“COMPARATIVE CLINICAL STUDY ON EFFECT OF VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN YOUVANA PIDAKA (ACNE VULGARIS)” – By – Anil S. Managuli Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfillment of the requirement for the degree of Ayurveda Vachaspati (Doctor of Medicine) In Panchakarma Under the guidance of Dr. Sanghamitra Patnaik M.D. (Ayu) Associate Professor & H. O. D. Department of P.G. Studies in Panchakarma Under the Co-guidance of Dr. Anilkumar Baccha M.D. (Ayu) Asst. Professor Department of Kayachikitsa DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA N.K.J. AYURVEDIC MEDICAL COLLEGE & P. G. RESEARCH CENTER, GUMPA, BIDAR – 585 403. 2009 .
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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“COMPARATIVE CLINICAL STUDY ON EFFECT OF VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN
YOUVANA PIDAKA (ACNE VULGARIS)” – By –
Anil S. Managuli
Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
In partial fulfillment of the requirement for the degree of
Ayurveda Vachaspati (Doctor of Medicine)
In
Panchakarma
Under the guidance of
Dr. Sanghamitra Patnaik M.D. (Ayu)
Associate Professor & H. O. D. Department of P.G. Studies in Panchakarma
Under the Co-guidance of
Dr. Anilkumar Baccha M.D. (Ayu)
Asst. Professor Department of Kayachikitsa
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA
N.K.J. AYURVEDIC MEDICAL COLLEGE & P. G. RESEARCH CENTER, GUMPA, BIDAR – 585 403.
2009.
Ayurmitra
TAyComprehended
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled
“COMPARATIVE CLINICAL STUDY ON EFFECT OF
VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN
YOUVANA PIDAKA (ACNE VULGARIS)” is a bonafide and
genuine research work carried out by me under the guidance of
Dr. Sanghamitra Patnaik M.D. (Ayu) Associate Professor Department of
P.G. Studies in Panchakarma and under the co-guidance of
Dr. Anilkumar Baccha M.D.(Ayu). Asst. Professor, Department of
Kayachikitsa N.K.J. Ayurvedic Medical College & P. G. Research
Center, Gumpa, Bidar.
Date : Signature of the Candidate
Place: BIDAR. (Anil S. Managuli)
DEPARTMENT OF POSTGRADUATE STUDIES IN
PANCHAKARMA
N.K.J.A.M.C., P.G. RESEARCH CENTER, BIDAR.
(Affiliated to Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka)
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled
“COMPARATIVE CLINICAL STUDY ON EFFECT OF
VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN
YOUVANA PIDAKA (ACNE VULGARIS)” is a bonafide
research work done by the “Anil S. Managuli” in partial fulfillment of
the requirement for the degree of Ayurveda Vachaspati M. D. (Ayu)
Signature of the Guide Dr. Sanghamitra Patnaik
M.D. (Ayu)
Associate Professor
Dept. of P.G. Studies in Panchakarma
N.K.J.A.M.C., P.G. Research Center, Bidar.
Date :
Place: BIDAR.
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 OF
VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN
YOUVANA PIDAKA (ACNE VULGARIS)” is a bonafide
research work done by the “Anil S. Managuli” in partial fulfillment of
the requirement for the degree of Ayurveda Vachaspati M. D. (Ayu)
Signature of the Co-Guide
Dr. Anilkumar Baccha M.D. (Ayu)
Asst. Professor,
Department of Kayachikitsa
N.K.J.A.M.C., P.G. Research Center, Bidar.
Date :
Place: BIDAR.
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 OF
VAMANA FOLLOWED BY LEPA AND ONLY LEPA IN
YOUVANA PIDAKA (ACNE VULGARIS)” is a bonafide
research work done by the “Anil S. Managuli” under the guidance of
Dr. Sanghamitra Patnaik M.D. (Ayu) Associate Professor & H. O. D.
Department of P.G. Studies in Panchakarma N. K. J. Ayurvedic
Medical College & P. G. Research Center, Gumpa, Bidar.
H. O. D. PRINCIPAL
Dr. Sanghamitra Patnaik Dr. K. V. L. N. Acharyulu M.D. (Ayu) M.D. (Ayu)
Department of P.G. Studies Principal & Dean
in Panchakarma
N. K. J. Ayurvedic Medical College & P. G. Research Center, Bidar.
Date : Place: BIDAR.
COPY RIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of
Health Sciences, Bangalore, Karnataka shall have the rights to
preserve, use and disseminate this dissertation in print or electronic
My vocabulary falls short of suitable words to express my recondite
sense of indebtedness –
� Dr. K. V. L. N. Acharuyulu M.D. (Ayu) Principal & Dean
� Dr. P. V. Sauvnur M.D. (Ayu) Vice-Principal
� Dr. V. S. Patil M.D. (Ayu) Medical Advisor
� Dr. Sanghamitra Patnaik, M.D. (Ayu) Guide & H. O. D.
� Dr. Anilkumar Bacha M.D. (Ayu)
N. K. J. A. M. C., P. G. Research Center, Bidar.
It is beyond the reach of my language to inscribe the profound
respect and devotion towards affectionate to
� Dr. Harini C. M.D.(Ayu), Asst. Prof. PG Dept. Of Panchakarma
� Dr. Manikrao Kulkarni M.D.(Ayu), Lecturer, PG Dept. Of Panchakarma
� Dr. Nagesh Gandagi, M.D. (Ayu) Lecturer, Dept. of Kayachikitsa
� Dr. Deepali Sherikar M.D.(Ayu), Lecturer, Dept. Of Kayachikitsa
� Dr. Sanjeev Kadalewad M.D.(Ayu), Lecturer, Dept. Of Kayachikitsa
� Dr. Ratnakar L. V. M.S.(Ayu), Prof. & HOD PG Dept. Of Prasutitantra
� Dr. Bandeppa Sangolagi, M.D. (Ayu) Asst. Prof. Dept. of Rasashastra
� Dr. Praveen Shimpi M.D. (Ayu) Asst. Prof. Dept. of Rasashastra
� Dr. Chandrakant Halli M.D. (Ayu) Asst. Prof, PG Dept. of Shalyatantra
� Dr. Divyadarshan Shelly M.D. (Ayu) RMO & Lecturer Dept. of
Shareera Rachana
N.K.J.A.M.C., & P.G. Research Center, Bidar.
I express my obligation and heartfelt thanks to my teachers � Dr. Anand Jabshetty M.S. (Ortho) Asst. Prof. BIMS, Bidar. � Dr. Vijaykumar Kote M.D.DVD Dermatologist, Asst. Prof. BIMS, Bidar. � Dr. Sipra Sasmal M.D. (Ayu) C.C.R.A.S., Bhuvaneshwar. � Dr. Mallikarjun Malipatil M.Pharma., Ph. D. Professor Dept. Of
Pharmacognosy, Karnataka College of Pharmacy I acknowledge technical and non-technical staff members of our
institute who have helped me – Shri. Rajakumar Kadam, (Lib.) Smt. Sakubai, Shri. Rajkumar, Shri. Kanteppa, Shri. Basavaraj, Smt. Parvathi, Smt. Guramma, Smt. Padmavati, Mr. Jagadish, Mr. Santosh, Shri. Mohan Reddy, at N. K. J. A. M. C., P. G. Research Center, Bidar.
I wish to express thanks to my friends, seniors, juniors & colleagues. Special thanks to Dr. K.P. Namboothiri, Dr. Girish, Dr. Pradeep, Dr. Gourish, Dr. Mahesh, Dr. Vivek, Dr. Prashant, Dr. Omprakash, Dr. Siddharam, Dr. Santosh, Dr. Shankar, Dr. Satish, Dr. Jyoti Dr. Raju, and Dr. Muralikrishna As I recall my parents Shri. Shivaputra B. Managuli and Smt. Sushila who advised me to enter in this noble profession. The truth dawns on me that the language of words suffers very stringent limitation. I have not been able to find words enough to express my sentiments, love, respect and gratitude for them.
I must record the occasion to show love and gratitude towards my younger brother Mr. Sunil & Shri. Umesh Patil & Smt. Sunita who inspired and blessed me to achieve this milestone in my life along with their timely help in many ways like moral support, financial assistance, etc.
I acknowledge my patients for their wholehearted consent to participate in this clinical trial. I thank my patients who exhibited high level of patience and subjected themselves for cooperating with me in every stage of my clinical work.
Lastly I express my thanks to all the persons who have helped me directly and indirectly with apologies for my inability to specify them individually. I did this work as a partial fulfillment of Post graduation degree, but dedicate to forthcoming researchers of Ayurveda.
DATE : (Anil S. Managuli) PLACE : BIDAR.
ABBREVIATIONS
� AH – Ashtanga Hridaya
� AS – Ashtanga Sangraha
� CS – Charaka Samhita
� BV – Bhavaprakasha
� MN – Madhava Nidana
� ShS – Sharangadhara Samhita
� SS – Sushruta Samhita
� YR – Yoga Ratnakara
� AD – Arundatta
� Gr – Group
� BT – Before Treatment (Day 0)
� AT – After treatment (Day 7)
� FU1 – 1st Follow up (45 Days after treatment)
� FU2 – 2nd Follow up (75 Days after treatment)
� FU3 – 3rd Follow up (105 Days after treatment)
� NI – No improvement
� MiR – Mild relief
� MoR – Moderate relief
� MrR – Marked relief
� CR – Complete relief
ABSTRACT
Background and Objectives
Acne vulgaris is a chronic inflammatory disease of the
pilosebaceous units of the skin of certain body parts with formation of a
papules / pustules eruption commonly known as pimples. The classical
description of Youvana Pidaka resembles with this.
Objective of the present study was to evaluate and compare the
effect of Vamana with Lepa and only Lepa in Youvana Pidaka (Acne
vulgaris).
Methods
30 patients filling the inclusion criteria of Youvana Pidaka were
randomly selected and divided into 2 groups. In Gr. A the patients were
subjected for Vamana with Kritavedhana followed by Manjishta Madhu
Lepa. In Gr. B the patients were subjected for Manjishta Madhu Lepa.
Source of the data – Patients were selected from OPD and IPD of
PG Department of Panchakarma, N.K.J.A.M.C., P. G. Research Center,
Bidar.
Clinical signs and symptoms were given suitable self formulated
scores according to its severity. Patients were assessed based on pre and
post data gathered through pre-designed research proforma.
The results having ‘p’ value less than <0.05 was considered to be
statistically significant in this study.
Results
Overall effect of the treatment in Gr. A was –
� Moderate improvement was found in 05 patients (33.33%)
� Marked improvement was found in 08 patients (53.33%)
� Complete relief was found in 02 patients (13.33%)
Overall effect of the treatment in Gr. B was –
� Moderate relief was found in 09 patients (60%)
� Marked improvement was found in 06 patients (40%)
Interpretation and conclusion
� Manjishtha-Madhu Lepa was found effective in the management of
Youvana Pidaka
� All the patients were responded to the given treatment without any
complications
� In most of the cases complete relief was found in pain, burning
sensation, number of Pidaka, dryness of the face, score of the
Pidaka on the basis of affected place and global acne grading
system after the treatment
� Manjistha-Madhu Lepa is an efficacious, cost effective, safe and
better drug in the management of Youvana Pidaka (Acne vulgaris)
� The effect of Lepa followed by Vamana was better than only Lepa
prescribed to the patient
� The result obtained in Gr. A were better than in Gr. B after treatment
as well as during subsequent follow ups with minimal recurrence
� Modern review – Shareera and Disease review 40 – 72
� Drug review 73 – 00
04) Methodology 00 – 86
05) Observations & Results 87 – 140
06) Discussion 141 – 173
07) Conclusion 174 – 175
08) Summary 176 – 178
09) Bibliography i – xviii
10) Annexure xix – xxxiv
LIST OF TABLES
SL. TABLE Pg. 01. Layers of the skin according to various authors 07 02. Explanation of Twacha According to Sushruta 08 03. Aharaja Nidana of Youvana Pidaka 13 04. Viharaja Nidana of Youvana Pidaka 14 05. Manasika Nidana of Youvana Pidaka 14 06. Anya Karana of Youvana Pidaka 14 07. Sign & Symptoms of Youvana Pidaka according to various
authors 18
08. Quantity of Sneha Dravya in Lepa formulation 31 09. Types of Lepa according to various seasons 32 10. Process of Vamana and effect of Vamaka Dravya 37 11. The criteria for the evaluation of Shuddhi 38 12. Samsarjana Krama on Various days 39 13. Differential Diagnosis on Acne Vulgaris 68
13a. Prescription guidelines for systemic antibiotics 70 13b. Adverse reactions associated with oral antibiotic usage 70 14. Drugs used during clinical study 73 15. Properties of Drugs used during clinical study 74 16. Karma & indication of Drugs used during clinical study 75 17. Preparation of Peyadi Samsarjana Krama 78
17a. Procedure of Conducting the Vamana 79 18. Distribution of patients registered in trial Groups 87 19. Distribution of patients according to Age 88 20. Distribution of patients according to Sex 88 21. Distribution of patients according to Religion 88 22. Distribution of patients according to Education 90 23. Distribution of patients according to Occupation 90 24. Distribution of patients according to Socio-Economic Status 90 25. Distribution of patients according to Habitat 92
26. Distribution of patients according to Marital Status 92 27. Distribution of patients according to Dietary Habits 92 28. Distribution of patients according to Prakriti 94 29. Distribution of patients according to Satwa 94 30. Distribution of patients according to Desha 94 31. Distribution of patients according to Vyayama Shakti 96 32. Distribution of patients according to Satmya 96 33. Distribution of patients according to Divaswapna 96 34. Distribution of patients according to Agni 97 35. Distribution of patients according to Ahara Nidana Specification 99 36. Distribution of patients according to Vihara Nidana Specification 100 37. Distribution of patients according to Site of Pidaka 101 38. Distribution of patients according to Chronicity 101 39. Distribution of patients according to Varna of Patient 103 40. Distribution of patients according to Shotha of Pidaka 103 41. Distribution of patients according to Onset of Pidaka 103 42. Distribution of patients according to aggravation of Pidaka
in Season
105
43. Distribution of patients according to Family history of acne 106 44. Distribution of patients according to Relation with
Rajopravrutti 106
45. Distribution of patients according to Type of Vedana 108 46. Distribution of patients according to Number of Pidaka 108 47. Distribution of patients according to Density of Pidaka 108 48. Distribution of patients according to Nature of Pidaka 110 49. Distribution of patients according to Area Affected 110 50. Distribution of patients according to Size of Pidaka 111 51. Distribution of patients according to Number of scars 111 52. Distribution of patients according to Pain 112 53. Distribution of patients according to Burning Sensation 112 54. Distribution of patients according to Use of cosmetics 115 55. Distribution of patients according to Dosha Pradhanata 115
56. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of pain in both the groups
117
57. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of burning sensation in both the groups
119
58. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of number of Pidaka in both the groups
121
59. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of size of Pidaka in both the groups
124
60. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of number of scar in both the groups.
126
61. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of oiliness of the face in both the groups
128
62. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of dryness of the face in both the groups
131
63. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of score of the Pidaka on the basis of affected place in both the groups
133
64. The “t” test result showing the difference between the means of samples before and after the treatment in reduction of severity of score of the Pidaka on the basis of Global Acne Grading System place in both the groups
135
65. The % of improvement in Individual Symptoms of Youvana Pidaka After treatment & 3rd Follow up
138
66. The over all Response of the Therapy 139
66a. The percentage of improvement in individual parameters of Youvana pidika after the treatment and Third follow up
66b. The over all improvement in both groups after treatment in all the parameters
67. Master Chart Showing Demographic Data of patients in group B.
–
68. Master Chart Showing Demographic Data of patients in group B
–
69. The assessment of Pain before & after the treatment and in all three follow ups
xxx
70. The assessment of burning sensation before & after the treatment and in all three follow ups
xxx
71. The assessment of number of Pidaka before & after the treatment and in all three follow ups
xxxi
72. The assessment of size of Pidaka before & after the treatment and in all three follow ups
xxxi
73. The assessment of number of scars before & after the treatment and in all three follow ups
xxxii
74. The assessment of oiliness of the face before & after the treatment and in all three follow ups
xxxii
75. The assessment of dryness of face before & after the treatment and in all three follow ups
xxxiii
76. The assessment of score of Pidaka on the basis of affected place before & after the treatment and in all three follow ups
xxxiii
77. The assessment of global acne grading system before & after the treatment and in all three follow ups
xxxiv
LIST OF GRAPHS
SL. TABLE Pg.
01. Age-wise distribution of the patients 89
02. Sex-wise distribution of the patients 89
03. Religion-wise distribution of patients 89
04. Educational status-wise distribution of the patients 91
05. Occupation-wise distribution of the patients 91
06. Socio-Economic status-wise distribution of the patients 91
07. Habitat-wise distribution of the patients 93
08. Marital status-wise distribution of the patients 93
09. Dietary habits-wise distribution of the patients 93
10. Prakriti-wise distribution of the patients 95
11. Satwa-wise distribution of the patients 95
12. Desha-wise distribution of the patients 95
13. Vyayama Shakti-wise distribution of the patients 97
14. Satmya-wise distribution of the patients 97
15. Divaswapna-wise distribution of the patients 98
16. Agni-wise distribution of the patients 98
17. Ahara specific Nidana wise distribution of the patients 102 18. Vihara specific Nidana wise distribution of the patients 102
19. Site of Pidaka-wise distribution of the patients 102
20. Chronicity-wise distribution of the patients 104
21. Varna of patient-wise distribution of the patients 104
22. Shotha of Pidaka-wise distribution of the patients 104
23. Onset of Pidaka-wise distribution of the patients 105
24. Aggravation of Pidaka in Season-wise distribution of the patients
107
25. Family history of Pidaka-wise distribution of the patients 107
26. Relation with menses-wise distribution of the patients 107
27. Type of Vedana-wise distribution of the patients 109
28. Number of Pidaka-wise distribution of the patients 109
29. Density of Pidaka-wise distribution of the patients 109
30. Nature of Pidaka-wise distribution of the patients 113
31. Area of Pidaka involved-wise distribution of the patients 113
32. Size of Pidaka-wise distribution of the patients 113
33. Number of scars-wise distribution of the patients 114
34. Pain-wise distribution of the patients 114
35. Burning Sensation-wise distribution of the patients 114
36. Use of Cosmetics-wise distribution of the patients 116
37. Dosha Pradhanata-wise distribution of the patients 116
38. % of Reduction in mean score in Pain of Pidaka 123
39. % of Reduction in mean score in Burning sensation 123
40. % of Reduction in mean score in Number of Pidakas 123
41. % of Reduction in mean score in Size of Pidakas 130
42. % of Reduction in mean score in Number of Scars 130
43. % of Reduction in mean score in Oiliness of the face 130
44. % of Reduction in mean score in Dryness of the face 137
45. % of Reduction in mean score in Score of Pidaka on the basis of Affected area
137
46. % of Reduction in mean score in Acne Global Grading Sysem
137
47. Results obtained After treatment & 3rd Follow up in Group A 139
48. Results obtained After treatment & 3rd Follow up in Group B 140
49. Over All improvement in Group A 140
50. Over All improvement in Group B 140
LIST OF FLOW CHARTS, FIGURES & PHOTOGRAPHS
Sl. Table Pg. FLOW CHARTS
01. Samprapti of Youvana Pidaka according to Sharangadhara
16
02. Samprapti of Youvana Pidaka according to Vagbhata & Sushruta
16
03. Summerized Samprapti of Youvana Pidaka 17 04. The Procedure of Lepa in detail 30 05. Pathological Consequences in Acne Vulgaris 53
PHOTOGRAPHS 05. Ghrita, Tila Taila, Yashtimadhu Kwatha Churna 06. Madhu, Ksheera, Yashtimadhu Phanta 07. Kritavedhana and Kritavedhana Churna 08. Dried Kritavedhana, Kritavedhana soaked in Yashtimadhu Phanta,
Kritavedhana ready for usage during Vaman 09. Saindhava Lavana, Manjishta, Manjishta-Madhu Paste ready for
application 10. Saindhava Jala, Trikatu Churna, Snehapana with Moorcchita Ghrita 11. Sarvanga Abhyanga with Moorcchita Tila Taila 12. Sarvanga Bashpaswedana, Aakantha Pana, Patient during Vamana
procedure 13. Mukha Prakshalana, Dhoomapana, Containts of the vomitus 14. Anatomy of Skin and Pathogenesis of Acne vulgaris 15. Pathogenesis and Clinical presentation of Acne vulgaris 16. Group – A – Vamana followed with Manjishta Madhu Lepa – Before,
During and After the treatment 17. Group – A – Vamana followed with Manjishta Madhu Lepa – Before
and After the treatment 18. Group – B – Only Manjishta Madhu Lepa – Before, During and After
the treatment
INTRODUCTION
Ayurveda, the holistic healing Shastra, deals with the concept of
individual approach. The preventive and curative aspects1 of individual life
related entities are summed up in eight branches of Ayurveda.2
Panchakarma is developing as an emerging individual specialty field
of research in Ayurveda. It has become the sole attraction of the Ayurvedic
treatment. All most all specialties require the Panchakarma procedures,
hence gained much popularity.
It is the natural instinct of mankind to have a healthy and glamorous
skin with attractive personality. But very few are blessed with naturally
perfect skin. People always have great concern about their health and
beauty (i.e. good looking). Thus, health and beauty are the two faces of
single coin.3
Face is the index of body & mind. Youvana Pidika is a most common
anomaly, usually self limiting, found in teenagers and young adults.4 This
results in disfigurement of facial skin leads to feeling of inferiority complex
and sometimes depression, isolation from society, suicidal tendency, etc.5
It is produced due to combine association of vitiated of Vata, Pitta, Kapha
Doshas along with Rakta as dushya.6 It is explained under the concept of
Kshudraroga.7
Acne vulgaris is a chronic inflammatory disease of the
pilosebaceous units of the skin in certain body parts with formation of a
papules / pustular eruption commonly known as pimples.8 The classical
description of Youvana Pidaka resembles with this.
It commonly affects the skin of face involving forehead, cheeks,
nose, and chin. It rarely affects neck, chest, shoulder, back. It is closely
related to the hormonal changes at puberty.9 Nearly 8 out of 10
adolescents suffers from acne vulgaris. Majority of patients recovers with
20-25 years, although 10-20% of adults may experience its severe forms.10
In women, it rarely lasts beyond the early 30’s and normally it is worse
before each menstrual period.11
Various systems of medicines come up with various remedies and
therapeutic procedures stating from simple topical applications till the
extensive management like use of X-ray, antibiotics, multivitamins,
hormones, corticosteroids, etc. In spite of their therapeutic values, these
procedures posses temporary relief, limitation and several health hazards
on body.12
Cosmetology is branch of medicine which is coming up with the
various methods to preserve and to restoring bodily beauty. Various
chemical and cosmetic agents are taken into practice which has got
temporary effect. Some of the chemicals used in the practice of
Cosmetology produces severe allergic reactions in few people.
Looking into above facts there is a need of treatment which can
prevent complications of the disease as well as reduces the recurrence
effectively.
In classics dozens of topical applications are explained for this
condition. Among that Manjishta-Madhu13 external application was
selected for the present clinical study.
Vamana is the treatment of choice for Kustha’s which produces in
Urdhvanganga Shareera. Sushruta14 praised utility of Vamana as a best
remedy, capable of alleviating the pathogenesis of Youvana Pidika
efficiently.
So an effort was made to study the comparative efficacy of Vamana
followed by Manjishtha Lepa & only Manjishtha-Madhu Lepa in the
management of Youvana Pidika.
30 patients were randomly selected and subjected into 2 groups.
� Group A – 15 patients were subjected for Classical Vamana
followed with Manjishta-Madhu Lepa.
� Group B – 15 patients were subjected for Manjishta-Madhu Lepa
alone.
During the duration of study the patients were assessed on the basis
of pre and post treatment with pre-designed research profile and self
designed severity grading. The data was collected as pre treatment (Day 0
– BT), after treatment (Day 30 – AT), first follow up (Day 45 – FU1 from
AT), second follow up (Day 75 – FU2 from AT), third follow up (Day 105 –
FU3 from AT).
OBJECTIVES OF THE STUDY
Vamana is one of the major procedures in Panchakarma. This is
a Shodhana procedure which has got effect all over the body with long
term results.
Lepa is local treatment procedure in which the medication is
made into a paste form and applied over the desired site with particular
thickness and removed after specified time.
The present study was undertaken in 2 groups with a course of
Vamana followed by Lepa and Lepa alone in cases of Youvana Pidaka
(Acne vulgaris). The samples were collected from OPD and IPD of
Department of P.G. Studies in Panchakarma, N. K. J. A. M. C. & P. G.
Research Center, Bidar with following objectives –
� Evaluate the effect of Manjishta-Madhu Lepa in Youvana Pidaka
� Evaluate the additional effect of Vamana with Kritavedhana followed
by Manjishtha-Madhu Lepa in Youvana Pidaka
� Compare the effect of only Lepa over the Vamana followed by Lepa
in Youvana Pidaka
HISTORICAL REVIEW
Youvana Pidaka is a common condition observed in day to day
life. But, detail explanation about its aetiopathogenesis is not mentioned in
classics. Numbers of remedies are explained in all most all treatises and
even in traditional practice.
PRE-VEDIC AND VEDIK ERA
The Vedik literature was the treasure of knowledge in those days. It
has briefed all the life related sciences in it. But the word Youvana Pidaka
or Youvana Pidaka and its independent explanation is not found in pre
Vedic or Vedic period.
Reference of the term Youvana Pidaka is found in Purana Kala,
Bhauddha Kala and Adhunika Kala.
SAMHITA PERIOD (BRIHAT TRAYEES)
Though the Samhita period was the important period for the
documentation of the clinical experiences of the sages, Sushruta was the
first to describe about Youvana Pidaka in the context of Kshudraroga.
Explanation about the condition is not found in Charaka.
LAGHU TRAYEES
After Sushruta, later texts have included the Youvana Pidaka in their
literature. The texts like Madhava Nidana, Sharangdhara, Vangasena,
Gadanigraha, Chakradatta, Basavarajeeyam, etc have briefed the aetio-
pathology of the disease and explained several treatment modalities for
the same.
ADHUNIKA KALA
Youvan Pidika described in later texts like Rasakamdhenu,
There are certain contra-indications for Vamana such as – Atibaala,
Atividdha, Atisthula, Atikrisha, Durbala, Shranta, Pipasita, Kshudhita, etc.
VAMANA INDICATED IN URDVABHAGAGATA KUSHTA5
Charaka explained that, when Doshas are in Utklishta Avastha in
Hridaya and Kushta is present in Urdvabhaga of Shareera then Vamana
should be advised.
VAMANA AND RITU
Vamana is advised in Vasanta Ritu to combat with the exaggerated
Kapha.6 Vasanta Ritu comprises of two months viz. Phalguna and Chaitra.
VAMANAKARMA PROCEDURE
The whole process in Vamana Karma can be divided into three
categories. Viz. –
� Poorvakarma
� Pradhanakarma
� Paschyatakarma
VAMANA POORVAKARMA
In this category, one has to fulfill the prerequisites required for
conducting the Vamana procedure. This includes –
� Examination of patient in terms of Vamya / Avamya
� Analysis of Ashtavidha and Dashavidha Bhava
� Examination of the disease and status of Tridosha
� General physical, biochemical and instrumental examinations
� Collection of drugs and utensils required for Vamana7
� Vamaka Drug selection and dosage fixation
� Preparation of Vamanopaga Dravya and set up in treatment room
� Preparation of the patient like – Proper concealing, Detail
information Informed written and oral consent, Proper pre-
medication like Deepana-Pachana, Abhyantara and Bahya
Snehana, Swedana, Vishramakala, Maanasopachara, etc.
VAMANA PRADHANAKARMA
This is the actual act of the Vamanakarma. This includes following
procedure, which are to be done carefully and with caution.8 Viz. –
� Examination and monitoring of vitals
� Guiding and monitoring the procedure of Vamanakarma
� Administration of Yavagu
� Administration of Aakanthapana Dravya like milk / Ilkshu Rasa
� Administration of suitable Vamaka Dravya and in required quantity
� Waiting for Swa-pravrita Vega for 1 Muhurta (48 minutes)
Table No. 10. Process of Vamana & effect of Vamaka Dravya on the body9
SL. SYMPTOMS
APPEARED
CHANGES
IN DOSHA
MECHANISM OF VAMANA
01. Appearance
of Sweating
on Forehead
Doshas are
liquefied
Due to Ushna, Teekshna and Vyavayi
properties, the Doshas are starts
melting from their site of adherence
(i.e. Doshadooshya Sammurcchana)
and start moving them through major
and minor channels.
02. Pilling of
hairs
Doshas
moving
towards
Amashaya
Due to Ushna, Teekshna and Vyavayi
property of Vamaka Dravya, the
vitiated Doshas start moving towards
Kostha.
Doshas moves through Srotas just
like water moving through polished
vessel without sticking to it.
03. Discomfort in
abdomen
Enters the
Amashaya
The moving Dosha enter the
Amasaya by Anupravana Bhava.
04. Nausea,
Salivation,
Pain in chest
region.
Doshas
moves in
upward
direction.
Due to excitement of Udana Vayu,
Agni, Vata predominance and self
tendency Vikrita Dosha to move
upwards, they start to move in
upward direction.
� Observation regarding extend of results obtained
Table No. 11. The criteria for the evaluation of Shuddhi. 10
VAMANA AVARA SUDDHI
MADHYAMA SUDDHI
PRAVARA SUDDHI
Vaigiki 4 Vega 6 Vega 8 Vega Maniki 1 Prastha 1 ½ Prastha 2 Prastha Antiki PITTANTAM Laingiki Signs of symptoms of Samyak Vamana
YOGA-AYOGATA OF VAMANA11
Vamana is complicated procedure. The attending physician must be keen enough to have a look on Yoga-Ayogata of the Vamana procedure. This is an important part in obtaining result through the procedure. The patient with Samyaka Yoga of Vamana will have – Kaale Pravritti, elimination of Kapha, Pitta and Vata respectively, Swayam Cha Avasthanam, Hridaya Shuddhi, Parshwa Shuddhi, Srotodushti, Indriya Dushti, Laghutwa, etc.
Kotha, Kandu, heaviness of body, Hridaya and Srotas Ashuddhi.
VAMANA VYAPAT12
It is the prime duty of attending physician check the Vamana vyapat and treats them accordingly. The patient suffer from the complications like – Adhmana, Parikartika, Parisrava, Gatragraha, Hridgraha, Jeevadana, Alpa Dosha Harana, Vata Shoola, Atiyoga, Pravahika, Vibandha, etc.
VAMANA PASCHYATA KARMA13
After conducting Vamana, one should look after the patient carefully. The immediate things to be done by the patients are –
� After Samyaka Vamana, patient is advised to wash mouth, hands & feet, then to rest for a Muhurtta
� Then the patient is subjected for Dhoomapana. � Then Kavala is advised with Saindhava Jala.
� Due to Dosha elimination, Agni becomes weak. So to restore the strength of Agni and Prana, Peyadi Samsarjana Krama should be followed.14
SAMSARJANA KRAMA
After Vamana, the diet regimen should be planned according to the
type of Shuddhi obtained.
Table No. 12. Samsarjana Krama on various days15
DAYS Annakala Pravara Suddhi (3Days)
Madhyama Suddhi (5 Days)
Avara Suddhi (7 Days)
1 Morning – – – I day 2 Evening Peya Peya Peya 1 Morning Peya Peya Vilepi II day 2 Evening Peya Vilepi Kritakrita
Yusa 1 Morning Vilepi Vilepi Kritakrita
Mamsarasa III day
2 Evening Vilepi Akrita Yusa Normal diet 1 Morning Vilepi Krita Yusa –
IV day 2 Evening Akrita Yusa Akrita Mamsarasa – 1 Morning Krita Yusa Krita Mamsarasa – V day 2 Evening Krita Yusa Normal diet – 1 Morning Akrita
Mamsarasa – –
VI day 2 Evening Krita
Mamsarasa – –
1 Morning Krita Mamsarasa
– – VII day
2 Evening Normal diet – – SPECIAL PRECAUTIONS AFTER VAMANA16
The who has underwent Vamana should specially avoid the
activities like – Loud speeches, sitting in one position for long duration,
standing in one position for long duration, long walks and riding vehicles
should avoided, exposure to excessive cold or heat or dew, exposure
directly to flowing winds, long journey, sleeplessness in the nights,
sleeping in day time, should also be prohibited.
ANATOMY OF SKIN
Introduction
The skin is the largest organ of the body covering all living tissues in
the body. It is made up of multiple layers of epithelial tissues and guards
the underlying muscles, bones, ligaments and internal organs.01
Skin interfaces with the environment and protects against
pathogens. Its other functions are insulation, temperature regulation,
sensation, synthesis of vitamin D, and the protection of vitamin B.
Severely damaged skin tries to heal by forming scar tissue which is
often discoloured and depigmented. In humans, skin pigmentation varies
among populations, and skin type can range from dry to oily skin.
Skin Components
Skin has melanin, provided by melanocytes, which absorb some of
the potentially dangerous ultraviolet radiation (UV) in sunlight. It also
contains DNA repair enzymes which help to reverse UV damage.
The skin has the largest surface area of all the organs. For the
average adult human, the skin has a surface area of between 1.5 to 2.0
� Carcinoma rarely supervenes in the sinus tracts of acne conglobata
� Systemic symptoms rarely accompany severe acne (acne fulminans)
fever, myalgia, arthralgia have been described. 64
� Embarrassment, Shame and lack of confidence are important
sequelae of acne.65
DIFFERENTIAL DIAGNOSIS
Acne is rarely misdiagnosed. Following are some of the conditions
which mimic like acne are as follows –
� Acne Rosacea – This occurs in older age groups. There are no
comedones, nodules or cysts and scarring does not occur.
� Peri-oral Eczema – These patients are usually females and a lesion
usually causes itching; the skin is dry and there will be lacking of
non-flamed lesions.
� Milia – Predominantly occur in the infra arbitrary region and are
whiter and can occur in a way that is unrelated to acne also.
� Folliculitis – It Is due to gram-negative organisms can complicate
acne therapy and rare folliculitis due to Candida may also present as
multiple pustular eruptions.
� Zinc deficiency – Can be mistaken associated with severe acne.
� Drug induced acne – Androgens, Halogens, corticosteroids, lithium
causes acne like lesions, which are easily misdiagnosed as acne
vulgaris.
GENERAL MEASURES
Patient with acne are often depressed and may need sympathetic
counseling and support. Particularly, those subjects need the explanation
of inevitability of this condition and this should be stressed.
There is no evidence that particular foodstuffs have any deleterious
effect and washing vigorously will help to remove lesions. Along with other
myths should be dispelled with straightforward explanation of the nature of
disease, its natural history and treatment.
Educating patient on the nature of the disease and daily skin care is
important. Expensive soap or strong detergents are not necessary. Oily
cosmetics and hair griseous causes Comedones and acne, hence should
not be used.
Table No. 13. Differential diagnosis of Acne.
SL. DIAGNOSIS Age of onset
Clinical feature
Location Clinical appearacne
01. Acne rosacea
30-50 Slow onset aggravated by cold, ethyl alcohol, hot foods, stress; unknown etiology
Central face Erythema, telangiectasias, papules/ pustules; can present with rhinophyma or chronic eye inflammation
02. Perioral dermatitis
Primarily adult women
Sometimes associated with prolonged use of high potency topical steroids
Chin, perioral and nasolabial folds
Erythramatous, sometimes scaly 1-2mm papules; may progress to diffuse, scaly, yellow-red plaques
03. Gram-negative, folliculitis
Any age Can be seen with longterm antibiotic therapy
Nose and mouth areas (common) Neck (uncommon)
Superficial pustules & Large nodules
04. Steroid acne
Teenage to adult years
Associated with oral corticosteroid therapy
Chest, upper arms, and scalp
Small, Monomorphic papules, Pustules, or closed comedoes
05. Milia – – Infra-arbitrary
White in Colour, similar to acne
MODERN LINE OF MANAGEMENT
Local application of antibiotics is most of the time preferred. If the
condition is not controlled then use of oral antibiotics, corticosteroids
ritinoids and hormonal therapy is advocated. But recurrent attack and
incomplete management makes the disease chronic even with the
complications.
Commonly used topical anti-bacterial drugs are –
� Benzyl Peroxide – 2.5%
� Erythromycin – 1.5 to 2 %
� Clindamycin – 1%
Commonly used topical comodolytic and exfoliant are –
� Tretinoin – 0.025% to 0.1%
� Tazarotene – 0.05%
� Adapalene – 0.1%
� Azelaic acid – 20%
� Glycolic acid – 10%
Commonly used oral antibiotics are –
� Tetracycline – 500mg BD
� Doxycycline – 100mg BD
� Minocycline – 50-100mg BD
� Erythromycin – 500mg BD
Commonly used oral retinoids are –
� Iso-tretinoin – 1 to 2mg/Kg
Commonly used drugs in hormonal therapy are –
� Progestin Norgestimate
� Ortho Tri-Cyclen
� Combination of Norgestimate, ethinyl estradiol,
� Norgestimate, Desogestrel, Spironolactone.
Table No. 13a. Prescription guidelines for systemic antibiotics.
SL. ANTIBIOTICS INITIAL DOSAGE
MAINTENANCE DOSAGE
COMMENTS
01. Tetracycline 500 mg twice daily
250 to 500 mg daily
Take on an empty stomach to avoid chelation with calcium, iron and other polyvalent cautions. Take with a large glass of water to decrease dyspepsia.
02. Doxycycline (Vibramycin)
100 mg twice daily
50 to 100 mg daily
Take with meals
03. Minocycline (Minocin)
50 to 100 mg twice daily
50 to 100 mg daily
Take with meals
04. Erythromycin 500 mg twice daily
250 to 500 mg daily
Take with meals
Note : Initial dosages should be continued until clear improvement in acne
is seen, usually three to six weeks.
Table No. 13b. Adverse reactions associated with oral antibiotic usage.
SL. DRUG ADVERSE REACTION 01. Tetracycline Dyspepsia, Vaginal yeast infection, Photosensitivity,
Possible interference with oral contraceptives, Tooth discolouratation in children younger than 13 years or in developing fetuses, Propionibacterium acnes antibiotic resistance, Pseudotumor cerebri, Single organ dysfunction, Hypersensitivity, reaction, Serum sickness like reaction
02. Doxycycline (Vibramycin)
Same as tetracycline
03. Minocycline (Minocin)
Same as tetracycline except Propionibacterium acnes antibiotic resistance
� Evaluate the effect of Manjishta-Madhu Lepa in Youvana Pidaka.
� Evaluate the additional effect of Vamana with Kritavedhana followed
by Lepa in Youvana Pidaka.
� Compare the effect of Lepa over the Vamana followed by Lepa in
Youvana Pidaka.
SOURCES OF DATA
01. Patients – The patients with classical signs and symptoms of Youvana
Pidaka were randomly selected by preset inclusion and exclusion criteria
from the OPD and IPD of Post-graduate studies in Panchakarma of Shri
Siddharoodha Charitable Hospital, Bidar attached to N. K. Jabshetty
Ayurvedic Medical College & P.G. Research Center Bidar, Karnataka.
02. Trial Drugs – All the raw drugs were identified, purchased from local
market and processed under good manufacturing practice in N. K.
Jabashetty Ayurvedic Pharmacy under the supervision of Dravyaguna &
Rasashala specialists.
The Kritavedhana (bitter variety) was cultivated in our herbal garden
and used for the present clinical trial. The well matured fruits were
collected and dried them in a sunshade. Fine powder is prepared out of it
and stored in a dry glass bottle to use as required.
METHOD OF DRUG PREPARATION FOR VAMANA
Drugs for the Deepana-Pachana (Trikatu Churna), Snehapana
(Moorchhita Ghrita) and Sarvanga Abhyanga (Moorcchita Tila Taila) were
taken from N. K. Jabashetty Ayurveda Pharmacy, Bidar.
� Yavagu preparation – It was prepared with Tila Kalka, Guda, Ghee,
Shaali, Ksheera. It is to be prepared in 1:6 proportion of the liquids
and Shaali.
� Aakantha Drava Dravya preparation – 2 liters of schemed milk or
Fresh Ikshu juice is to be prepared with machine.
� Vamaka Dravya – One Tola of Kritavedhana Phala Churna
(Approximately 12 gms) soaked in one Anjali (Approximately 192 ml)
of Yashtimadhu Kwatha soaked over night. Then it is to be filtered in
the morning. Add Madhu and Saindhava Lavana to it before
administration for Vamana. (Approximately 40 ml of Madhu and 5
gms of Saindhava Lavana are taken according to Balaabala of the
patient)
� Vamanopaga Dravya – Yashtimadhu Kwatha Churna is soaked in
hot water for over night in 1:6 proportion. (5 liters of hot water is to
be soaked in 30 gms of Yashtimadhu Kwatha Churna for over night.)
� Shuddhi Drava Dravya – 2 liters of Sukhoshna Jala is mixed with
20 gms of Saindhava Lavana.
METHOD OF PREPARATION OF SAMSARJANA PROCEDURE
Table No. 17. Preparation of Peyadi Samsarjana Krama.
SL. SAMSARJANA RECIPE TO PREPARE
01. Peya 1 cup of old rice + 14 cups of water. Cook the rice
and collect the supernatant part of it. (Ganji)
02. Vilepi 1 cup of old rice + Add 6 cups of water and cook
the rice and collect the semisolid rice.
03. Akrita Yusha 1 cup of old green gram + 14 cups of water, cook
it and have it with cooked rice
04. Krita Yusha 1 cup of old green gram + Add 14 cups of water
and cook it. Add Pope, Salt and little spice and
have it with cooked rice.
05. Akrita Mamsa
Rasa
50 gms of pounded meet + Add 4 cups of water
and reduce to one cup. Have it with cooked rice.
06. Akrita Masha
Yusha
50 gms of blackgram + 14 cups of water and boil,
have with cooked rice.
07. Krita Mamsa
Rasa
50 gms of pounded meet + Add 4 cups of water
and reduce to one cup. Add Pope, Salt and little
spice and have it with cooked rice.
08. Krita Masha
Yusha
50 gms of blackgram + 14 cups of water and boil.
Add Pope, Salt and little spice and have it with
cooked rice.
Patient is advised to follow Samsarjana Krama according the nature
of Shuddhi obtained. After evaluating the status of Agni the patient is
shifted to normal diet regimens. For vegetarians Masha Yusha was used
and for mixed food habits patients were advised Mamsarasa.
METHOD OF DRUG PREPARATION FOR LEPA Daily fresh Lepa drug was prepared for Lepa. Required quantity of
fine powder (Approximately 7 to 10 gms) of Manjishtha (Rubia cardifolia) was taken in a vessel. Add Madhu (Honey) to it slowly (Approximately 5 to 7 gms) with stirring it, to mix them and prepare homogenous paste of it. PROCEDURE OF CONDUCTING VAMANA KARMA
The Vamana karma is conducted at early in the morning at 5 am. Table No. 17a. Procedure of conducting Vamana.
SL. PROCEDURE PREPARATION DURATION 01. Deepana-Pachana Trikatu Churna
(5-10gms) Till Nirama Dosha Lakshana appears
02. Snehana Abyantara Snehapana
Moorchhit Ghrita Arohana Snehapana was carried out till Samyaka Snigdha Lakshana appears (Less than 7 days)
Snehana Bahya sneha (Sarvanga Taila Abhyanga)
Moorchhit Tila Taila
Sarvanga Abhyanga was carried out with Moorcchita Tila Taila on the day of Virama Kala & on the day of Vamana. It was done in the morning till Samyaka Swedana Lakshana appears. In the night Khapha Utkleshaka diet was given prior to the day of Vamana.
Swedana (Sarvaanga Swedana)
Bashpa Sweda Till Samyaka Swedana Lakshana observed
03. Pradhana karma Vamaka Dravya is to be prepared in prescribed manner.
Yavagu was given. Aakanthapaana Drava Dravyas was given. Vamaka Dravya was given. Wait for 1 Moohurta. Yashtimadhu Phanta as a Vamanopaga. Shuddhi Lavana Jala was given for Shuddhi.
04. Pashchat karma � Dhoomapana � Samsarjana
Krama
Dhooma varti Peyadi Samsarjana Karma
Till Samyak Yoga Laxana. According to Shuddi of Vamana it was followed. Pravar Shuddi – 7days, 3 Annakaala Madhyama Shuddi – 5 days, 2 Annakaala Avara Shuddi – 3 days, 1 Annakaala
After Samsarjan Krama, the patients were advised to start
Manjishta-Madhu Lepa as per the regimen of Lepa for 15 days.
PROCEDURE OF CONDUCTING LEPA
The patient was advised to conduct Lepa in morning hours between
7 to 10 am.
Procedure of Lepa karma:-
It was conducted in three steps. Viz. –
� Poorva Karma
� Pradhana Karma and
� Paschat Karma
Poorva karma
� The patient was asked to wash the face with luke warm water prior
to application of Lepa with gentle massage against the hair follicles.
Pradhana Karma
� Lepa was applied preferably in morning hours between 7 and 10 am.
Keep the Lepa over face at least for 30 minutes or until it gets dried.
� Required quantity of Manjishta Choorna Lepa was taken and applied
to the affected site in opposite direction of hair roots.
� The Lepa was applied with the thickness of 4 to 5 mm.
Paschyat Karma
� After completing Lepa the patients were advised to wash the face
with luke warm water.
INTERVENTION CHART
The details of Vamana Karma and Samsarjana Karma procedures
were recorded in interventional proforma.
METHODS OF COLLECTION OF DATA
Patients who were fulfilling the criteria for diagnosis and inclusion
were randomly selected for study.
A. Research Design : Comparative study with pre and post test design.
B. Sample Size : 30 patients.
C. Diagnostic Criteria : Diagnosis was established on the basis of history,
symptoms mentioned in classical texts and by objective parameters /
investigations mentioned in contemporary texts.
D. Inclusion Criteria :
� Patients fulfilling the diagnostic criteria.
� 16 to 30 years of age group.
� Irrespective of sex, religion, socioeconomic status and occupation.
� Patients who are fit for Vamana karma & Lepa karma.
� Chronicity less than 7 years.
E. EXCLUSION CRITERIA
� Patients having Pidika other than face
� Patient having other type of Kshudraroga and Kushta.
� Pidika produced due to side effect of any drug.
� Patients who were contraindicated for Vaman and Lepa in classics.
� The patients suffering from systemic pathologies like DM, HTN, etc.
F. LABORATORY INVESTIGATIONS
Blood and Urine routines were carried out for all the patients to rule
out the secondary things related to Youvana Pidaka.
G. Treatment Groups
All 30 patients were divided in 2 groups. Viz. –
� Group A : 15 Patients were subjected for administered Vaman with
Kritavedhana Yoga followed by Manjishtha-Madhu Lepa all over the
face for 30 minutes or until it get dried up. Lepa was done daily in
the morning for the period of 30 days.
� Group B : 15 Patient were subjected for Manjishtha-Madhu Lepa
over the affected part of the face for 30 minutes or until it get dried. It
was done daily in the morning for the period of 30 days.
H. POSOLOGY :
For Vamana the drugs were requires in following dosages.
� Trikatu Churna – 50 gms to 75 gms.
� Moorcchita Ghrita – 150 ml to 320 ml.
� Moorcchita Tila Taila – 200 ml.
� Yavagu – 100 to 150 gms.
� Aakanthapana Drava Dravya – 2 liters of schemed milk or Ikshurasa.
� Vamaka Dravya – Approximately 200 ml. (192 ml)
� Vamanopaga Drava Dravya – 5 liters of Yashtimadhu Phanta.
� Shuddhi Drava Dravya – 2 liters of Lavana Jala.
For Lepa each patient was supplied with Manjishta-Madhu.
� Fine power of Manjishta – Approximately 150 gms.
� Shuddha Madhu – Approximately 125 to 150 gms.
I. STUDY DURATION : 30 days.
J. FOLLOW UP :
After the treatment 3 follow ups were done. 1st follow up assessment
was done 15 days after the treatment. 2nd follow up assessment was done
30 days after the treatment. 3rd follow up assessment was done 60 days
after the treatment in both the groups. (AT-30 days, FU1-45 days, FU2-75
days, FU3-105 days)
K. RECURRENCE : Reappearance of the symptoms within follow up
period were considered as recurrence of the disease.
ASSESSMENT OF RESULTS
Effect of the therapies was compared before and after the treatment
on the basis of self formulated scoring scale to signs and symptoms in
subjective and objective parameters.
Subjective parameters
� Pain
� Burning sensation
Objective parameters
� Pictorial presentation
� Number of Pidaka
� Size of Pidaka
� Number of scars
� Oiliness of the face
� Dryness of the face
� Score of Pidaka on the basis of affected place
� Global Acne Grading System
PARAMETERS GRADATION INDEX
SUBJECTIVE PARAMETER
PAIN
0 – No pain
1 – Occasionally pain on deep pressure
2 – Pain on mild pressure
3 – Pain on touch
4 – Continuous pain even without touch
BURNING SENSATION
0 – No burning sensation
1 – Occasionally burning sensation
2 – Burning sensation on rubbing
3 – Burning sensation on deep touch
4 – Intolerable burning sensation
OBJECTIVE PARAMETER
NUMBER OF PIDAKA
0 – No Pidaka
1 – 0 – 5 on Right side & 0 – 5 on Left side
2 – 6 – 10 on Right side & 6 – 10 on Left side
3 – 11 – 15 on Right side & 11 – 15 on Left side
4 – More than 20 Pidaka on Right side & More than 20 Pidaka on Left side
SIZE OF PIDAKA
0 – No Pidaka
1 – Less than 5 mm
2 – 6 mm to 10 mm
3 – 11mm to 15 mm
4 – More than 16 mm
NUMBER OF SCAR
0 – No Scar
1 – 1-5 Scars
2 – 5-10 Scars
3 – 10-15 Scars
4 – >15 Scars
OILINESS ON THE FACE
0 – Normal skin
1 – Face becomes oily 3 to 4 hours after face wash
2 – Face becomes oily 1 to 2 hours after face wash
3 – Requires face wash within 1 hour
4 – Require face wash frequently
DRYNESS OF THE FACE
0 – No Dryness / Normal Skin
1 – Feels dryness in winter season only
2 – Dryness subsides with application of moisturizers
3 – Dryness feels during all seasons
4 – Feels dryness in all seasons and require moisturizers frequently
SCORE OF PIDAKA ON THE BASIS OF AFFECTED PLACE
2 – Forehead
2 – Right Cheek and Right side of face
2 – Left Cheek and Right side of face
1 – Nose
4 – Chin
4 – Chest & upper back
GLOBAL ACNE GRADING SYSTEM
Grade Score Description
None 0 No lesion
Mild 1 01 – 18 Comedons
Moderate 2 19 – 30 Comedons
Severe 3 31 – 38 Comedons
Very severe 4 > 39 Comedons
GRADATION INDEX FOR OVERALL RESPONSE
The overall results were assessed based on data obtained before
and after the treatment. The percentage of improvement is calculated and
graded in following ways –
� No improvement – Less than 25% of the obtained result.
� Mild relief – 25% to 50% of the obtained result.
� Moderate relief – 50% to 75% of the obtained result.
� Marked relief – More than 75% of the obtained result.
� Complete relief – 100% relief in the obtained result.
STATISTICAL ANALYSIS OF THE RESULTS
The obtained data was subjected for paired ‘t’ test and ‘p’ value less
than 0.05 is considered as statistically significant in this study.
����
OBSERVATIONS
The present clinical study was conducted to evaluate the
comparative efficacy of Vamana followed by Lepa and only Lepa in
Youvana Pidaka. The patients were randomly registered irrespective of
age, sex, socio-economical status and religion. All the patients were
received the trial drug as per the research protocol.
For the present clinical study 38 patients were registered. The
patients were divided into 2 groups.
Table No. 18. Distribution of patients registered in trial groups.
SL. Trial Groups Total Registered Discontinued Completed
01. Group A 18 03 15
02. Group B 20 05 15
Among the 38 patients, only 30 patients completed the duration of
research protocol. In group A, 03 patient discontinued the treatment and in
group B, 05 patients discontinued the treatment schedule due to several
reasons, like fear, anxiety to the therapy, irregular in follow up, etc.
The data was recorded in special research proforma designed. The
results were assessed on the basis of changes in subjective and objective
parameters recorded accordingly during the study. The collected data is
broadly classified under four groups. Viz. –
� Section A – Demographic Data
� Section B – Data related to Disease
� Section C – Statistical Analysis
� Section D – Overall Response
SECTION A – DEMOGRAPHIC DATA The demographic data collected during the study is as follows –
Table No. 19. Distribution of the patients according to age.
Gr. A Gr. B TOTAL SL.
Age in Yrs No. of Pt’s % No. of Pt’s % No. of Pt’s %
01. 14-17 00 00.00 01 06.66 01 03.33
02. 18-21 07 46.66 09 60.00 16 53.33
03. 22-25 06 40.00 05 33.33 11 36.66
04. 26-29 01 06.66 00 00.00 01 03.33
05. 30-33 01 06.66 00 00.00 01 03.33
Among 30 patients, maximum numbers of 16 patients (53.33%) were
in 18-21 years, 11 patients (36.66%) were in 22-25 years, 01 patient
(03.33%) each was in 14-17 years, 26-29 years, 30-33 years of age group.
Table No. 20. Distribution of the patients according to sex.
Gr. A Gr. B TOTAL SL.
Sex No. of Pt’s % No. of Pt’s % No. of Pt’s %
01. Male 03 20.00 05 33.33 08 26.66
02. Female 12 80.00 10 66.66 22 73.33
Among 30 patients, maximum numbers of 22 patients (73.33%) were
female and 08 patients (26.66%) were male. Table No. 21. Distribution of the patients according to religion.
Gr. A Gr. B TOTAL SL.
Religion No. of
Pt’s % No. of
Pt’s % No. of
Pt’s %
01. Hindu 09 60% 10 66.66 19 63.33
02. Muslim 02 13.33 02 13.33 04 13.33
03. Christian 01 6.66 02 13.33 03 10.00
04. Others 03 20 01 6.66 04 13.33
Among 30 patients, maximum numbers of 19 patients (63.33%) were
Hindu, 04 patients (13.33%) each were Muslim and other religion, 03
patients (10%) were christian.
Graph No. 01. Age-wise distribution of the patients.
Age-wise distribution of Pt.'s
0
76
1 11
9
5
0 00123456789
10
14-17 18-21 22-25 26-29 30-33
Age in Years
No.
of P
t.'s
Gr. A Gr. B
Graph No. 02. Sex-wise distribution of the patients.
Sex-wise distribution of Pt.'s
3
12
5
10
0
2
4
6
8
10
12
14
Male FemaleSex
No.
of P
t.'s
Gr. A Gr. B
Graph No. 03. Religion-wise distribution of patients.
Religion-wise distribution of Pt.'s
9
21
3
10
2 21
0
2
4
6
8
10
12
Hindu Muslim Christian Others
Religion
No
. of
Pt.
's
Gr. A Gr. B
Table No. 22. Distribution of the patients according to education. Gr. A Gr. B TOTAL
Among 30 patients, maximum numbers of 15 patients (50.00%) were PUC and below, 09 patients (30.00%) were graduates, 04 patients (13.33%) were post-graduates and 02 patients (06.66%) were illiterate. Table No. 23. Distribution of the patients according to occupation.
Gr. A Gr. B TOTAL SL.
Occupation No. of
Pt’s % No. of
Pt’s % No. of
Pt’s %
01. Students 10 66.66 11 73.33 21 70.00 02. House wife 03 20.00 02 13.33 05 16.66 03. Agriculture
/ Labour 01 06.66 01 06.66 02 06.66
04. Business 00 00.00 00 00.00 00 00.00 05. Office work 01 06.66 01 06.66 02 06.66
Among 30 patients, maximum numbers of 21 patients (70.00%) were students, 05 patients (16.66%) each were house wife, 02 patients (06.66%) each were in agriculture, labour occupation. Table No. 24. Distribution of the patients according to S-E Status.
Gr. A Gr. B TOTAL SL.
S-E Status No. of
Pt’s % No. of
Pt’s % No. of
Pt’s %
01. Lower Class 03 20.00 02 13.33 05 16.66 02. Middle Class 07 46.66 09 60.00 16 53.33 03. Upper Class 05 33.33 04 26.66 09 30.00
Among 30 patients, maximum numbers of 16 patients (53.33%) were
of middle class, 09 patients (30.00%) were of upper class and 05 patients
(16.66%) were of lower class socio-economic status.
Graph No. 04. Educational status-wise distribution of the patients.
Education-wise distribution of Pt.'s
1
6 6
21
9
3
1
0123456789
10
Illiterate PUC & Below Graduation Postgraduate
Education
No.
of P
t.'s
Gr. A Gr. B
Graph No. 05. Occupation-wise distribution of the patients.
Occupation-wise distribution of Pt.'s
10
3
10
1
11
21
01
0
2
4
6
8
10
12
Students House wife Agriculture /Labour
Business Office work
Occupation
No
. of P
t.'s
Gr. A Gr. B
Graph No. 06. Socio-Economic status-wise distribution of the patients
S-E Status-wise distribution of Pt.'s
2
7
5
2
9
4
0123456789
10
Lower Class Middle Class Upper Class
S-E Status
No. o
f Pt.'s
Gr. A Gr. B
Table No. 25. Distribution of the patients according to habitat.
Gr. A Gr. B TOTAL
SL.
Habitat No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Slum 02 13.33 02 13.33 04 13.33
02. Rural 03 20.00 03 20.00 06 20.00
03. Suburban 04 26.66 08 53.33 12 40.00
04. Urban 06 40.00 02 13.33 08 26.66
Among 30 patients, maximum numbers of 12 patients (40.00%) were
residing in sub-urban area, 08 patients (26.66%) were residing in urban
area, 06 patients (20.00%) were residing in rural and 04 patients (13.33%)
were residing in slum area.
Table No. 26. Distribution of the patients according to marital status.
Gr. A Gr. B TOTAL SL.
Marital Status
No. of Pt’s % No. of Pt’s
% No. of Pt’s
%
01. Married 04 26.66 03 20.00 07 23.33
02. Unmarried 11 73.33 12 80.00 23 76.66
Among 30 patients, maximum numbers of 23 patients (76.66%) were
unmarried and 07 patients (23.33%) were married.
Table No. 27. Distribution of the patients according to dietary habits.
Gr. A Gr. B TOTAL
SL.
Dietary
Habits No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Vegetarian 05 33.33 07 46.66 12 40
02. Mixed 10 66.66 08 53.33 18 60
Among 30 patients, maximum numbers of 18 patients (60.00%) were
mixed food habits and 12 patients (40.00%) were vegetarian.
Graph No. 07. Habitat-wise distribution of the patients.
Habitat-wise distribution of Pt.'s
2
34
6
2
3
8
2
0
12
34
5678
9
Slum Rural Suburban Urban
Habitat
No
. of
Pt.
's
Gr. A Gr. B
Graph No. 08. Marital status-wise distribution of the patients.
Marital Status-wise distribution of Pt.'s
4
11
3
12
0
2
4
6
8
10
12
14
Married Unmarried Marital Status
No. o
f Pt.'s
Gr. A Gr. B
Graph No. 09. Dietary habits-wise distribution of the patients.
Diatory Habit-wise distribution of Pt.'s
5
10
78
0
2
4
6
8
10
12
Vegetarian MixedDiatory Habits
No.
of P
t.'s
Gr. A Gr. B
Table No. 28. Distribution of the patients according to Prakriti.
Gr. A Gr. B TOTAL
SL
Prakriti No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Vata-Pitta 05 33.33 06 40.00 11 36.66
02. Kapha-Pitta 03 20.00 04 26.66 07 23.33
03. Vata-Kapha 07 46.66 05 33.33 12 40.00
Among 30 patients, maximum numbers of 12 patients (40.00%) were
of Vata-Kapha Prakriti, 11 patients (36.66%) were of Vata-Pitta Prakriti and
07 patients (23.33%) were of Kapha-Pitta Prakriti.
Table No. 29. Distribution of the patients according to Satwa.
Gr. A Gr. B TOTAL
SL.
Satwa No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Pravara 07 46.66 04 26.66 11 36.66
02. Madhyama 06 40.00 05 33.33 11 36.66
03. Avara 02 13.33 06 40.00 08 26.66
Among 30 patients, maximum numbers of 11 patients (36.66%) each
were having Pravara Satwa and Madhyama Satwa and 08 patients
(26.66%) were having Avara Satwa.
Table No. 30. Distribution of the patients according to Desha.
Gr. A Gr. B TOTAL
SL.
Desha No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Anupa 08 53.33 07 46.66 15 50.00
02. Janghal 04 26.66 05 33.33 09 30.00
03. Sadharana 03 20.00 03 20.00 06 20.00
Among 30 patients, maximum numbers of 15 patients (50.00%) were
from Anupa Desha and 09 patients (30.00%) were from Jangala Desha
and 06 patients (20.00%) were Sadharana Desha.
Graph No. 10. Prakriti-wise distribution of the patients.
Prakriti-wise distribution of Pt.'s
5
3
7
6
4
5
0
1
2
3
4
5
6
7
8
Vata-Pitta Kapha-Pitta Vata-KaphaPrakriti
No
. of
Pt.
's
Gr. A Gr. B
Graph No. 11. Satwa-wise distribution of the patients.
Satwa-wise distribution of Pt.'s
7
6
2
4
5
6
0
1
2
3
4
5
6
7
8
Pravara Madhyama Avara
Satwa
No.
of P
t.'s
Gr. A Gr. B
Graph No. 12. Desha-wise distribution of the patients.
Desha-wise distribution of Pt.'s
8
43
7
5
3
0123456789
Anupa Jangal Sadharana
Desha
No
. of
Pt.
's
Gr. A Gr. B
Table No. 31. Distribution of the patients according to Vyayama Shakti.
Gr. A Gr. B TOTAL
SL.
Vyayama
Shakti No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Pravara 07 46.66 04 26.66 11 36.66
02. Madhyama 06 40.00 05 33.33 11 36.66
03. Avara 02 13.33 06 40.00 08 26.66
Among 30 patients, maximum numbers of 11 patients (36.66%) each
were having Pravara and Madhyama Vyayama Shakti, and 08 patients
(26.66%) were having Avara Vyayama Shakti.
Table No. 32. Distribution of the patients according to Satmya.
Gr. A Gr. B TOTAL
SL.
Satmya No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Pravara 00 00.00 00 00.00 00 00.00
02. Madhyama 15 100.00 15 100.00 30 100.00
03. Avara 00 00.00 00 00.00 00 00.00
Among 30 patients were having Madhyama Saatmya.
Table No. 33. Distribution of the patients according to Diwaswapna.
Gr. A Gr. B TOTAL
Sl. Diva
Swapna No. of Pt’s % No. of Pt’s % No. of Pt’s %
01. No 13 86.66 08 53.33 21 70.00
02. <1 hr 01 06.66 02 13.33 03 10.00
03. 1-2 hrs 01 06.66 05 33.33 06 20.00
04. >2 hrs 00 00.00 00 00.00 00 00.00
Among 30 patients, maximum numbers of 21 patients (70.00%) were not
sleeping at day time, 06 patients (20.00%) were sleeping 1-2 hours and 03
patients (10.00%) patients were habituated for day sleep less than 1 hour in
day time.
Table No. 34. Distribution of the patients according to Agni. Gr. A Gr. B TOTAL
Among 30 patients, 22 patients (73.33%) were having Samagni and 08 patients (26.66%) were having Mandagni. Graph No. 13. Vyayama Shakti-wise distribution of the patients.
Vyayama Shakti-wise distribution of Pt.'s
76
2
45
6
012345678
Pravara Madhyama Avara
Vyayama Shakti
No.
of P
t.'s
Gr. A Gr. B
Graph No. 14. Satmya-wise distribution of the patients.
Satmya-wise distribution of Pt.'s
0
15
00
15
00
2
4
6
8
10
12
14
16
Pravara Madhyama Avara
Satmya
No.
of P
t.'s
Gr. A Gr. B
Graph No. 15. Diwaswapna-wise distribution of the patients.
Diwaswapna-wise distribution of Pt.'s13
1 10
8
2
4
00
2
4
6
8
10
12
14
No <1 hr 1-2 hrs >2 hrs
Diwaswapna
No.
of P
t.'s
Gr. A Gr. B
Graph No. 16. Status of Agni-wise distribution of the patients.
Status of Agni-wise distribution of Pt.'s13
0
2
0
9
0
6
00
2
4
6
8
10
12
14
Sama Vishama Manda Teekshna Agni
Status of Agni
No.
of P
t.'s
Gr. A Gr. B
SECTION B – DATA RELATED TO DISEASE Table No. 35. Distribution of the patients according to Nidana in Ahara specifications.
Gr. A Gr. B TOTAL SL.
Ahara
specifications No. of Pt’s
% No. of Pt’s
% No. of Pt’s
%
01. Excess use of Masha
00 00.00 00 00.00 00 00.00
02. Excess use of Dadhi
02 13.33 02 13.33 04 13.33
03. Excess use of Dugdha Vikara 02 13.33 01 06.66 03 10.00
04. Excess use of Ice creams 00 00.00 00 00.00 00 00.00
05. Excess use of oily food 04 26.66 03 20.00 07 23.33
06.
Excess use of Sore items / Pickles
00 00.00 00 00.00 00 00.00
07.
Excess use of Bakery items / Spicy items
02 13.33 03 13.33 05 16.66
08.
Excess use of Sweets / Ikshu Vikara / Chocalate
02 13.33 03 33.33 05 16.66
09. Excess use of Matsya 00 00.00 00 00.00 00 00.00
10. Excess use of Chicken / Meat 03 20.00 03 26.66 06 40.00
Among 30 patients, maximum numbers of 07 patients (23.33%) were
habituates to excess use of oily food and 06 patients (26.66%) were
habituates to Chicken / Meat and, 05 patients (16.66%) each were
habituates to excess use of sweets / Ikshu Vikara / Chocolates, Excess
use of bakery items / Spicy items. 04 patients (16.66%) were habituated to
excess use of Dadhi and 03 patients (10%) were habituated to excess use
of Milk products.
Table No. 36. Distribution of the patients according to Nidana in Vihara
specification.
Gr. A Gr. B TOTAL
SL.
VIHARA No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Exposure to
Dhooma 03 20.00 04 26.66 07 23.33
03. Exposure to
Atapa 00 00.00 03 20.00 03 10.00
04. Exposure to
dust 02 13.33 00 00.00 02 06.66
06. Diwaswapna 04 26.66 02 13.33 06 20.00
07. Nishajagarana 03 20.00 02 13.33 05 16.66
08. Pravasa 02 13.33 02 13.33 04 13.33
09. Ativyayama 03 20.00 02 13.33 05 16.66
10. Avyayama 00 00.00 00 00.00 00 00.00
Among 30 patients, 07 (23.33%) were exposed to Dhooma, 06
patients (20.00%) were doing Deewaswpna, 05 patients (16.66%) each
were doing Nishajagarana & Ativyayam, 04 patients (13.33%) were
exposed to Pravasa, 03 patients (10.00%) were exposed to Aatapa, 02
patients (06.66%) were exposed to dust.
Table No. 37. Distribution of the patients according to Site of
Pidaka.
Gr. A Gr. B TOTAL
SL.
Site of
Pidaka No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Face 15 100 15 100 30 100
02. Neck 03 20.00 02 13.33 05 16.66
03. Chest 03 20.00 00 00.00 03 10.00
04. Back 05 33.33 03 20.00 11 36.66
05. Shoulder 03 20.00 02 13.33 05 16.66
Among 30 patients, all patients were having Pidaka over face, 11
patients (36.66%) were having Pidaka on the back, 05 patients (16.66%)
were having Pidaka on the shoulder and neck and 03 patients (10.00%)
were having Pidaka on the chest.
Table No. 38. Distribution of the patients according to Chronicity.
Gr. A Gr. B TOTAL
SL.
Chronicity No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. 0 – 1 yrs 05 33.33 06 40.00 11 36.66
02. 2 – 3 yrs 08 53.33 05 33.33 13 43.33
03. 4 – 5 yrs 01 06.66 02 13.33 03 10.00
04. 6 – 7 yrs 01 06.66 02 13.33 03 10.00
Among 30 patients, maximum numbers of 13 patients (43.33%) were
having 2-3 yrs chronicity, 11 patients (36.66%) were from 0-1 yrs of
chronicity and 03 patients (10.00%) each were having chronicity of 4-5 yrs
and 6-7 yrs.
Graph No. 17. Aharaja Nidana-wise distribution of the patients.
Aharaja Nidana-wise distribution of Pt.'s
0
2 2
0
4
0
2 2
0
3
0
2
1
0
3
0
3 3
0
3
00.5
11.5
22.5
33.5
44.5
Masha Dadhi Dugdha Vikar a Ice cr eams Oi ly f ood Sor e i tems / Pickles Baker y i tems /Spicy i tems
Sweets / IkshuVikar a / Chocalate
Matsya Chicken / Meat
Aharaja Nidana
No
. of P
t.'s
Gr. A Gr. B
Graph No. 18. Viharaja Nidana-wise distribution of the patients.
Viharaja Nidana-wise distribution of Pt.'s
3
0
2
4
3
2
3
0
4
3
0
2 2 2 2
00
0.51
1.52
2.53
3.54
4.5
Exposur e to Dhooma Exposur e to Atapa Exposur e to dust Diwaswapna Nishajagar ana Pr avasa Ativyayama Avyayama
Viharaja Nidana
No.
of P
t.'s
Gr. A Gr. B
Graph No. 19. Site of Pidaka-wise distribution of the patients.
Site of Pidaka-wise distribution of Pt.'s15
3 3
5
3
15
2
0
32
0
2
4
6
8
10
12
14
16
Face Neck Chest Back ShoulderSite of Pidaka
No.
of P
t.'s
Gr. A Gr. B
Table No. 39. Distribution of the patients according to Varna of patient.
Gr. A Gr. B TOTAL
SL.
VARNA No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Goura 03 20.00 02 13.33 05 16.66
02. Shyava 08 53.33 10 66.66 18 60.00
03. Krishna 04 26.66 03 20.00 07 23.33
Among 30 patients, maximum numbers of 18 patients (60.00%)
patients were having Shyava Varna, 07 patients (23.33%) were having
Krishna Varna and 05 patients (16.66%) were having Goura Varna.
Table No. 40. Distribution of the patients according to Shotha of Pidaka.
Gr. A Gr. B TOTAL
SL.
SHOTHA No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Bahala 07 46.66 07 46.66 14 46.66
02. Alpa 08 53.66 08 53.66 16 53.33
Among 30 patients, maximum numbers of 16 patients (53.33%) were
having Alpa Shotha and 14 patients (47%) were having Bahala Shotha.
Table No. 41. Distribution of the patients according to onset of Pidaka.
Gr. A Gr. B TOTAL
SL.
ONSET No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Sudden 00 00.00 02 13.33 02 06.66
02. Gradual 15 100 13 87.00 28 93.33
03. Insidious 00 00.00 00 00.00 00 00.00
Among 30 patients, 28 patients (93.33%) were having gradual onset
and 02 patients (06.66%) were of sudden onset.
Graph No. 20. Chronicity-wise distribution of the patients.
Chronicity of Pidaka-w ise distribution of Pt.'s
5
8
1 1
65
2 2
0
2
4
6
8
10
0 – 1 yrs 2 – 3 yrs 4 – 5 yrs 6 – 7 yrs
Chronicity in years
No
. of
Pt.
's
Gr. A Gr. B
Graph No. 21. Varna of the patient-wise distribution of the patients.
Varna of the Pt-wise distribution
3
8
4
2
10
3
0
2
4
6
8
10
12
Goura Shyava KrishnaVarna Specification
No.
of P
t.'s
Gr. A Gr. B
Graph No. 22. Shotha of the Pidaka-wise distribution of the patients.
Shotha of Pidaka-wise distribution of Pt.'s
78
78
1
2
3
4
5
6
7
8
9
10
Bahala AlpaShotha of the Pidaka
No
. of
Pid
aka
Gr. A Gr. B
Graph No. 23. Onset of Pidaka-wise distribution of the patients.
Onset of Pidaka-wise distribution of Pt.'s
0
15
02
13
002468
10121416
Sudden Gradual InsidiousOnset of Pidaka
No.
of P
idak
a
Gr. A Gr. B
Table No. 42. Distribution of the patients according to aggravation
of Pidaka in various seasons.
Gr. A Gr. B TOTAL
SL.
Aggravation No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Summer 05 33.33 04 26.66 09 30.00
02. Winter 01 06.66 00 00.00 01 03.33
03. Sunlight 03 20.00 01 06.66 04 13.33
04. Menstruation 06 40.00 06 40.00 12 40.00
05. No relation 06 40.00 07 46.66 13 43.33
Among 30 patients, maximum numbers of 13 patients (43.33%)
shows no relation of Pidaka with season. 12 patients (40.00%) were
complaining aggravation of Pidaka at menstruation. 09 patients (30.00%)
were complaining of aggravation of Pidaka during summer. 04 patients
(13.33%) were complaining of aggravation of Pidaka during sunlight and
01 patient (03.33%) was complaining of aggravation of Pidaka during
winter season.
Table No. 43. Distribution of the patients according to family
history of Acne.
Gr. A Gr. B TOTAL
SL.
Family
history
No. of
Pt’s
% No. of
Pt’s
% No. of
Pt’s
%
01. Sister 04 26.66 03 20.00 07 29.16
02. Brother 05 33.33 04 26.66 09 37.50
03. Mother 02 13.33 02 13.33 04 16.66
04. Father 02 13.33 02 13.33 04 16.66
Among 30 patients 24 patients represented with the family history of
acne. Among those maximum numbers of 09 patients (37.50%) patients
were having family history of Acnes to their brothers, 07 patients (29.16%)
were reported with the history of Acne to their sisters and 04 patients
(16.66%) each were having history Acne to their mothers and fathers.
Table No. 44. Distribution of the patients of Acne eruption in
relation with Rajopravrutti reported by 24 female patients.
Gr. A Gr. B TOTAL
SL.
Relation with
Menses No. of Pt’s
% No. of Pt’s
% No. of Pt’s
%
01. Aggravates 07 46.66 06 40.00 13 54.16
02. No relation 05 33.33 06 40.00 11 45.83
Among 24 females patients, maximum numbers of 13 patients
(54.16%) were complains of aggravation of Pidaka during menstrual period
and 11 patients (45.83%) says no relation of Pidaka with menstruation.
Graph No. 24. Distribution of patients according to season-wise
aggravation of Pidaka.
Distribution of Pt.'s according to Season-wise aggravation of Pidaka
5
1
3
6 6
4
01
67
0
2
4
6
8
Summer Winter Sunlight Menstruation No relation
Seasonal Variations
No
. of
Pt.
's
Gr. A Gr. B
Graph No. 25. Distribution of patients according to family history of Pidaka.
Family History-wise distirbution of Pt.'s
4
5
2 2
3
4
2 2
0
1
2
3
4
5
6
Sister Brother Mother Father
Family History
No.
of P
t.'s
Gr. A Gr. B
Graph No. 26. Distribution of patients according to relation with menses.
Distribution of Pt.'s according to relation with Menses
7
56 6
012345678
Aggravates No relationRelation with Menses
No
. of
Pt.
's
Gr. A Gr. B
Table No. 45. Distribution of the patients of according to the type of Vedana experienced by the patient.
Among 30 patients, maximum numbers of 18 patients (60%) was complaint of Shoola, 10 patients (33.33%) were having Kandu and 02 patients (06.66%) were having Daha. Table No. 46. Distribution of the patients according to number of Pidaka.
Among 30 patients, maximum numbers of 18 patients (60.00%) was having 11-15 Pidaka on each Right & Left side of face, 08 patients (26.66%) were having > 15 Pidaka and 04 patients (13.33%) were having 6-10 Pidaka on each Right & Left side of face. Table No. 47. Distribution of the patients according to density of Pidaka.
of Tundikeri along with the recent advancement and researches.
HISTORICAL REVIEW
By casting a glance on the literatures available regarding, Youvana
Pidika we may conclude that, it might not be prevalent during those days.
Hence, Sushruta was first who explained the condition and then
forthcoming texts.
NATURE OF THE DISEASE
Youvana Pidaka is a disease which harms the beauty of the face
typically during adolescent. It is the age when all are most conscious about
their beauty.
It is estimated that, nearly 80% of young adult between the ages of
12- 24 years suffers from Youvana Pidaka (Acne vulgaris). Majority of
patients recover within the ages of 20-30 years, perhaps 10-20% of adults
may continue to experience severe form of complications.
Looking into above facts there is a need of treatment which can
prevent complications of the disease as well as reduces the recurrence
effectively, which was tried to solve through this work.
CLASSIFICATION OF THE DISEASE
In most of the instances this disease is self limiting. It runs its course
and then gradually disappears. This could be the reason why Acharyas
might have classified this disease under Kshudraroga.
ADHISHTANA OF YOUVANA PIDAKA
In the context of Kshudraroga, Sushruta has explained various
diseases occurring in different layers of skin. Though Sushruta was the
first to explain Youvana Pidaka. but not mentioned the exact site of the
lesion. This could be because Sushruta might have seen various
conditions togetherly in which the acnes are involving the whole body
involving the neck, chest, back, etc.
Though, the term Kushta includes all types of skin diseases, there is
no specific reference about the involvement of particular layer of Twak in
Youvana Pidaka. Dr. Ghanekar in his commentary on Sushruta Samhita
has been correlated Vedini and Rohini layer of Twak with papillary layer &
reticular layer of the skin. This explanation withholds much similarity in
view of aetio-pathological review of Acne vulgaris.
Sushruta has documented the course of the disease and its typical
presentation which resembles with the features of Acne vulgaris. Acne
vulgaris is an inflammatory dermatological condition of saebaceous gland
situated in dermis. Papillary and reticular layer are layers of dermis.
Reticular layer fibres are found in hair bulbs, sweat gland & sebaceous
gland. Hence, with this we can consider Rohini Kala (reticular layer of
dermis) as the site of origin of Youvana Pidaka.
Most commonly affected site of Youvana Pidaka is the face leaving
the mouth and all the parts of face like checks, fore head, nose and chin
are affected.
NIDANA
01. AHARAJ NIDANA
This condition has its own nature and course of the disease. Diet
has very less relevance with the causation of the disease. Even though the
patients with the habits of using bakery, spicy, fast and junk food habits got
higher incidence than the patients under normal and routine diet.
02. VIHARAJ NIDANA
Daily regimens have very less relevance with the causation of the
disease. But, higher incidence was noted in the patients who were
indulging in excess of physical exercise, sexual intercourse, exposure to
dust, smoke, sunlight, etc may be taken as some of the predisposing
factors for acne vulgaris.
03. MANASIKA KARANA
Behavioral regimens have very less relevance with the causation of
the disease. But, higher incidence was noted in the patients who were
indulging in mental / psychological abuse like excess of Kama, Krodha,
Bhaya, Lobha, Moha, Chinta, Shoka, etc may be taken as some of the
predisposing factors for acne vulgaris.
04. ANYA KARANA
Though the classic says that, Kapha, Vata, Rakta are the causative
factors for the disease, Bhavaprakasha added Swabhava. (i.e. It one of the
natural process which runs its course) Sharangdhara added
Vaktrasnigdhata and Pidika as Mala of Shukradhatu.
Active production of Shukradhatu starts at Youvana Avastha. Due to
Swabhava at particular age there is active Shukra Utpatti and
simultaneously Mala formation in other terms production of Youvana
Pidaka occurs.
Use of oil & gel based cosmetics may predispose to the production
of Acne. Excess production of androgen, progesterone & steroids causes
hyperplasia of sebaceous oil glands. This could be a predisposing factor.
POORVAROOPA
These premonitory signs and symptoms of Youvana Pidika are not
mentioned in classics. Clinically it was observed that, patient feels
unctuousness burning sensation, itching of the face and mild pain.
ROOPA
For better understanding of subject, comparison is the tool by which
we can get the proper knowledge of the subject. Following are some of the
terms being used in classics while describing the features of Youvana
Pidaka.
01. SALMALI KANTAKAVAT
While describing Youvana Pidika, sages used the word Shalmali
Kantaka which denotes following things –
� For the exact diagnoses of the Youvana Pidaka and to differentiate it
with other skin disorders.
� The pain which is felt by the patient in Youvana Pidaka is same as
pricking of Shalmali Kantaka.
� To indicate Shalmali Kantaka as the drug of choice in Youvana
Pidaka.
� To tell the shape of Pidaka as Shalmali Kantaka. (i.e. Follicle with
broad base and triangular elevation and pustule)
02. PIDIKA
Pidika means eruption. The disease is in the form of eruptions. The
Pidaka word refers to the various types of the pain are being experienced
by the patient.
In this disease, the external beauty of an individual is affected,
hence called as Mukhadooshika.
03. SARUJA
The eruptions are painful. The pain may be mild tolerable and
frequently unknowingly disturbs an individual.
04. GHANA
The word Ghana means thick, hard or indurate. So the eruptions in
this disease are hard and thick caused by the aggravated Kapha.
05. MEDOGARBHI
Vagbhata added the Medo Garbhata which refers to existence of a
substance inside the Pidaka resembling the qualities of Meda Shlakshana,
Sthira Mrudu, Pichilla)
Similarly the patho-physiological consequences of acne show
obstruction of pilo-sebaceous gland which secretes sebum rich in fatty
acids.
Acne vulgaris occurs due to excessively secreted / infected /
obstructed secretion of sebum through pilo-sebaceous gland. When it
undergoes Paka and squeezed, it gives whitish, slimmy, thick secretions.
In white head also we can see the keratin and sebum.
As the Pidaka are packed with Meda in them. It comes out in the
form of discharge when the pressure is applied over the eruption. This
discharge may vary in colour according to the dominant Dosha.
06. YUNA MUKHE
The characteristic feature of the disease is, it appears in the
adulthood and typically vitiates face. This pinpoints towards the exclusion
of other types of acnes.
After the compilation of all the above symptoms we find following
characters of this disease.
There is increased activity of androgens during adulthood, which
intern causes stimulation of sebaceous gland through an enzyme called 5
alpha reductase. This enzyme binds to specific receptors in the sebaceous
glands and increases the sebum secretion and which leads to blockage of
the pilosebacious duct and leads to production of an irruption associated
with pain, burning sensation and discharge, called as acne.
SAMPRAPTI
Specific Samprapti is not mentioned in classics. Though the disease
occurs as a part of its Swabhava, it has influence of Vata, Kapha and
Rakta Dosha in the appearance of pain and nature of Pidaka.
If the Youvana Pidaka occurs due to Vata predominance, it gives
thin, stingy, watery discharge with pricking type pain associated with
dryness, etc.
If the Youvana Pidaka occurs due to Pifta predominance, it gives
thin, yellowish-pink tinged secretions, burning sensation, etc.
If the Youvana Pidaka occurs due to Rakta predominance, it gives
the features of Pitta predominance along with Pustulo-papillary
appearance, etc.
If the Youvana Pidaka occurs due to Kapha Dosha Predominance, it
gives big cystic swelling, thick, curdy white discharge with less pain, etc.
CLINICAL TYPES OF YOUVANA PIDAKA
There is no direct reference which tells about types of Youvana
Pidaka. An attempt is made to classify the Youvana Pidaka based on the
associated features and relevant Doshika involvement. Youvana Pidaka
can be categorized into four types as Vataja, Pittaja, Kaphaja & Raktaja
Youvana Pidaka. The signs and symptoms of them are as follows –
01. Vatika Youvana Pidaka
This type of eruption assumes a black colour and felt rough to touch,
and characterized by excruciating pain and scanty discharge.
02. Paittika Youvana Pidaka
The Pidaka appears abruptly with yellowish colour. These are hot
and soft in touch, associated with severe burning sensation. Pidaka grows
rapidly and suppurates quickly. These Pidaka gives out hot yellowish red
discharge.
Pitta and Rakta Dosha got Ashraya-Ashrayee relation. Hence, both
types of Pidaka appear in similar features. Papules and papillary pustular
Pidaka may resembles with Rakta and Pitta predominant Pidaka.
03. KAPHAJA YOUVANA PIDAKA
This type of Pidaka requires long time to manifest and also to cure.
These appear pale white in colour, heavy, unctuous, smooth, and
compact. It is characterized by numbness, itching and mild pain. The
growth of Pidaka and its suppuration is slow.
The discharge is thick whitish in colour. The lesions are pale, hard,
and fairly large in size. These have oily secretions which tend to aggravate
in cold weather. Cysts and nodular verity of Pidaka can be considered
under this type of Pidaka.
04. Raktaja Youvana Pidaka
These eruptions assume a black or reddish colour. Intolerable
burning sensation and pain occurs along with all the features of Pitta
Dosha predominant Youvana Pidaka. The discharge will be of pinkish-red
in colour.
COMPLICATIONS OF MOOKHADOOSHIKA
This condition does not have serious and life threatening
complications except cosmetic disfigurement of the face. During adulthood,
people are much concern about their physical appearance. If their face is
disfigured due to such eruptions then they loose their self confidence and
develop nurvousness. So, the patients of Mookhadooshika will have
psychological complications rather than physiological complications.
CHIKITSA
There is no satisfactory remedy for Kulaja, Swabhavaja Vikara.
Though, dozens of external applications are elaborated in classics for
Youvana Pidaka, only to obtain symptomatic relief.
The treatment is explained in various steps like just external
application, applications with certain internal medications, local and
systemic therapeutic procedures. It is also advised that, when one
treatment is not enough to manage the condition, shift the patient in further
steps of management like Vamana, Virechana, etc in Panchakarma.
Youvana Pidaka is a palliative condition which gives symptomatic
relief with local application. Hence, to get long term relief and to prevent
unwanted complications Vamana was specially advised.
Yogaratnakar praised Manjishta & Madhu Lepa, as a single drug
formulation. Thus, the present study was done to check additional efficacy
and utility of Vamana in Youvana Pidaka.
DISCUSSION ON OBSERVATIONS
AGE
In present study among 30 patients, maximum numbers of 16
patients (53.33%) were in 18-21 years, 11 patients (36.66%) were in 22-25
years of age group. This statistical data supports the
Charaka says that, during the age of 16-30 years, all the Dhatus
undergo increase in their quantity and quantity and especially at this age
Shukra Dhatu start functioning. In this stage of life person becomes more
Chanchala and there is predominance of Pitta. (Cha. Vi. 8/122)
SEX
In present study among 30 patients, maximum numbers of 22
patients (77.33%) were female and 08 patients (26.66%) were male. This
would be because of the early onset of puberty in females. In incidence of
this disease is slightly more in females than in males.
In general females are more conscious about the beauty than males.
Hence, females got convinced for the therapy early than males. This could
be one of the reasons for high number of female patients registered and
completed treatment protocol promptly.
RELIGION
In present study among 30 patients, maximum numbers of 19
patients (63.33%) were Hindu, 04 patients (13.33%) were Muslim, 04
patients (13.33%) were other religion and 03 patients (10%) was christian.
As such there is no relation of religion with the incidence of the
disease. During the study sample selection was done randomly
irrespective of religion. Hospital is located in Hindu dominant area.
EDUCATION
In present study among 30 patients, 15 patients (56%) were
students (PUC and below), 09 patients (30%) were graduates.
Maximum number of patients was in adolescent stage, in which the
incidence of the disease is high. This could be due to high levels of
androgens at this age of life.
Most of them were students who were exposed to excess of dust,
smoke, fast food, sweets, bakery products, soared items, etc.
OCCUPATION
In present study among 30 patients, maximum numbers of 21
patients (70.00%) were students in adolescent age group. Particularly, in
this age group hormonal changes play a major role.
SOCIO-ECONOMIC STATUS
In present study among 30 patients, maximum numbers of 16
patients (53.33%) were from middle class families. 09 patients (30%) were
from upper class families.
The study sample was collected incidentally. The study was
conducted in a private institute located in urban area. Lower socio-
economical group people much concern about their physical appearance
and beauty conscious. In middle class families, after satisfying their routine
needs, people think of other relevant things.
HABITAT
In present study among 30 patients, 12 patients (40%) were residing
in urban and 08 patients (26.66%) were residing in sub-urban area.
The study was conducted in urban area hence the incidence of
urban patient might be more. Recent studies have shown that the
incidence of the disease is more in middle socio-economical groups and in
urban habitat.
MARITAL STATUS
In present study among 30 patients, maximum numbers of 23
patients (76.66%) were unmarried and 07 patients (23.33%) were married.
Legally the age of marriage in India is 18 years for female and 21 for
male. But, due to long courses of higher education and less opportunities
of employment the age of marriage is raised till 30 years. Maximum
number of patients reported was students. This could be one of the
reasons for reporting maximum of un-married patients.
Marriage is like a mile stone which comes after the age of
adolescence and from which the incidence of Youvana Pidaka decreases.
HABITAT / DIET
In present study among 30 patients 18 patients (60%) were of mixed
food habit and 12 patients were reported with vegetarian food habits.
As such there is no proven and specific food which triggers Youvana
Pidaka. Usually, non-vegetarian food contains more of spicy, irritant and
lipid rich. Excessive intake of such substances vitiates Vata, Pitta and
Rakta in tern vitiates Meda to enhance the pathology of Youvana Pidaka.
PRAKRITI
In present study among 30 patients 12 patients (40%) were of Vata-
Kapha Prakriti and 11 patients (36.66%) were of Vata-Pitta Prakriti.
Maximum number of 14 patients (46.66%) reported with Vata-Pitta
variety of Pidaka as well as Deha Prakriti. Maximum number of 11 patients
(37%) reported with Vata-Kapha variety of Pidaka as well as Deha Prakriti.
This shows higher incidence of the similar Doshik anomalies in
similar type of Doshik Deha Prakriti. The prognosis is also poor because of
the Balabala of the Vyadhi in similar type of Doshik predominance.
SATWA AND VYAYAMA SHAKTI
In present study among 30 patients 11 patients each 36.66% were
having Pravara and Madhyama Shareerika as well as Maanasika Bala.
As such no relation of physical and mental potency in relation to
Youvana Pidaka is found. In general, Pravara Satwa patients were referred
for Vamana, as these patients were capable of bearing the strain of
Vamana. And those with Avara Satwa were taken for Lepa procedure.
DIWASWAPNA
In present study among 30 patients 21 patients (70%) were reported
with no habit of Diwaswapna. Maximum number of patients was students
who were busy in their academic activities.
The incidence of no Diwaswapna was found. As such the relation of
Diwaswapna with Youvana Pidaka is not found in practice, but those who
indulge in Nishajagarana, suffering with sleep disturbances have greater
the incidence of this condition.
AGNI
In present study among 30 patients 22 (73.3%) patients were having
Samagni and 08 (27%) were having well Mandagni.
The status of Agni is directly less concern with the development of
Youvana Pidaka. Agni is an entity of the body which maintains all the
physio-pathological changes in body. There is no specific cause for the
evolution of Pidaka similarly it subsides gradually. But, during its
appearance it gets Balaabala for its clinical features through the status of
Agni.
AHARA SPECIFIC NIDANA
Though there is no direct relation of etiological factors concern to
food habits, in present study all most all patients were exposed to one or
the other pre-disposing factor for Youvana Pidaka. But, the obtained
statistics is not up to the universal acceptability of it as an etiological factor.
VIHARA SPECIFIC NIDANA
There is very poor co-relation between etiological factors concern to
daily and seasonal regimens. In present study all most all patients were
exposed to one or the other pre-disposing factor for Youvana Pidaka. But,
the obtained statistics is not up to the universal acceptability of it as an
etiological factor.
SITE OF PIDIKA
In present study almost all patients were included with the Pidaka on
Mukha including Ganda, Lalata Pradesha, Chibuka and Nasika. The
definition of Youvana Pidaka itself says that, Pidaka occurs on face.
It could be because of the maximum number of sebaceous glands
found on these sites are comparatively larger in size.
CHRONICITY
In present study among 30 patients, maximum numbers of 13
patients (43.33%) were having 2-3 yrs chronicity, 11 patients (36.66%) had
0-1 yrs of chronicity and 03 patients (10.00%) each were having chronicity
of 4-5 yrs and 6-7 yrs.
This condition appears typically during adolescence age group and
subsides gradually. So, as the time passes the history of similar complaints
might not have re-occurred. In few patients it might have given trouble in
adult and late adulthood, which may require systemic line of management.
VARNA
In present study among 30 patients maximum number of 18 patients
(60%) was having Shyava Varna and 7 patients (23.33%) Krishna Varna.
Shyava and Krishna Varna skin people usually have Vata-Pitta
Prakriti and are more prone to get Youvana Pidaka. The incidence of
Youvana Pidaka is slightly higher than in white races.
SHOTHA
In present study among 30 patients maximum number of 16 patients
(57%) were having Alpashotha, 14 patients (47%) had Bahala Shotha.
This might be because of the nature of condition itself. Youvana
Pidika is a chronic inflammatory dermatological condition, where the lesion
starts as a small comedon, eruption and land up to the formation of cysts.
ONSET
In present study among 30 patients maximum number of 18 patients
(93.33%) was had the history of gradual development of the eruptions and
only 02 patients (6.66%) had faster the rate of acne development.
This could be because of the nature of the disease. Another reason
that can be though is gradual increase in sex hormones during adults.
AGGRAVATING FACTORS OF ACNE
In present study among 30 patients maximum number of 13 patients
(43.33%) had no relation of seasonal variation in acne, 12 patients (40%)
had relation with menstrual changes where as only 9 patients (30%) had
seasonal changes in disease typically during summer.
This entire disease process is course of natural physiological
changes that takes place in body. Hence, less interference is found in the
course of disease with various influencing factors.
FAMILY HISTORY
In present study among 24 patients maximum number of 16 patients
(66.66%) reported with the family history of acne in siblings. 08 patients
(33.32%) had the family history with their parents.
The genetical inheritance of the disease is not found. But, according
to the present study statistical values denotes that, siblings are suffering
means it shows the natural run coarse of the disease.
RAJOPRAVRUTTI
In present study among 22 females 13 patients (59%) patients were
having increase in number of the Pidaka one or two days prior to the onset
of menses and some says increase during the menstrual period and
subsides after the cessation of bleeding. This shows the involvement of
oestrogen hormone in the course of the disease.
VEDANA
In present study among 30 patients maximum number of 18 patients
(60%) had pricking type of pain, 10 patients (33.33%) had burning
sensation and only 2 patients (6.66%) were had Kandu.
This shows that almost all patients were had some sort of pain. Pain
is the typical features of Vata Dosha. Many of the patients had pricking
type of pain means Vata dominancy is found.
NUMBER OF PIDAKA
In present study among 30 patients maximum number of 18 patients
(60%) had more than 11 to 15 Pidaka on right and left side of face.
This shows that, most of the patient represented with moderate
severity of the disease.
DENSITY OF PIDAKA
In present study among 30 patients maximum number of 15 patients
(50%) had density of 5 to 10 cm2 Pidaka. 12 patients (40%) were had
density of 1 to 5 cm2.
This shows that, most of the patient represented with moderate
severity of the disease.
NATURE OF PIDAKA
In present study among 30 patients maximum number of 9 patients
(30%) reported with black comedone, 08 patients (26.66%) reported with
pustules, 06 patients (20%) reported with nodules.
This shows that, maximum number of patients reported with black
comedones and other types of pathologies are found in Youvana Pidaka.
AREA AFFECTED
In present study among 30 patients maximum number of 17 patients
reported with localized Pidaka only on face. 08 patients reported with
localized as well as few Pidaka over the other body parts also. The
distribution of Pidaka in all the patients was asymmetrical.
This shows that the classical feature i.e. Yuna Mukhe was
prominently found in present study.
SIZE OF PIDAKA
In present study among 30 patients maximum number of 14 patients
(46.66%) reported diameter of with 6 to 10 mm Pidaka, 11 patients
(36.66%) with 11 to 15 mm diameter Pidaka.
This shows that, in present clinical study moderate severe form of
Pidaka patients were included.
USE OF COSMETICS
In present study maximum number of 21 patients was habituated for
use of soap and oil base cosmetics.
This shows that, though maximum number of patients had the
history of use of cosmetics and less fluctuation of the condition noted in
aggravating factors too. This could be because of the nature of the disease
itself.
DISCUSSION ON RESULTS
The effect of Vamana with Kritavedhana followed by Manjishtha-
Madhu Lepa and Only Manjishtha-Madhu Lepa in Youvana Pidaka was
studied over 30 patients in assigned two groups. The patients were
assessed four times throughout the study protocols based on nine
parameters. The assessment was done with self defined scoring for each
parameter.
PAIN
In present study, majority of the patients were of Vata-Pitta type of
Youvana Pidaka. Local dermatological inflammatory condition causes
moderate to severe but tolerable pain to the patients.
The pain felt by the patient was assessed on the basis of its
frequency and intensity. The intensity, appearance and nature of pain
changes as the inflammatory process come down or aggravates.
In Gr. A, the reduction in pain immediately after the treatment was
92.10% with significant p value <0.001. In Gr. B, the reduction in pain after
the treatment was 78.94% with significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the pain but, the response in Gr. A was better than in Gr. B.
In Gr. A, the reduction in pain after 3rd follow up was 71.05% with
significant p value <0.001. In Gr. B, the reduction in pain after 3rd follow up
was 50% with significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the pain statistically, but there is big gap of percentage of relief in
both the group. In Gr. A the recurrence of symptoms is less and with good
percentage of improvement is observed.
Pain is the characteristic feature of inflammatory process. Reduction
in pain indicates subsiding the local inflammatory process.
This could be because of the systemic effect of Vamana in Youvana
Pidaka. Vamana might have done Chhedana of Vikrita Kapaha and
Rukshana dries up the Vikrita Meda and Lasika.
The local therapy might have done the counter action over the
inflammatory process, resulted in temporary relief. Hence, in that group
50% patient got recurrence during the period of follow up itself.
BURNING SENSATION
In present study, majority of the patients were of Vata-Pitta type of
Youvana Pidaka. Local dermatological inflammatory condition causes
moderate to severe but tolerable burning sensation to the patients.
The burning sensation felt by the patient was assessed on the basis
of its frequency and intensity. The intensity, appearance and nature of
burning sensation changes as the inflammatory process come down or
aggravates.
In Gr. A, the reduction in burning sensation immediately after the
treatment was 93.75% with significant p value <0.001. In Gr. B, the
reduction in burning sensation after the treatment was 82.75% with
significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the burning sensation but, the response in Gr. A was better than
in Gr. B.
In Gr. A, the reduction in burning sensation after 3rd follow up was
78.12% with significant p value <0.001. In Gr. B, the reduction in burning
sensation after 3rd follow up was 13.79% with significant p value <0.05.
This data shows that, both the treatment modalities were effective in
reducing the burning sensation statistically, but there is big gap of
percentage of relief in both the group. In Gr. A the recurrence of symptoms
is less and with good percentage of improvement is observed.
Burning sensation is the characteristic feature of inflammatory
process. Reduction in burning sensation indicates subsiding the local
inflammatory process.
This could be because of the systemic effect of Vamana in Youvana
Pidaka. As already discussed, Vamana has got long term effect over the
body to reduce the inflammatory processes as well as burning sensation.
In Gr. A, though there is small gap of 15.63% of result in immediately
after the treatment and 3rd follow up, it could be because of recurrence of
comparatively less severe eruptions.
The local therapy might have done the counter action over the
inflammatory process, resulted in temporary relief. Hence, in that group
71.96% result was decreased during the period of follow up itself.
EFFECT ON NUMBER OF PIDAKA
In present study, majority of the patients were of Vata-Pitta type of
Youvana Pidaka. Local dermatological inflammatory condition causes
eruptions.
In Gr. A, the reduction in number of Pidaka immediately after the
treatment was 88.88% with significant p value <0.001. In Gr. B, the
reduction in number of Pidaka after the treatment was 69.38% with
significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the number of Pidaka but, the response in Gr. A was better than
in Gr. B.
In Gr. A, the reduction in number of Pidaka after 3rd follow up was
69.38% with significant p value <0.001. In Gr. B, the reduction in number of
Pidaka after 3rd follow up was 55.10% with significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the number of Pidaka statistically, but there is big gap of
percentage of relief in both the group. In Gr. A the recurrence of symptoms
is less and with good percentage of improvement is observed.
Number of Pidaka shows the recurrence of inflammatory process.
Reduction in number of Pidaka indicates subsiding the local inflammatory
process.
This could be because of the systemic effect of Vamana in Youvana
Pidaka. As already discussed, Vamana has got long term effect over the
body to reduce the inflammatory processes as well as number of Pidaka.
In Gr. A, though there is small gap of 13.33% of result in immediately
after the treatment and 3rd follow up, it could be because of recurrence of
comparatively less severe eruptions.
The local therapy might have done the counter action over the
inflammatory process, resulted in temporary relief. Hence, in that group
14.28% result was decreased during the period of follow up itself.
EFFECT ON SIZE OF PIDAKA
In present study, majority of the patients were of Vata-Pitta type of
Youvana Pidaka. Extend of local dermatological inflammatory condition
influences on the effect of size of Pidaka.
In Gr. A, the reduction in size of Pidaka immediately after the
treatment was 93.54% with significant p value <0.001. In Gr. B, the
reduction in size of Pidaka after the treatment was 77.14% with significant
p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the size of Pidaka but, the response in Gr. A was better than in
Gr. B.
In Gr. A, the reduction in size of Pidaka after 3rd follow up was
70.96% with significant p value <0.001. In Gr. B, the reduction in size of
Pidaka after 3rd follow up was 51.42% with significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the size of Pidaka statistically, but there is big gap of percentage
of relief in both the group. In Gr. A the recurrence of symptoms is less and
with good percentage of improvement is observed.
Sizes of Pidaka show the chronicity and extend of inflammatory
process. Reduction in size of Pidaka indicates subsiding the local
inflammatory process though-out its indurations.
This could be because of the systemic effect of Vamana in Youvana
Pidaka. As already discussed, Vamana has got long term effect over the
body to reduce the inflammatory processes as well as size of Pidaka.
In Gr. A, though there is small gap of 22.58% of result in immediately
after the treatment and 3rd follow up, it could be because of recurrence of
comparatively less severe eruptions.
The local therapy might have done the counter action over the
inflammatory process, resulted in temporary relief. Hence, in that group
25.72% result was decreased during the period of follow up itself.
EFFECT ON NUMBER OF SCAR
Scar formation is the grave result of local inflammatory process.
Several depressions are formed over the face due to eruptions and
evacuation of Pidaka. Number of scar shows the chronicity as the as the
high indurations of Pidaka in the surface of the skin. There is very less
effect of tropical application in reducing the number of scars. These should
be healed spontaneously as part of natural healing process.
In Gr. A, the reduction in number of scars immediately after the
treatment was 38.46% with significant p value <0.001. In Gr. B, the
reduction in number of scars after the treatment was 25% with significant p
value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the number of scars but, the response in Gr. A was better than in
Gr. B.
In Gr. A, the reduction in number of scars after 3rd follow up was
34.61% with significant p value <0.01. In Gr. B, the reduction in number of
scars after 3rd follow up was 17.85% with significant p value <0.02.
This data shows that, both the treatment modalities were effective in
reducing the size of Pidaka statistically, but there is not a big difference in
percentage of relief in both the group. In Gr. A the recurrence of symptoms
is less and with good percentage of improvement is observed.
This could be because of the systemic effect of Vamana in Youvana
Pidaka. Though, this is a Rukshana Chikitsa, during Snehapana, Sarvanga
Abhyanga some sort of Brimhana process occurs which might have helped
in healing of scars. Majishtha and Madhu both have got anti-oxidant effect
as well as healing properties. But, these works better in wet pathologies
like active eruptions. Where as the scar is bundle of fibroblasts that makes
up the scar. Scars have blood supply but no oil glands or elastic tissues. In
Youvana Pidaka, patient develops atrophic scars.
In Gr. A, though there is small gap of 3.85% of result in immediately
after the treatment and 3rd follow up, it could be because of recurrence of
comparatively less severe eruptions as well growth of atrophic scar.
The local therapy might have done the counter action over the
inflammatory process, resulted in temporary relief. Hence, in that group
7.15% result was decreased during the period of follow up itself.
EFFECT ON OILINESS OF THE FACE
In present study, majority of the patients were of Vata-Pitta type of
Youvana Pidaka. Usually, the patients with Pitta Dosha dominancy in
Prakriti posses oiliness of skin, which is one of the predisposing factor for
eruptions.
In Gr. A, the reduction in oiliness of the face immediately after the
treatment was 73.91% with significant p value <0.001. In Gr. B, the
reduction in oiliness of face after the treatment was 70% with significant p
value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the oiliness of face equally.
In Gr. A, the reduction in oiliness of face after 3rd follow up was
34.78% with significant p value <0.001. In Gr. B, the reduction in oiliness of
face after 3rd follow up was 35% with significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the oiliness of face statistically. There is no big gap of percentage
of relief in both the group. In both the groups the recurrence of symptoms
was observed. This could be due to the involvement of the Prakriti itself
which is formed at the birth and maintained throughout the life without any
fluctuations.
Though, the recurrence in oiliness of face might be the cause for the
recurrence of the symptoms, there was significant reduction in pain,
burning sensation, number of Pidaka, size of Pidaka, number of scar, etc.
This could be because of the systemic effect of Vamana in Youvana
Pidaka. As already discussed, Vamana has got long term effect over the
body to reduce the inflammatory processes as well as number of Pidaka.
In Gr. A, though there is big gap of 39.13% of result in immediately
after the treatment and 3rd follow up, it could be because of clearance of
the Srotases through the Vamana Karma. Vamana might have cleared the
obstructive pathology at pilosebaceous gland and reduced the rate of
recurrence.
The local therapy might have done the counter action over the
oiliness of the face and resulted in temporary relief. Hence, in that group
50% result was decreased during the period of follow up itself.
EFFECT ON DRYNESS OF THE FACE
In present study, majority of the patients were of Vata-Pitta type of
Youvana Pidaka. Usually, the patients with Vata Dosha dominancy in
Prakriti posses dryness of skin, which is not a predisposing factor for
eruptions. But, even though, patients of dry skin developed eruptions in
Youvana Pidaka. This feature was found in only 23.33% patients.
In Gr. A, the reduction in dryness of face immediately after the
treatment was 14.28% with significant p value >0.1. In Gr. B, the reduction
in dryness of face after the treatment was 100% with significant p value
<0.05.
This data shows that, both the treatment modalities were effective in
reducing the dryness of face. But, in Gr. B the results were encouraging.
This could be due to local Guruta & Snigdhata of Majishtha and Madhu.
In Gr. A, the reduction in dryness of face after 3rd follow up was
14.28% with significant p value >0.1. In Gr. B, the reduction in dryness of
face after 3rd follow up was 25% with significant p value >0.1.
This data shows that, both the treatment modalities were not
effective in reducing the dryness of the face. There is no big gap of
percentage of relief in both the group. In both the groups the recurrence of
symptoms was observed. This could be due to the involvement of the
Prakriti itself which is formed at the birth and maintained throughout the life
without any fluctuations.
It is very difficult to assess the rationality behind the relation between
dryness of the face, effect of the therapy and recurrence of the eruptions.
In Gr. A, there is difference in the results of immediately after the
treatment and third follow up.
The local therapy might have done the counter action over the
oiliness of the face and resulted in temporary relief. Hence, in that group
75% result was decreased during the period of follow up itself.
EFFECT ON SCORE OF THE PIDAKA ON THE BASIS OF AFFECTED
PLACE
Score of the Pidaka based on the affected place is globally accepted
parameters.
In Gr. A, the reduction in Score of the Pidaka based on the affected
place immediately after the treatment was 85.13% with significant p value
<0.001. In Gr. B, the reduction in Score of the Pidaka based on the
affected place after the treatment was 68.91% with significant p value
<0.001.
This data shows that, both the treatment modalities were effective in
reducing the Score of the Pidaka based on the affected place but, the
response in Gr. A was better than in Gr. B.
In Gr. A, the reduction in Score of the Pidaka based on the affected
place after 3rd follow up was 71.62% with significant p value <0.001. In Gr.
B, the reduction in Score of the Pidaka based on the affected place after
3rd follow up was 43.24% with significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the Score of the Pidaka based on the affected place statistically.
But there is big gap of percentage of relief in both the group. In Gr. A the
recurrence of symptoms is less and with good percentage of improvement
is observed.
This score is just an evaluation of the Pidaka at various places.
Reduction in this score refers to the gross reduction in all the parameters
responsible for the eruptions.
This could be because of the systemic effect of Vamana in Youvana
Pidaka.
In Gr. A, though there is small gap of 13.51% of result in immediately
after the treatment and 3rd follow up, it could be because of recurrence of
comparatively less severe eruptions.
The local therapy might have done the counter action over the
inflammatory process, resulted in temporary relief. Hence, in that group
25.67% result was decreased during the period of follow up itself.
EFFECT ON GLOBAL ACNE GRADING SYSTEM
Effect on global acne grading system is globally accepted scale for
the assessment of acne vulgaris.
In Gr. A, the reduction in global acne grading system immediately
after the treatment was 87.87% with significant p value <0.001. In Gr. B,
the reduction in global acne grading system after the treatment was
54.54% with significant p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the global acne grading system but, the response in Gr. A was
better than in Gr. B.
In Gr. A, the reduction in global acne grading system after 3rd follow
up was 76.47% with significant p value <0.001. In Gr. B, the reduction in
global acne grading system after 3rd follow up was 55.88% with significant
p value <0.001.
This data shows that, both the treatment modalities were effective in
reducing the global acne grading system statistically. But there is big gap
of percentage of relief in both the group. In Gr. A the recurrence of
symptoms is less and with good percentage of improvement is observed.
This score is just an evaluation of the Pidaka at various places.
Reduction in this score refers to the gross reduction in all the parameters
responsible for the eruptions.
This could be because of the systemic effect of Vamana in Youvana
Pidaka.
In Gr. A, though there is a gap of 33.33% of result in immediately
after the treatment and 3rd follow up, it could be because of recurrence of
comparatively less severe eruptions.
The local therapy might have done the counter action over the
inflammatory process, resulted in temporary relief. Hence, in that group
20.59% result was decreased during the period of follow up itself.
OVERALL RESULTS
Parameter wise result of the clinical study shows the better
performance of Gr. A in all most all parameters except dryness of the face.
In Gr. B the results based on all most parameters were good except in
number of scars.
MODE OF ACTION OF VAMANA
Vamana is a systemic line of management, specially praised by
Sushruta in the management of Youvana Pidaka. Vamana has got a prime
role All these Karma has got there won actions in order to combat the
physio-pathological consequences of Youvana Pidaka is discussed as
follows –
Vamana drugs posses following properties. Viz. –
� Ushna
� Teekshna
� Sukshma
� Vyavayi
� Vikasi
� Urdhwabhagahara
Following pharmacological action of Vamaka Dravya work in
collaboration with each other to produce emesis –
� Due to Ushna Guna, it produces Pachana, Dahana, Svedana and
spreading of the Drug at cellular level. Lavana produces
Vishyandana in the body that is why Vamana Dravyas are
administered with Lavana.
� Tikshna Guna of Vamaka Dravya is responsible for its quick action,
Sodhana, Pachana, Chhedana and Sravana of Doshas at their own
places.
� With the help of Sukshma Guna, the Vamana Dravya enters at the
level of micro circulatory channels (Srotasas) and leads to Pachana
and Vishyandana of Doshas and ultimately directs Doshas towards
Koshtha, from where they are eliminated easily.
� Due to Vishyandi and Vikasi Gunas, the Vamaka Dravya reaches at
the cellular level (all Dhatus) without being digested and produces
Sandhi Saithilya i.e. Doshas Leena in Dhatus are attacked by the
Vamaka Dravya and migrated to Koshtha for elimination
� Vamaka Dravyas produce Vamana due to it is “Urdhwa Bhagahara
Prabhava.” (Ch.Ka.1/5)
The main action of Vamaka Dravya is on stomach of the individual.
In the stomach it acts on the very root cause of the vitiation of Kapha. The
vitiated Kapha present in entire body is alleviated and expelled out through
the mechanism of Vamana and disease process is suppressed up to the
maximum level. The Snehana and Svedana therapy aggravates the
Doshas i.e. Kleda of the body is increased. Ushna and Tikshna Guna of
Vamaka Dravyas are responsible for removal of Kleda from the body in the
form of Vomitus.
The fat contents of the blood (serum cholesterol etc.) increase
temporarily after Snehana, but after the Vamana Karma is over, these fat
contents return to normal level, because infect Sneha is brought from the
cellular level to the Koshtha from Rasadi Dhatus (tissues and cells) and
finally is thrown out of the body. As per the mode of action of Vamana
Karma, as described above, it clears the channels (Srotasas) from the
Sanga, created by vitiated Kapha, Meda and Ama.
Maximum Doshas are thrown out from the body, by this process.
Thus detoxifying the body up to a certain level. The remaining Doshas are
controlled by Shamana therapy which holds Pitta Shamaka, Rakta
Prasadana, Vranaropana, Kapha-Vatahara etc. properties. Because it is
much easier to pacify the small quantity of Doshas with Shamana therapy
which remain after Shodhana, in spite of starting medication in the full
bloom vitiation of Doshas.
MODE OF ACTION OF LEPA
In this study, Manjishtha-Madhu was used for the external
application over the affected part of the face. Both the drugs have got their
own action in the management of Youvana Pidaka.
The probable mode of action the drugs used in Lepa can be thought
as follows –
MANJISHTHA
� It has got Tikta, Kashaya and Madhura Rasa, which predominantly
acts on Pitta and Rakta Vikara. The appearance of Pidaka is one of
the characteristic features of Pitta malformations. Majishtha due to
its Tikta, Kashaya and Madhura Rasa reduced the Vikrita Pitta and
Rakta effectively.
� Manjishtha is a widely used herb for the management of chronic
wound, discoloured skin, microbial diseases, leprosy and known
blood purifier.
� It also prevents the lipid peroxidation, which is involved in the
pathogenesis of acne vulgaris. Its protective effect was found better
than Vitamin E and Parabenzoquinine.
� It has iron chelatoin property and rubiadin was associated for its anti-
oxidant property. This maintains the healthy status of skin as well as
maintains the integrity.
� Extracts of Rubia cordifolia inhibited platelet activation factor induced
aggregation of rabit blood. In classics also it is mentioned that, it is
Pitta and Rakta Shamaka. Hence, might have acted better in pusto-
papillar lesions of Acne vulgaris.
� It has got anti-pyogenic property, which prevents the formation of
new skin lesions.
� It has got anti-inflammatory activity, which might have acted to
conquer the local pathology in acne vulgaris.
� Antioxidant activity – The antioxidant properties have been well
established. The herb significantly inhibited FeS04-induced lipid
peroxidation and glutathione depletion...7 The activity was ascribed
to the quinone rubiadin.
� Antiinflammatory activity – Rubia cordifolia inhibited the lip
oxygenase enzyme pathway" and the production of cumene
hydroperoxides. The lip oxygenase pathway catalyses the
production ofvarious inflammatory mediators such as the
leukotrienes which are involved in asthma, arthritis and other
inflammatory disorders.
� Antiplatelet activity – Platelet -activating factor (PAF) is a
phospholipid involved in thrombosis, allergy and nervous disorders.
Rubia cordifolia extract inhibited the aggregation of rabbit platelets in
a dosedependent manner, measured in a binding assay using 3H-
labelled PAF.
� Anticancer activity – The cyclic hexapeptidel and quinones of
Rubia exhibited a significant anticancer activity against various
proliferating cells. The hexapeptides showed potent antitumour
activity by binding to eukaryotic 80S ribosomes, resulting in inhibition
of aminoacyl-tRNA binding and peptidyl-tRNA translocation, thus
leading to the stoppage of protein synthesis.
� Hepatoprotective activity – Protection against different liver toxins
has been established. It has been found to be effective against
acute and chronic hepatitis caused by the hepatitis B virus (HBY) by
interfering with the secretion of hepatitis B surface antigen (HBsAg)
in human hepatoma cells (Hep3B). The quinone derivatives are
thought to be the active components.
� Others – The plant has activity against allergies,t8 bacterial
infection,t9 excessive bleeding20 and diabetic ulcer.
� Safety profile – No adverse effects have been reported at
recommended doses and the herb is usually categorised as GRAS
(generally recognisedas safe).
MADHU
Application of Madhu and Ghrita is indicated in superficial lesions
like wounds, burns, cuts, bed sores, diabetic wounds, etc. Infected
wounds that had not responded to conventional treatments were free of
infection within 7 days of the first honey application. During the course
of honey application, the dead tissues were quickly replaced with
healthy granulation tissues. In some cases, diabetic ulcers were
successfully treated with honey and skin grafts.
Honey is a saturated or super saturated solution of sugars and is
said to have osmotic properties. Due to which it has got anti-bacterial
property. The presence of hydrogen peroxide generated by the
enzymatic activity of glucose oxidase in dilute honey also contributes to
its antibacterial activity. As hydrogen peroxide decomposes, it
generated highly reactive free radicals which react with and kill bacteria.
� It prevents infection because of its antibacterial or bacteriostatic
properties (i.e. inhibits the growth of both Gram- negative and Gram-
positive bacteria)
� It provides a viscous barrier to fluid loss and wound invasion by
bacteria thus preventing infection.
� It contains enzymes which may aid the healing process by promoting
tissue formation.
� It absorbs edema fluid (pus) thereby cleaning the wound.
� It reduces pain and irritation and eliminates offensive smell.
COMBINE EFFECT OF THE BOTH THERAPIES
The properties of Majishtha and Madhu acts as Dosha Pratyanika as
well as Vyadhi Pratyaneeka Chikitsa. It also acts an healing as well as
preventive agent in the management of Youvana Pidaka.
Both the drugs combat the local pathology in Youvana Pidaka
through their anti-inflammatory, anti-biotics, healing promotion, etc.
properties.
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CONCLUSION
� Youvana Pidaka in considered among one of the Kshudraroga with
less explanation in most of instances resembles with Acne vulgaris.
� Combine understanding of all available reference defines the
condition clearly.
� Usually, it is a self-limiting condition caused by Tridosha vitiation &
Rakta.
� Incidence is more in the age group of 16-27 and after this it slowly
disappears in 70% to 80% of individuals.
� Both the sexes are prone to develop the condition in equal strength,
but with slightly more incidence in female.
� The incidence of the condition with religion, occupation, socio-
economical status, marital status and dietic regimens of patient.
� Excessive intake of oily substances, irritants, Teekshna food articles
and use of oily cosmetics, etc are predisposing factors.
� In this study reveals that the effect of Vamana followed by Lepa
group was much better than the only Lepa group.
� In Group A, marked improvement in 53.33% patients, Moderate
improvement in 33.33% patients, complete relief in 13.33% of
patients were observed.
� In Group B, marked relief was found in 40.00%, moderate relief was
found in 60.00% patients.
� The effect of Vamana followed by Lepa is also better in subsequent
follow-up with minimal recurrence.
� The effect of only Lepa is good only immediately after treatment had
greater rate of recurrence.
� The hypothesis of Sushruta i.e. Vamana is Vishesha Chikitsa in
Youvana Pidaka proved with significant statistical values obtained
immediately after the treatment.
� This shows the additional effect of Vamana in the management of
Youvana Pidaka as compared with the Lepa therapy.
� Both Vamana followed by Lepa & only Lepa are found effective as a
Dosha Pratyanika Chikitsa in the management of Youvana Pidaka.
� During the procedure of vamana & lepa no complication had been
noted. So, it can be concluded that for the management of Mukha
Dushika vamana & lepa karma can be administer as safest &
effective procedure.
� Results of this study are very encouraging but the study was
conducted in small group of patients because of various limitations,
so trial should be conducted on large sample with better parameters.
����
SUMMARY
INTRODUCTION
Youvana Pidika is a most common anomaly, usually self limiting,
found in teenagers and young adults. This results in disfigurement of facial
skin leads to feeling of inferiority complex and sometimes depression,
isolation from society, suicidal tendency, etc. It is produced due to combine
association of vitiated of Vata, Pitta, Kapha Doshas along with Rakta as
dushya. It is explained under the concept of Kshudraroga.
Acne vulgaris is a chronic inflammatory disease of the
pilosebaceous units of the skin of certain body parts with formation of
comedone, papules and pustular eruption commonly known as pimples.
AIMS & OBJECTIVES
� Evaluate the effect of Manjishta-Madhu Lepa in Youvana Pidaka
� Evaluate the additional effect of Vamana with Kritavedhana followed
by Lepa in Youvana Pidaka
� Compare the effect of only Lepa over the Vamana followed by Lepa
in Youvana Pidaka
REVIEW OF LITERATURE
It is seen in adolescent age groups with irrespective of age, sex,
religion, socio-economical status & geographical distribution. The classical
description of Youvana Pidaka in most of the instances resembles with
Acne vulgaris.
The clinical features of Youvana Pidaka like Shalmali Kantakvat
Pidika, Medogrbhi, Ruja, Shotha, Daha and Vaktre Snigdhata.
MATERIALS AND METHODS
Research worked was done in 30 patients in two groups.
� Group A – 15 patients received Vamana with Kritavedhana
followed by Majishtha-Madhu Lepa for one month.
� Group B – 15 patients received only Majishtha-Madhu Lepa for
one month.
Routine blood investigations were done in order to rule out the
secondary conditions and to know the general health. Clinical data was
graded as per gradation index of assessment criteria. Pre-test and post-
test data was collected and subjected for statistical analysis in paired ‘t’
test. The statistical significance level was decided at <0.05.
OBSERVATION AND RESULTS
Observations were collected on basis of demographic data which
includes age, sex, religion, occupation, socio-economical status,
educational status, marital status, Satwa, Prakriti, etc. The data related
disease includes Nidana, predisposing factors, chief complaints, etc. The
collected data were subjected for statistical analysis and results are
interpreted accordingly.
Table No. 66a. The percentage of improvement in individual parameters of
Youvana pidika after the treatment and Third follow up.
Improvement in percentage Group A Group B
SL.
PARAMETERS
AT FU3 AT FU3 01. Pain 92.10 71.05 78.94 50.00 02. Burning Sensation 93.75 78.12 82.75 13.79 03. Number of Pidaka 88.88 75.55 69.38 55.10 04. Size of Pidaka 93.54 70.69 77.14 51.42 05. Number of Scars 38.46 34.61 25.00 17.85 06. Oiliness of the face 73.91 34.78 70.00 35.00 07. Dryness of the face 14.28 14.28 100.00 25.00 08. Score of the Pidaka on the basis
of the place 85.13 71.62 68.91 43.24
09. Global acne grading system 87.87 54.54 76.47 55.88
Table No. 66b. The over all improvement in both groups after treatment in
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74. Shabda Kalpadruma by Raja Radha Kanta Deva 3rd edt. 1967 IIIrd Part PN-735.
75. Vagbhata, Ashthanga Sangra of Vagbhataa Text English Translatio Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 36/05 PN-316.
76. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Ayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 31/05-888.
78. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Chi 20/37 PN-480
79. Vagbhata, Ashthanga Sangraha of Vagbhataa Text English Translatio Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 37/05 PN-321
80. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 32/03 PN-891
81. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/35 PN-587
82. Chakradatta with “Bhavaartha Sandeepino” Hindi commentary - Vaidya Jagadeeshwaraprasaada Tripathi 5th Edition 1983 Chap- 55/43 PN-425
83. Yoga Ratnakara with Vaidhyaprabha Hindi commentary By. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni.Shloka-124 PN-694
85. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 32/03 PN-891
86. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Su. Chi 21/37
87. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Su. Chi 20/37-480
88. Vagbhata, Ashthanga Sangraha of Vagbhataa Text English Translatio Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 37/05 PN- 321
89. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/35 PN-587
90. Chakradatta with “Bhavaartha Sandeepino” Hindi commentary - Vaidya Jagadeeshwaraprasaada Tripathi 5th Edition 1983 Chap- 55/43 PN-425
91. Y.R Kshu. Ro. Ni-Chi Shloka-124 PN-694 92. Sharangadhara Samhita of Shargadharaachaarya English
93. Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai Kshu.Ro. Chi PN-247.
94. Sushruta, Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya reprint 2003 - Choukamba Surabhaarati Prakashana Varanasi Chi 20/ 37 1/2 PN-480.
95. Vagbhata, Ashthanga Sangraha of Vagbhataa Text English Translatio Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 37/05 PN- 321
96. Vagbhata, Ashthanga Sangraha of Vagbhataa Text English Translatio Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 37/05 PN- 321
97. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 32/03 PN-890
98. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 32/03 PN-890
99. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/35 PN-587
100. Chakradatta with “Bhavaartha Sandeepino” Hindi commentary - Vaidya Jagadeeshwaraprasaada Tripathi 5th Edition 1983 Chap- 55/43 PN-425
101. Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai Kshu.Ro. Chi PN-247.
103. Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni.Shloka-123 PN-694
104. Sharngdhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Sha. U. Kha 11/12 PN-371
105. Bhaishajya Ratnavali of Govind Dasji Bhishagratna English Translated by Dr.Kanjiv .Lochan Volume-3 1st edition Bh.R. 60/38 PN-173
106. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/34 PN-587
107. Chakradatta with “Bhavaartha Sandeepino” Hindi commentary – Vaidya Jagadeeshwaraprasaada Tripathi 5th Edition 1983 Chap- 55/43 PN-425
108. Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai Kshu.Ro. Chi PN-247.
109. Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni.Shloka-123
110. Sharangadhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Utt. Kha11/11 PN-371
111. Sharangadhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Utt. Kha11/11 PN-371
112 Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit Samsthan Varanasi 61/35 PN-587
113 Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai Kshu.Ro. Chi PN-247
114 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-125 PN-695
115 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu.Ro.Ni. Shloka-122 PN-695
116 Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai PN-247
117 Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai PN-247
118 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-124 PN-695
119 Sharangadhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Utt. Kha11/12 PN-371
120 Brihannighantu Ratnakara Hindi comnt. 6th part by Shri Dattaram Shrikrishnalala Mathur edt.1996 Somaraja Shrikrishnadasa Prakashana Mumbai PN-247
121 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-124 PN-695
122 Sharngdhara Samhita of Shargadharaachaarya English Translation Translated by.Dr.Himasagara Chandra Murthy 2nd edition 2007 Utt. Kha11/12 PN-371
123 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-129-132nd Shloka PN-703
124 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Kshu. Ro. Ni-Chi Shloka-135-140th Shloka PN-704
125 Rasaratna Samucchaya edited with Hindi Commentary by Kaviraj Shri Ambikadatta Shastri 8th edition 1998 Kshudraroga Adhyaya 25/03 PN-520
126 Bhaarat Bhaishajya Ratnaakara By. Shri. Ganidasa Chaganalal Shaha Rasa Vaidya 2nd edition 1928 reprinted August 1999 B.Jain Publishers Pri.Ltd. Newdehli. Bh.Bhai. Ra 5th part Ksudra Rogadhikar 5th Chap Drug No-7950
127 Rasendra Saara Sangraha of Shri Gopal Krishna English Translation By. Ashok. D. Satpute 1st edition 2003 Chapter 3/01 PN-615
128 Brihat Yogatarangini 2nd Part 27/12 129 Bhaishajya Ratnavali of Govind Dasji Bhishagratna English
Translated by Dr.Kanjiv Lochan. Volume-3 1st edition Kshudraraogadhikara
130 Vagbhata, Ashthanga Sangraha of Vagbhataa English Translation, Volume3 translated by Prof. Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt. 37/05 PN- 321
131 Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 32/03 PN-890
132 Chakradatta with “Bhavaartha Sandeepino” Hindi commentary - Vaidya Jagadeeshwaraprasaada Tripathi 5th Edition 1983 Chap- 55/43 PN-425
133 Yoga Ratnakara with Vaidhyaprabha Hindi commentary by.Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi.Kshu. Ro. Ni-Chi Shloka-121 Shloka PN-695
138 Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt.2/8 PN-26
139 Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edition 1935 Choukamba Surabhaarati Prakashana Varanasi Utt. 2/15 PN-28
6. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/111 PN-196
7. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/113 PN-196
8. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/114 PN-196
9. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/115 PN-196
10. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/116 PN-196
11. Charaka,Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/117 PN-196
12. Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani - Vaidya Yaadavji Trikamji Aachaarya 1st edt. 2001 Chi.25/118 PN-196
13. Vagbhata,Ashthanga Sangra of vaagbhataa Text English Translation Volume 3 translated by. Prof.Dr.K.R. Shrikantha Moorthy 1st edition 1997 Utt.30/08 PN-264-265
14. Sharangadhara,Sharangadhara Samhita of Sharngdharacharya text English translation 2ND Edition 2007 translated by Dr. P.Himasagar chandramoorthy chapter.11/01-02 PN-370
15. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/14-15 PN-300
19. Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya repr. 2003 Choukamba Surabhaarati Prakashana Varanasi Su 18/12-15 PN-85,86.
20. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/16 PN-301
21. Sushruta Samhita with Nibandhasangraha commentary by Vaidya Yaadavji Trikamji Aachaarya repr. 2003 Choukamba Surabhaarati Prakashana Varanasi Su.18/10 PN-85
22. Bhavaprakasha of shri Bhavamishra edited with the Vidyotini Hindi commentary By.Bhishgratna Pandit Shri Brahma Shankara Mishra 8th edition 2003 Choukamba Sanskrit samsthan Varanasi 5/94 PN-119
23. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/19-21 PN-301
24. Vagbhata,Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/18 PN-301
25. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/22 PN-301
26. Vagbhata, Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/17 PN-301
27. Yoga Ratnakara with Vaidhyaprabha Hindi commentary By. Dr.Indradeva Tripathi and Dr.Dayashankar Tripathi 1st edition 1998 Krishnadas Academy Varanasi. Nitya Pravrutti Prakarana Shloka 77-78 PP-52
28. Vagbhata,Ashthanga Hridaya with Sarvaanga Sundara of Arunadatta and Aayurvedarasaayana of Hemadri - Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri reprint of 6th edt. 1935 Choukamba Surabhaarati Prakashana Varanasi Su.22/17 PN-301
VAMANA 1. Charaka, Charaka Samhita with Ayurveda Dipika Commentary,
Choukhamba Sanskrit series .Varanasi.1994.Kalpa Sthana 1 / 4. 2. Charaka, Charaka Samhita with Ayurveda Dipika Commentary,
Choukhamba Sanskrit series .Varanasi.1994.Sutra Sthana 16th chap. 3. Charaka, Charaka Samhita with Ayurveda Dipika Commentary,
Choukhamba Sanskrit series .Varanasi.1994.Sidhi Sthana 2 /10 pn 979. 4. Charaka, Charaka Samhita with Ayurveda Dipika Commentary,
Choukhamba Sanskrit series .Varanasi.1994.Sidhi Sthana 2 /10 pn 978. 5. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya
12. Ingham E, Eady EA, Goodwin CE, Cove JH, Cunliffe WJ. Pro-inflammatory levels of interleukin-1 alpha-like bioactivity are present in the majority of open comedones in acne vulgaris. J Invest Dermatol. Jun 1992;98(6):895-901. [Medline].
13. Practice of dermatology 9th edition 2004 By.P.N.Behll, A.Agarwal, Govind Srivatsava chapter-31 PN-408
14. Dermatology and venerology by Ajay choudhri 1st edition PN-113 15. Roxburg’s common skin diseases PP-152-153 16. Dermatology and venerology by Ajay choudhri 1st edition PN-113 17. Roxburg’s common skin diseases PN-149 18. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02
19. Illustrated synopsis of dermatology and sexually transmitted diseases 1st edition1st Edition 2005, PN-84-85
20. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th edition PN-02
21. Illustrated synopsis of dermatology and sexually transmitted diseases 1st edition 2005, PN-84-85
22. Dermatology an illustrated color text 3rd edition by. David J. Gawkrodger PN-60-61
23. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th edition PN-02
24. Illustrated synopsis of dermatology and sexually transmitted diseases 25. Dermatology an illustrated color text 3rd edition by. David J.
Gawkrodger PN-60-61 26. Roxburg’s common skin diseases PN-149 27. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 28. Illustrated synopsis of dermatology and sexually transmitted diseases
Practice of dermatology 9th edition 2004 By.P.N.Behl, A.Agarwal, Govind Srivatsava chapter-31 PN-408
29. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th edition PN-02
30. Illustrated synopsis of dermatology and sexually transmitted diseases 31. Roxburg’s common skin diseases PN-149 32. Illustrated synopsis of dermatology and sexually transmitted diseases 33. Dermatology an illustrated color text 3rd edition by. David J.
Gawkrodger PN-60-61 34. Practice of dermatology 9th edition 2004 By.P.N.Behll, A.Agarwal,
Govind Srivatsava chapter-31 PN-408 35. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 36. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 37. Practice of dermatology 9th edition 2004 By.P.N.Behll, A.Agarwal,
Govind Srivatsava chapter-31 PN-408 38. Practice of dermatology 9th edition 2004 By.P.N.Behll, A.Agarwal,
Govind Srivatsava chapter-31 PN-408 39. Illustrated synopsis of dermatology and sexually transmitted diseases 40. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 41. www.emedicine .com 42. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 43. Illustrated synopsis of dermatology and sexually transmitted diseases 44. www.emedicine.com 45. www.emedicine.com
46. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th edition PN-02
47. Roxburg’s common skin diseases PN-149 48. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 49. Illustrated synopsis of dermatology and sexually transmitted diseases 50. Dermatology an illustrated color text 3rd edition by. David J.
Gawkrodger PN-60-61 51. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 52. Dermatology an illustrated color text 3rd edition by. David J.
Gawkrodger PN-60-61 53. Illustrated synopsis of dermatology and sexually transmitted diseases 54. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 55. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 56. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology 5th
edition PN-02 57. Illustrated synopsis of dermatology and sexually transmitted diseases 58. Illustrated synopsis of dermatology and sexually transmitted diseases 59. www.emedicine .com 60. www.emedicine .com 61. www.emedicine .com 62. Illustrated synopsis of dermatology and sexually transmitted diseases 63. Fitzpatrick’s PN-2 64. Illustrated synopsis of dermatology and sexually transmitted diseases 65. Roxburg’s common skin diseases 66. Illustrated synopsis of dermatology and sexually transmitted diseases 67. Skin disease and sexually transmitted infection PN-112-117, 5th
edition reprint 2005. 68. www.emedicine.com 69. www.emedicine.com DRUG REVIEW 1. Dravya Guna Vignana By Prof Sharma PV, Vol II, Choukhambha
Bharati Academy ,Varanasi,Reprint 2005, 2. Charaka, Charaka samhita with vidyotini hindi commentery by vaidya
I here by agree that, I have been fully educated and informed with the disease and nature of the treatment. Here, by satisfied whole heartedly accept the medical trial over me.
Signature of the investigator Signature of the patient
C. PRADHANA VEDANA VRUTTANTA
Onset of the disease in order with chronicity
Onset : Sudden / Gradual / Insidious
Duration : Acute / Sub-acute / Chronic
D. POORVA VYADHI VRUTTANTA
History of similar previous complaints – Present / Absent
Give details –
Diseases
Skin
Disorders
Vyanjaka
Nidana
Trauma Infection Climate Drugs Tropical
agents
Food
History of other diseases like Measles / Mumps / Rubella / Herpes,
etc
Specify if any other –
E. POORVA CHIKITSA VRUTTANTA
Whether patient has taken treatment for present complaints?
Yes / No. If yes, give details _ _ _
History of any medical management – Yes / No.
History of any surgical procedures – Yes / No.
If Yes, give details – (Give the details of the previous management with
similar complaints) Topical Steroids
antibiotics Anti-allergic
Hormonal therapy
Anti-depressants
other Treat-
-ment
F. KAUTUMBIKA VRUTTANTA
Any history of similar complaints in the family? Yes / No.
Details –
H/o of any other disease –
G. VAIYAKTIKA VRUTTANTA
01. Appetite –
02. Bowel – Sama / Nirama / Santushta / Asantushta
13. Redness – No redness / Mild redness / Moderate redness / Severe
redness
PALPATION –
01. Pain – Mild tolerable / Felt only after touching / Moderate pain / Severe
intolerable pain
02. Temperature – No increase in local temperature / Mild increase in
local temperature / Moderate rise in temperature / Severe temperature
K. LABORATORY INVESTIGATIONS –
HB% – gms% TC – cells/cumm
DC – N – %, L – %, E – %, M – %, B – %,
ESR – ____ For 1st Hr. RBS – mg/dl
L. DIAGNOSIS –
M. TREATMENT SCHEDULE
Group A – Vamana Followed by Lepa
Vamana Poorvakarma :
� Deepana-Pachana was given with Trikatu Churna.
From _ _ _ _ _ _ _ To _ _ _ _ _ _ _.
� Snehapana with Moorcchita Ghrita.
From _ _ _ _ _ _ _ To _ _ _ _ _ _ _.
Observations Date No of Day
Matra Time of Snehapatra
Time of Appetite Jry L Jr L Sm L
01 02 03 04 05 06 07 *Jry L – Sneha Jeeryamana Lakshana, *Jr L – Sneha Jeerna Lakshna,
*Sm L – Sneha Samyak Lakshana
NOTE : Sneha Jeeryamana Lakshana
A Shiro Ruja B Lalasrava C Sneha Udwega D Anga Sada E Arati F Klama G Trishna H Daha I Bhrama J Moorccha Sneha Jeerna Lakshna
A Udgara Shuddhi B Vatanulomana C Kshudha Pravritti D Trishna Pravritti E Mala Pravritti F Shareera Laghuta Sneha Samyak Lakshana
A Vatanulomana B Agnideepti C Sneha Udwega
D Asamhata Varchasu E Anga Laghawata F Gatra Snigdhata
G Purisha Snigdhata H Klama
� Vishrama Kala was given. On that day Sarvanaga Abhyanga with Moorcchita Tila Taila followed by Bashpaswedana was planned.
From _ _ _ _ _ _ _ To _ _ _ _ _ _ _. � Patient advised for Guru, Snigdha, Abhishyandi, Kapha Utkleshaka
Ahara advised at night. � Next day prior to Vamana Sarvanaga Abhyanga with Moorcchita Tila
Taila followed by Bashpaswedana was planned. Date _ _ _ _ _ _ _.
Vamana Pradhanakarma – i) Freshly prepared Yavagu given at _ _ _ _ _ _ _ on _ _ _ _ _ _ _. ii) Akanthapoorna Ksheerapana / Ikshu Rasa
Sl. Drug Time Qty BP/PR Vega Colour App. Qty
Remarks
01. Milk 02. Vamana
Yoga Swedapradurbhava
Kukshi Adhmana Romaharsha Vamana Vegapradhurbhava
03. Vamanopaga Yoga (Yashti-madhu Phanta)
04. Saindhava Jala
Vamana Shuddhi Obtained –
ANTIKI MANIKI VAIGIKI LAINGIKI
Paschyata Karma –
Dhoomapana –
Samyaka Lakshana –
Observation up to 4 pm –
Group B – Manjishtha-Madhu Lepa
Patients advised for external application of Manjishta-Madhu Lepa
for 15 days early morning once in a day for 30 minutes and washed with
luke warm water.
� Weight of the patient before Vamana Karma – Kgs
� Weight of the patient after Vamana Karma – Kgs
N. RESULT ASSESSMENT
BT AT FOLLOW UP (In days) Sl. PRESENT COMPLAINT 0 30 45 75 105
01. Pain 02. Burning Sensation 03. Number of Pidaka 04. Size of Pidaka 05. Number of scars 06. Oiliness of the face 07. Dryness of the face 08. Score of Pidaka on the
basis of affected place
09. Global Acne Grading System
DATE Signature of SCHOLAR Signature Of GUIDE
O. RESULTS – No Improvement / Mild Relief / Moderate Relief / Marked Relief / Complete Relief
Signature of Guide Signature of PG Scholar
REFERENCES OF YOUVANA PIDAKA IN CLASSICS����SUSHRUTA SAMHITA