|Year : 2014 | Volume
| Issue : 1 | Page : 50-53
Management of Vyanga (facial melanosis) with Arjuna Twak Lepa and Panchanimba Churna
Savita S Angadi1, Sumitra T Gowda2
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 Publication||29-Sep-2014|
Savita S Angadi
P.G. Department of Shalakya Tantra, Shri J.G.C.H.Society's Ayurvedic Medical College, Ghataprabha, Belgaum - 591 306
Source of Support: None, Conflict of Interest: None
| 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
| Introduction|| |
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,  occurs due to vitiation of Vata, Pitta followed by Rakta Dosha.  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.  However, the topical steroids are not completely free from adverse effects such as irritation, rashes.  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.  In addition to this, bloodletting is also described. 
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  and Panchanimba Churna was selected for oral medication as these preparations have Kusthaghna, Kandughna, Raktashodhaka, Twak Prasadaka and Varnyakara properties.
| Materials and Methods|| |
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.
- Age group: 15-45 years
- Chronicity less than 5 years
- Shavavarnayukta, Niruja Mandalas present over the face.
Any specific disease underlying as the cause of Vyanga like,
- Inflammatory pigmentation
- Malignant melanoma
- Acne Vulgaris were excluded from the study.
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 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].
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.
Patients were asked to attend the OPD on alternate weeks for follow-up for a period of 90 days.
| Observations and Results|| |
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)|
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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].
| Discussion|| |
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,  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,  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,  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. , 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  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 Amalaki Maricha, Nimba and Haridra are having Kusthaghna and Kandughna properties by which possibly significant efficacy was observed.
| Conclusion|| |
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|| |
The author would like to express sincere thanks to Prof. Sumitra T. Gowda M.D (AYU), for her constant support and suggestions.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]