from their site of adherence (i.e. Doshadooshya Sammurcchana) and start moving them through major and minor channels.02. Pilling of Doshas Due to Ushna, Teekshna and Vyavayi hairs moving property of Vamaka Dravya, the towards vitiated Doshas start moving towards Amashaya Kostha. Doshas moves through Srotas just like water moving through polished vessel without sticking to it.03. Discomfort in Enters the The moving Dosha enter the abdomen Amashaya Amasaya by Anupravana Bhava.04. Nausea, Doshas Due to excitement of Udana Vayu, Salivation, moves in Agni, Vata predominance and self Pain in chest upward tendency Vikrita Dosha to move region. direction. upwards, they start to move in upward direction. Observation regarding extend of results obtained
  57. 57. Table No. 11. The criteria for the evaluation of Shuddhi. 10VAMANA AVARA MADHYAMA PRAVARA SUDDHI SUDDHI SUDDHIVaigiki 4 Vega 6 Vega 8 VegaManiki 1 Prastha 1 ½ Prastha 2 PrasthaAntiki PITTANTAMLaingiki Signs of symptoms of Samyak VamanaYOGA-AYOGATA OF VAMANA11 Vamana is complicated procedure. The attending physician must bekeen enough to have a look on Yoga-Ayogata of the Vamana procedure.This is an important part in obtaining result through the procedure. Thepatient with Samyaka Yoga of Vamana will have – Kaale Pravritti,elimination of Kapha, Pitta and Vata respectively, Swayam ChaAvasthanam, Hridaya Shuddhi, Parshwa Shuddhi, Srotodushti, IndriyaDushti, Laghutwa, etc.VAMANA ATIYOGA LAKSHANA Trishna, Moha, Moorccha, Vata Prakopa, Nidranasha, Balahaani.VAMANA AYOGA LAKSHANA Kotha, Kandu, heaviness of body, Hridaya and Srotas Ashuddhi.VAMANA VYAPAT12 It is the prime duty of attending physician check the Vamana vyapatand treats them accordingly. The patient suffer from the complications like– Adhmana, Parikartika, Parisrava, Gatragraha, Hridgraha, Jeevadana,Alpa Dosha Harana, Vata Shoola, Atiyoga, Pravahika, Vibandha, etc.VAMANA PASCHYATA KARMA13 After conducting Vamana, one should look after the patient carefully.The immediate things to be done by the patients are – After Samyaka Vamana, patient is advised to wash mouth, hands & feet, then to rest for a Muhurtta Then the patient is subjected for Dhoomapana. Then Kavala is advised with Saindhava Jala. Due to Dosha elimination, Agni becomes weak. So to restore the strength of Agni and Prana, Peyadi Samsarjana Krama should be followed.14
  58. 58. SAMSARJANA KRAMA After Vamana, the diet regimen should be planned according to thetype of Shuddhi obtained.Table No. 12. Samsarjana Krama on various days15DAYS Annakala Pravara Suddhi Madhyama Suddhi Avara Suddhi (3Days) (5 Days) (7 Days)I day 1 Morning – – – 2 Evening Peya Peya PeyaII day 1 Morning Peya Peya Vilepi 2 Evening Peya Vilepi Kritakrita Yusa 1 Morning Vilepi Vilepi KritakritaIII day Mamsarasa 2 Evening Vilepi Akrita Yusa Normal diet 1 Morning Vilepi Krita Yusa – IV day 2 Evening Akrita Yusa Akrita Mamsarasa – V day 1 Morning Krita Yusa Krita Mamsarasa – 2 Evening Krita Yusa Normal diet – 1 Morning Akrita – – VI day Mamsarasa 2 Evening Krita – – Mamsarasa 1 Morning Krita – – VII day Mamsarasa 2 Evening Normal diet – – 16SPECIAL PRECAUTIONS AFTER VAMANA The who has underwent Vamana should specially avoid theactivities like – Loud speeches, sitting in one position for long duration,standing in one position for long duration, long walks and riding vehiclesshould avoided, exposure to excessive cold or heat or dew, exposuredirectly to flowing winds, long journey, sleeplessness in the nights,sleeping in day time, should also be prohibited.
  59. 59. ANATOMY OF SKINIntroduction The skin is the largest organ of the body covering all living tissues inthe body. It is made up of multiple layers of epithelial tissues and guardsthe underlying muscles, bones, ligaments and internal organs.01 Skin interfaces with the environment and protects againstpathogens. Its other functions are insulation, temperature regulation,sensation, synthesis of vitamin D, and the protection of vitamin B. Severely damaged skin tries to heal by forming scar tissue which isoften discoloured and depigmented. In humans, skin pigmentation variesamong populations, and skin type can range from dry to oily skin.Skin Components Skin has melanin, provided by melanocytes, which absorb some ofthe potentially dangerous ultraviolet radiation (UV) in sunlight. It alsocontains DNA repair enzymes which help to reverse UV damage. The skin has the largest surface area of all the organs. For theaverage adult human, the skin has a surface area of between 1.5 to 2.0square meters (16.1 to 21.5 sq ft.) 1 square centimeter of skin holds 650 sweat glands, 20 bloodvessels, 60,000 melanocytes, and more than a thousand nerve endings.Layers of the Skin Skin is composed of three primary layers – Epidermis – It provides waterproofing and serves as a barrier to infection. Dermis – It serves as a location for the appendages of skin; and Hypodermis
  60. 60. Epidermis In the word epidermis, "epi" comes from the Greek meaning "over"or "upon," is the outermost layer of the skin. The epidermis contains no blood vessels. Cells in the deepest layersof skin are nourished by diffusion from blood capillaries extending to theupper layers of the dermis. The major constitutes of epidermis are Merkel cells, Keratinocytes,Melanocytes and Langerhans cells.Layers of the Epidermis Epidermis is divided into five layers. These cells are formed bymitosis at the innermost layers. They move up the strata changing shapeand composition as they differentiate and become filled with keratin. Theyeventually reach the top layer called stratum cornium and becomesloughed off, or desquamated. This process is called keratinization andtakes place within weeks. The outermost layer of Epidermis consists of 25to 30 layers of dead cells.Sub-layers of Epidermis Epidermis is divided into the following 5 sub layers or strata. Viz. – Stratum cornium Stratum lucidum Stratum granulosum Stratum spinosum Stratum germinativum (also called "stratum basale")
  61. 61. DERMIS The dermis is the layer of skin beneath the epidermis that consists ofconnective tissue. It cushions the body from stress and strain. The dermisis tightly connected to the epidermis by a basement membrane. Dermis also harbors many mechanoreceptors (nerve endings) thatprovide the sense of touch and heat. It contains hair follicles, sweat glands,sebaceous glands, apocrine glands, lymphatic vessels and blood vessels.The blood vessels in the dermis provide nourishment and waste removal toits own cells as well as the Stratum basale of the epidermis. Dermis is divided into the following two sub layers or strata. Viz. – Papillary Region – Area adjacent to the epidermis. Reticular Region – Deep thicker area below papillary region.Hypodermis The hypodermis is not part of the skin. Its purpose is to attach theskin to underlying bone and muscle as well as supplying it with bloodvessels and nerves. It consists of loose connective tissue and fibroblasts,macrophages and adiposities (the hypodermis contains 50% of body fat).Fat serves as padding and insulation for the body.Physiology of Skin Protection – Skin is an anatomical barrier from pathogens and damage between the internal and external environment in bodily defense. Langerhans cells in the skin are part of the adaptive immune system. Sensation – It contains a variety of nerve endings that react to heat and cold, touch, pressure, vibration, and tissue injury.
  62. 62. Thermo-regulation – The skin contains a blood supply far greaterthan its requirements which allows precise control of energy loss byradiation, convection and conduction. Dilated blood vessels increaseperfusion and heat loss while constricted vessels greatly reducecutaneous blood flow and conserve heat.Control of evaporation – The skin provides a relatively dry andimpermeable barrier to fluid loss. Loss of this function contributes tothe massive fluid loss in burns.Storage & Synthesis – It acts as a storage center for lipids andwater, as well as a means of synthesis of vitamin D by action of UVon certain parts of the skin.Excretion – Sweat contains urea. However, its concentration is1/130th that of urine. Hence excretion by sweating is at most asecondary function to temperature regulation.Absorption – Oxygen, nitrogen and carbon dioxide can diffuse intothe epidermis in small amounts. In addition, medicine can beadministered through the skin, by ointments or by means ofadhesive patch.Water Resistance – The skin acts as a water resistant barrier soessential nutrients arenwashed out of the body. tHygiene – Unclean skin favors the development of pathogenicorganisms. The dead cells that continually slough off the epidermismix with the secretions of the sweat and sebaceous glands.Along with this dust form the environment forms a thick layer on itssurface. If it is not washed away it forms decomposed by bacterialflora and produces foul smell.
  63. 63. Cosmetics should be used carefully because these may cause allergic reactions. Each season requires suitable clothing in order to facilitate the evaporation of the sweat. Sunlight, water and air play an important role in keeping the skin healthy. The skin supports its own ecosystems of microorganisms, including yeasts and bacteria, which cannot be removed by any amount of cleaning. The skin is continuous with the inner epithelial lining of the body at the orifices, each of which supports its own complement of microbes. Oily skin is caused by overactive glands that produce sebum, a naturally healthy skin lubricant. When the skin produces excessive sebum, it becomes heavy and thick in texture. Oily skin is typified by shininess, blemishes and pimples. The oily skin type is not necessarily bad, since such skin is less prone to wrinkling, or other signs of aging, because the oil helps to keep needed moisture locked into the epidermis. The negative aspect of the oily skin type is that oily complexions are especially susceptible to clogged pores, blackheads, and buildup of dead skin cells on the surface of the skin. Oily skin can be sallow and rough in texture and tends to have large, clearly visible pores everywhere, except around the eyes and neck.SEBACEOUS GLAND02 The skin contains sebaceous glands and the sweat glands.Sebaceous glands are ovoid or spherical in shape and situated at the siteof the hair follicle .these glands develop from hair follicles .so, thesebaceous glands are absent over the thick skin. Each gland is covered bya connective tissue capsule. The alveoli of the gland are lined by stratifiedepithelial cells.
  64. 64. The sebaceous glands open into the neck of the hair follicle bymeans of a duct. In some areas like face, lips, nipple, glans penis and labiaminora the sebaceous glands open directly into exterior.Secretion of Sebaceous Gland The sebaceous gland secretes an oily substance called sebum.Sebum is formed by the liquefaction of the alveolar cells, and poured outthrough the ducts either via the hair follicle or directly into exterior.Composition of sebum Sebum contains free fatty acids, triglycerides, squalene, sterols,waxes and paraffin.Functions of sebaceous glands The free fatty acid content of the sebum has antibacterial and anti fungal actions. Thus, it prevents the infection of skin by bacteria or fungi. The lipid nature of sebum, keeps the skin smooth and oily. It protects the skin from unnecessary desquamation and injury caused by dryness. The lipids of the sebum prevent heat loss from the body. This is particularly useful in cold climate.Sebaceous glands at puberty The sebaceous glands are stimulated by sex hormones in both maleand females. At the time of puberty particularly in males, due to theincreased secretion of sex hormones especially dehydro-epiendrosteron,the sebaceous glands are stimulated suddenly leading to the developmentof acne over face at the time of puberty. The acne disappears within fewyears when the sebaceous glands become adapted to the sex hormones.
  65. 65. ACNE VULGARIS Acne is commonly known as Acne vulgaris. It is a chronicinflammatory dermatological condition affects nearly all people duringadulthood with formation of comedone, papules or pustule eruptions,commonly known as Pimple.01DEFINITION Acne is an inflammation of the pilosebaceous units of certain bodyarea (face, trunk, rarely buttocks) due to obstructed with plugs of sebumand desquamated keratinocytes that occurs most frequently inadolescence.02NATURAL HISTORY It is one of the commonest skin disorders, and popularly known asacne or pimple. It is a disorder of adolescence and is more commonamongst male than in females.03 It has been estimated that 70% of the total population have someclinically evident acne at some stage during adolescence.04 It develops atpuberty when sebaceous glands are most active. In twenties, it graduallydecreases and again seen especially in women after the age of 28 or so(post adolescent acne), since they usually adopt family planning. It occursboth in girls and boys in the later in a some what sever form.05EPIDEMIOLOGY About 70% of the population develops some clinically evident acneat some point during adolescence and early adult life, but only 10-20%request medical attention for the problem. Acne develops earlier in female than in males. This may reflect theearlier onset of puberty in females. However, some subjects may showsmall non-inflamed lesions by the age 8-9 years. The age of greatestseverity and incidence is 16-18 years for females and 18-19 years formales. The incidence of acne in females at 17 years is 40% and in malesat 18 years is 35%.06
  66. 66. After the age of 35 years acne resolves very slowly. At 40 years ofage lesions are found in 1% of males and 5% of females. Acnes are morepredominant and persistent in females and why they resolve bythemselves is obscure. Duration of lesions takes weeks to months forrecovery and condition worsens in winter season.07,08AETIOLOGY09a The etiology of the acne is not fully understood. Certain factorsresponsible for the occurrence of acne includes – Basic or primary causes Predisposing or aggravating factorsBASIC / PRIMARY CAUSES The basic seborrhoeic state & the tendency to acne itself may cause Androgenic stimulation of pilosebaceous follicles & thickening of horny layer take place at puberty. In older patients, the ratio of androgenic to estrogenic substance may be abnormal. Due to these probabilities acnes are directly affecting the skin or thepilosebaceous unit and produces excess amount of sebum. Accumulatedsebum in ducts may have allergic manifestation and bacillary interference.01. Hormones – This disease is closely linked with the sex hormones. Atpuberty either of the sexes is affected. In females during the phase ofpremenstrual congestion the condition is often worse. The increasedproductions of sex hormones make the sebaceous glands hyperactive.Androgen and progesterone are responsible for the hyperplasia of oilglands. The main hormones associated with the acne are is as follows –02. Androgens – These are male and female sex hormones. In males it isproduced in the testes. In females these are produced in adrenal glandand ovaries.
  67. 67. The most important androgen is testosterone, which affects the face,pubic area and armpits. The excessive secretion of testosterone stimulatessebaceous glands, which produces excess sebum, may leads to formationof acne lesions. This fact was studied in 139 women afflicted with acne. 90% wereobserved to have above average plasma testosterone levels and only 10%of individuals were had normal or below normal testosterone.03. Estrogens – These are female hormones, produced by the ovaries. Itreduces the secretion of sebum and thus helps in remission of acnelesions. The estrogen benefits the skin by retarding the wrinkling processand gives it a clear and moistures look.04. Steroids – These are produced by the adrenal glands. Excessproduction of steroids cause skin atrophy, prone for skin infections andpoor healing. Thus stimulates the sebaceous glands which may causeacne. Lack of steroids causes loss of body hair and pigmentation of theskin.05. Bacillary Interference – Although acne is not primarily a bacterialdisease but exudates may show presence bacilli like cornye bacteriumacne, propioni bactrium acne, staphylococcus epidermis albus which mayalter the characters of oily secretions. The acne bacillus belongs todiptheriod group. Bacteria enter in the orifice of sebaceous gland, formscomedone and large lumpy deep lesions. Microscopically, the deep-seatedindurate lesions show a granulomatus structure with many giant cells.06. Allergic Manifestation – Allergy also plays a role in the formation ofacne up to some extent. The persons working in the manufacturingindustries, catering works and those dealing with oils may have acne.
  68. 68. Excessive intake of Bromides and iodides in the form of tonic,medicines or diet causes acne. When these salts are discontinued, lesionsare subsided.PREDISPOSING FACTORS Certain factors which do not produce acne but may predispose inacne lesion are enlisted as follows –01. Diet – Certain diets and regimens may precipitates in acne like butter,cream, ice cream, chocolates, fried foods, fats, excess starches, sweets,delicious greasy dishes, overeating, chilies, alcohol, aerated drinks, teaetc. These foods may aggravate acne. Acne appears less frequently in Zambia, Nigeria and Japan as theirdiet differ from West Europe. The incidence is said to be low in Eskimo’seating a diet rich in fish.02. Climate – The disease is commonest in moist temperate climate, whileit is uncommon in Eskimos of the hemisphere. A dry sunny producesmarked improvement. Exposure to sun and wind increases desquamationof the exposed skin, diminishes hyperkeratosis of the hair follicles, thusreduces comedone formation.03. Use of cosmetics – Excess use of greasy cosmetics may cause acne.It blocks the pores of sebaceous and sweat glands. Natural cosmeticagents do not have any hazardous effect but artificial cosmetics mayproduce or aggravates the lesions. The habit of squeezing the lesions andlack of hygiene of face also makes the condition worse.04. Mental stress – Mental stress can aggravate acne lesions. Forexample, acne lesions may become more in adolescence with epilepsy isalso notable. About 70% of ladies complain exacerbation of 2-7 dayspremenstrual. Possibly, it is related to a premenstrual change in thehydration of the pilosebaceous epithelium.
  69. 69. Acne may relate to severe increased anger or anxiety. The stressescauses excess secretion of androgens and subsequently lead to acne.05. Occupation – The persons working in the industries of heavy metals,oils may have tendency of developing acne.06. Constipation – A common predisposing cause to produce acne isintestinal stasis, especially the constipation.07. Season – The condition predominantly seen in winter than in summer.The condition of the disease is worse in the winter and spring months.PATHOLOGICAL CAUSES01. Increased Sebum Secretion Sebaceous glands activity is controlled by androgens. Increasedproduction of sex hormones makes the sebaceous glands hyperactive.Normally both men and women have androgen hormones circulatingthrough blood.02. Microbial Colonization Bacterias such as P acnes is an anaerobic organism predominantlyfound on the surface of the skin. It can contaminate the pilosebaceous unitand start reproducing themselves. This process is further promoted by theincreased temperature in the infected area. The presence of P acnespromotes inflammation through a variety of mechanisms. P acnes stimulate inflammation by producing proinflammatorymediators that diffuses through the follicle wall. Studies have shown that Pacnes activate the toll-like receptor 2 on monocytes and neutrophils.9b Activation of the toll-like receptor 2 then leads to the production ofmultiple proinflammatory cytokines, including interleukins 12 and 8 andtumor necrosis factor. Hypersensitivity to P acnes may also explain whysome individuals develop inflammatory acne vulgaris while others do not.9c

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