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CLINICAL RESEARCH
Year : 2014  |  Volume : 35  |  Issue : 1  |  Page : 50-53  

Management of Vyanga (facial melanosis) with Arjuna Twak Lepa and Panchanimba Churna


1 P.G. Department of Shalakya Tantra, Shri J.G.C.H.Society's Ayurvedic Medical College, Ghataprabha, Belgaum, India
2 Department of P.G. Studies in Shalakya Tantra, Government Ayurvedic Medical College, Bengaluru, Karnataka, India

Date of Web Publication29-Sep-2014

Correspondence Address:
Savita S Angadi
P.G. Department of Shalakya Tantra, Shri J.G.C.H.Society's Ayurvedic Medical College, Ghataprabha, Belgaum - 591 306
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.141924

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   Abstract 

Background: Vyanga is one of the Kshudraroga, characterized by the presence of Niruja (painless) and Shavavarna Mandalas (bluish-black patches) on face. It is one of the most common diseases as regards the face is concerned. On the basis of clinical features, it can be compared with facial melanosis, one of the hyper pigmented disorders. Drugs with Rakta Prasadaka, Twak Prasadaka and Varnyakara properties are helpful in the management of Vyanga, that pacifies aggregated Doshas and help in Raktashodhana (blood purification). Aim: To evaluate the efficacy of Arjunatwak Lepa and Panchanimba Churna in Vyanga. Materials and Methods: In this study, the trial drugs used were Arjunatwak Churna for Lepa (tropical application) and Panchanimba Churna for oral administration. A total 30 patients of Vyanga were selected from outpatient department and inpatient department of Shalakya Tantra Department and allotted randomly in two groups. In group-A, the patients were treated with external application of Arjunatwak Churna and Madhu for 21 days, while in group-B, patients received Panchanimba Churna orally for 21 days in addition to Arjunatwak Churna for Lepa. Effect of therapy on chief complaint i.e., bluish-black pigmentation in Group A was 60% relief, while in Group B 80% relief was found. Conclusion: The clinical study has shown that combined therapy gives better results than topical treatment.

Keywords: Arjunatwak Churna , facial melanosis, Panchanimba Churna, Vyanga


How to cite this article:
Angadi SS, Gowda ST. Management of Vyanga (facial melanosis) with Arjuna Twak Lepa and Panchanimba Churna. AYU 2014;35:50-3

How to cite this URL:
Angadi SS, Gowda ST. Management of Vyanga (facial melanosis) with Arjuna Twak Lepa and Panchanimba Churna. AYU [serial online] 2014 [cited 2020 Feb 21];35:50-3. Available from: http://www.ayujournal.org/text.asp?2014/35/1/50/141924


   Introduction Top


Smooth and glowing complexion of the face increases the beauty of a person and also gives self-confidence. Vyanga is a disease, which decreases the glowing complexion of the face and affects the skin. Among many diseases concerned with cosmetic values, Vyanga is common disease known to us from thousands of years. Though it is considered as Kshudra Roga (minor disease), has got a major importance as a cosmetic problem in the society. It is characterized by the presence of Niruja (painless), Tanu (thin) and Shavavarna Mandalas (bluish-black patches) on face, [1] occurs due to vitiation of Vata, Pitta followed by Rakta Dosha. [2] Treating this condition has become a problem, since safe drugs are not available for long-term therapy.

In modern medical science, topical steroids have been described in the management of facial melanosis. [3] However, the topical steroids are not completely free from adverse effects such as irritation, rashes. [4] Apart from this, generally the topical steroids are expensive and sometimes poor patients cannot afford this treatment. Hence there is a need to search better methods of management in facial melanosis considering the above drawbacks.

Ayurveda mentions a good number of medicines for skin care. Massage with oils, application of paste of medicines etc., makes the face smooth, soft and glowing. [5] In addition to this, bloodletting is also described. [6]

Drugs having Kusthaghna, Kandughna, Raktashodhaka, Twak Prasadaka and Varnyakara properties are helpful in the management and can produce cutaneous depigmentation that remove the blackish discoloration of skin.

Considering these points, Arjunatwak Churna was selected for Lepa [7] and Panchanimba Churna was selected for oral medication as these preparations have Kusthaghna, Kandughna, Raktashodhaka, Twak Prasadaka and Varnyakara properties.


   Materials and Methods Top


Source of data

Patients, fulfilling the clinical criteria of Vyanga were randomly selected irrespective of their sex, religion, occupation, etc., from out-patient department and inpatient department sections of the Department of Shalakya Tantra, S.J.I.I.M Bangalore, Karnataka. The study was cleared by the Institutional Ethics Committee (vide letter no.: GAMC / IEC / Shalakya / 11.01.2000 / 11). Written consent was taken from each patient willing to participate before starting the study.

Inclusion criteria

  1. Age group: 15-45 years
  2. Chronicity less than 5 years
  3. Shavavarnayukta, Niruja Mandalas present over the face.


Exclusion criteria

Any specific disease underlying as the cause of Vyanga like,

  1. Inflammatory pigmentation
  2. Malignant melanoma
  3. Acne Vulgaris were excluded from the study.


Investigations

Routine investigations of blood, urine and stool were carried out before treatment to rule out any systemic diseases.

Arjuna Twak Churna and Panchanimba Churna preparation

Arjuna Twak
Churna and Panchanimba Churna[8] were prepared according to the standard method of preparation of Churna, in the pharmacy of GAMC Bangalore. The ingredients of Panchanimba Churna are depicted at [Table 1].
Table 1: Ingredients of Panchanimba Churna

Click here to view


Grouping and treatment schedule

A total of 30 patients were registered and divided in two groups, comprising 15 patients each in Group A and Group B.

Group A The patients under this group were treated with Lepa of Arjunatwak Churna along with Madhu for 30 min, once daily for 21 days.

Group B The patients under this group were treated with Lepa of Arjunatwak Churna along with Madhu for 30 min, once daily and internal medication of Panchanimba Churna in the dose of 4 g for three times daily with water after food for 21 days.

Follow-up

Patients were asked to attend the OPD on alternate weeks for follow-up for a period of 90 days.


   Observations and Results Top


Maximum number of patients (56.66%) were in the age group of 26-35 years. Majority of the patients were females (90%). Most of the patients (63.33%) were from middle class. Nearly 56.67% of patients have patches on cheeks, nose and fore head. In 43.33% of patients, the color of patch was dark brown, in 33.33% it was blue-black and in 23.34% of patients it was light brown in color.

Pattern of changes in the color of Mandalas with the treatment in group A

In Group A, before treatment, in three patients the Mandalas were blue black colored, in eight patients the Mandalas were dark brown colored and in four patients the Mandalas were light brown colored. On 7 th day of observation, in three patients the color of Mandalas became to bluish black, in seven patients the color became to dark brown, in four patients, it was light brown and one patient attained the normal skin color. On 14 th day of observation, two patients had bluish black colored patches, three patients had dark brown patches, three patients had light brown colored patches and seven patients attained the normal skin color. At the end of the treatment, in two patients the patches were dark brown in color, in four patients the patches were light brown in color and nine patients attained normal skin color.

In group A, out of 15 patients, 09 patients were cured completely, which was statistically significant at the level of P < 0.01. Four patients have shown marked improvement and two patients showed slight improvement. Statistically significant result was obtained in the symptom blackish/brownish patch over the face [Table 2].
Table 2: Effect of therapy on chief complaint (bluish‑black discoloration of skin)

Click here to view


Pattern of changes in the color of Mandalas with the treatment in group B

In Group B, before treatment, in seven patients the Mandalas were bluish black colored, in five patients the Mandalas were dark brown colored and in three patients the Mandalas were light brown colored. On 7 th day of observation, in seven patients the color of Mandalas became bluish black, in four patients the color became dark brown, in two patients it became light brown and two patients attained the normal skin color. On 14 th day of observation, three patients attained bluish black colored patches, two patients had dark brown patches, two patients had light brown colored patches and eight patients attained the normal skin color. At the end of treatment, one patient had dark brown color patches. In two patients, the light brown colored patches were still persisting and 12 patients had attained normal skin color.

In group B, out of 15 patients, 12 patients had attained normal skin color, which was statistically highly significant at the level of P < 0.001, also one patient had mild improvement and two patients have moderate improvement. Statistically significant result was obtained in the symptom bluish-black patch over the face [Table 2].

The images shows effect of the treatment in one of the patients of Group B [Figure 1] and [Figure 2].
Figure 1: Before treatment

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Figure 2: After treatment

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   Discussion Top


Vyanga is explained as a Kshudra Roga in Ayurveda. While describing the etiological factors of Vyanga, Acharya has given special emphasis towards psychological factors like Krodha (anger), Shoka (grief) and Shrama (exhaustion), which are commonly found in most of the patients. In Samprapti of Vyanga, Acharya Charaka has mentioned that the aggravation of Pitta along with Rakta is the chief culprit for initiation of the pathology. Vyanga is a Rakta Pradoshaja Vyadhi, [9] hence the very first Dosha affected is Rakta Dhatu. Dosha Prakopaka Hetus like Krodha, Shoka and Shrama are mainly Tama (Manasika Dosha), Pitta and Vata (Shareerika Dosha) dominance, [10] vitiates the Agni (Pitta Dosha) which resides in Rasa and initiates the pathogenesis of Vyanga. Here Ranjaka Pitta is responsible for the conversion of Rasa Dhatu into Rakta Dhatu which results in the formation of normal skin color. However due to etiological factors like Krodha and Shoka mainly Pitta vitiation takes place which in turn affects the Jatharagni and normal functioning of Ranjaka Pitta i.e., Varnotpatti. Based on Ashraya-Ashrayee Bhavas, the derangement of Pitta Dosha leads to abnormality of Rakta Dhatu. Shrama and Shoka will lead to Udana Vata vitiation. Thus vitiated Ranjaka Pitta, Rakta Dhatu as well as Udana Vata travel in body through Dhamanis and get Sthana Samshraya in Mukhagata Twacha and causes vitiation of Bhrajaka Pitta giving rise to discoloration of the skin.

Mode of action of drug

The mode of action of the drug under trial can be understood on the basis of inherent properties of the drug.

Rasa of Arjunatwak is Kashaya Rasa, [11] Gunas are Laghu, Ruksha, Veerya is Sheeta and mainly having Pitta Shamaka and Rakta Prasadaka properties. With property of Kashaya Rasa, it will encounters Pitta and Rakta Dosha. The Kashaya Rasa removes the Twak Vaivarnyata and helps to attain the normal skin color. [12],[13] Due to Sheeta Veerya it encounters the Pitta Dosha. Prasadana property of Sheeta Veerya also helps to purify the accumulated Doshas in Vyanga. The Rakta Prasadaka and Twak Prasadaka actions of Arjuna help to pacify the Sanchita Doshas locally. In Panchnimba Churna almost all drugs like Nimba, Bakuchi [14] Araghwadha, Haridra, Chakramarda, Bhallataka etc., are having Rakta Prasadaka and Twak Doshahara properties. In Panchanimba Churna the main ingredient is Nimba that have Tikta, Kashaya Rasa and Laghu, Snigdha properties by which Pitta Shamaka action can be observed. Aragwadha[15] Amalaki[16] Maricha, Nimba and Haridra[17] are having Kusthaghna and Kandughna properties by which possibly significant efficacy was observed.


   Conclusion Top


Both trial drugs showed encouraging results. Arjuna Twak along with Madhu has not shown any skin reactions, so it could be used safely. From the observations and results of this study, it can be concluded that Arjuna Twak Lepa along with Panchanimba Churna have provided better results in hyperpigmentation of the patches seen in cases of Vyanga.


   Acknowledgments Top


The author would like to express sincere thanks to Prof. Sumitra T. Gowda M.D (AYU), for her constant support and suggestions.

 
   References Top

1.Sushruta. Sushruta Samhita, Nidana Sthana, Kshudraroga Nidana Adhyaya, 13/45-46, edited by Kaviraj Ambikadatta Shastri, 14 th ed., Chaukhamba Sanskrit Sansthan, Varanasi, 2003;288.  Back to cited text no. 1
    
2.Agnivesha, Charaka, Dridhabala. Charaka Samhita, Sutra Sthana, Trishothiya Adhyaya, 18/25, edited by Aacharya VJ, Reprint ed. Chaukhamba Prakashan, Varanasi, 2009;107.  Back to cited text no. 2
    
3.Rook A, Text Book of Dermatology. Vol. I 4 th ed. London: Blackwell Scientific Publications; 1986. pp. 670.  Back to cited text no. 3
    
4.Satoskar RS, Bhandarkar SB, Ainapure SS. Pharmacology and Pharmaco Theuraputics. 16 th ed., Sec. XIII. Mumbai: Popular Prakashan; 1999. pp. 843-4.  Back to cited text no. 4
    
5.Yogaratnakara, Kshudra Roga Chikitsa, edited by Bhishagratna Brahmashankar Shastri, 8 th ed., Chaukhamba Sanskrit Sansthan, Varanasi, 2004;283.  Back to cited text no. 5
    
6.Sushruta, Sushruta Samhita, Chikitsa Sthana, Kshudraroga Chikitsa Adhyaya, 20/33, edited by Kaviraj Ambikadatta Shastri, 14 th ed., Chaukhamba Sanskrit Sansthan, Varanasi, 2003;94.  Back to cited text no. 6
    
7.Govinda Dasaji, Bhaishajya Ratnavali, Kshudraroga Chikitsa, 60/40, edited by Kaviraj Shri Ambikadatta Shastri, 4 th ed., Chaukhamba Sanskrit Sansthan, Varanasi, 2002;663.  Back to cited text no. 7
    
8.Sharngadhara, Sharngadhara Samhita, Madhya Khanda, Churna Kalpana, 6/148-153, Subhodhini Hindi commentary by Prayaga Datta Sharma, 7 th ed., Chaukamba Amar Bharati Prakashan, Varanasi, 1987;197.  Back to cited text no. 8
    
9.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra sthana, Vividashitapeeteeya Adhyaya, 28/11-12, edited by Vaidya Jadhavaji Trikamji Aacharya, Reprint ed., Chaukhamba Prakashan, Varanasi, 2009;179.  Back to cited text no. 9
    
10.Sushruta, Sushruta Samhita, Sutrasthana, Vrana Prashna Adhyaya, 21/19,21, edited by Kaviraj Ambikadatta Shastri, 14 th ed., Chaukhamba Sanskrit Sansthan, Varanasi, 2000;91.  Back to cited text no. 10
    
11.Shastry JLN, Illustrated Dravyaguna Vijnana, Vol II, 2 nd ed.., Varanasi: Chaukhamba Orientalia; 2005. pp. 493.  Back to cited text no. 11
    
12.Vaghbhata, Ashtanga Sangraha, Sutrasthana, 18/17, edited by Shrikantha Murthy, 9 th ed., Chaukhamba Orientalia, Varanasi, 2005;340.  Back to cited text no. 12
    
13.Bhavamishra, Bhava Prakasha, Mishra Prakaranama/193, edited by Bhrahma Shankar Shastri, 9 th ed., Chaukhamba Sanskrit Bhavan, Varanasi, 1999;187.  Back to cited text no. 13
    
14.Khare CP. Encyclopedia of Indian Medicinal Plants. New York: Springer-Verlag; 2004; 384-6.  Back to cited text no. 14
    
15.Pandey G, Dravyaguna Vignyana, Vol I, 2 nd ed.. Varanasi: Krishnadas Academy; 2002. pp. 169.  Back to cited text no. 15
    
16.Phyllanthus_emblica Available from http://en.wikipedia.org/wiki/Phyllanthus_emblica, [cited 2012 Oct 19].  Back to cited text no. 16
    
17.Baruah MK, Choudhary PD, Sharma GC. Ethnomedicinal plants used by Khasi tribe of Lachar district, Assam. J Econ Taxon Bot 2006; 30 suppl:110-114.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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