Management of Khalitya through Pracchana followed by Vanadhanyakadi Lepa - A Case Report

Geetismita Boruah; K Prapulla; Rajouri Joshi; Ashvini Kumar M; BA Lohith

Management of Khalitya through Pracchana followed by Vanadhanyakadi Lepa - A Case Report

Boruah G.^1*, Prapulla K.², Joshi R.³, Kumar M A.⁴, Lohith B.⁵

DOI:

^1* Geetismita Boruah, Postgraduate Scholar, Department of Panchakarma, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

² K Prapulla, Postgraduate Scholar, Department of Panchakarma, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

³ Rajouri Joshi, Postgraduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

⁴ Ashvini Kumar M, Professor, Department of Panchakarma, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

⁵ BA Lohith, Associate Professor and HOD, Department of Panchakarma, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Alopecia is caused by androgen and genetic factors. Androgens cause hair follicles to shrink and eventually disappear if they are not addressed. It is inherited as an autosomal dominant trait. A 26-year-old male presented to the Panchakarma OPD Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, with complaints of gradual hair loss and scalp itching over a two-year period. It was diagnosed as a case of Khalitya and was treated with Udwartana to Shira Pradesha, Pracchana, and Lepa application. The Norman Hamilton scale, hair pull test and symptoms before and after treatment were used to evaluate the case. Following treatment, there was a significant reduction in symptoms and significant hair growth.

Keywords: Ayurveda, Khalitya, Pracchana, Lepa, Nasya, Case Report

Corresponding Author	How to Cite this Article	To Browse
Geetismita Boruah, Postgraduate Scholar, Department of Panchakarma, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India. Email:	Geetismita Boruah, K Prapulla, Rajouri Joshi, Ashvini Kumar M, BA Lohith, Management of Khalitya through Pracchana followed by Vanadhanyakadi Lepa - A Case Report. J Ayu Int Med Sci. 2022;7(8):171-175. Available From https://www.jaims.in/jaims/article/view/2041

Introduction

Hair has been traditionally associated with beauty and grandeur. Long, thick hair has been a symbol of attractiveness and it has a significant impact on the cosmetic industry in civilized nations.

In this era where grooming and appearances are vital, hair loss can highly distressful and may impact on the quality of life of an individual. The overall incidence of Alopecia is approximately 20.2 per 100,000 people.

The prevalence of Alopecia ranges from 0.1 to 0.2%, depending on the geographic location and ethnic background. Alopecia incidence appears to increase almost linearly with age, but the mean age of onset appears to be between 25 and 36 years. Androgenic alopecia affects about 60% of men, throughout their lives, and probably 25% of women.^[1]

Alopecia may be associated with hyperthyroidism, psoriasis, stress, inflammatory bowel disease. The active phase, also known as the anagen phase, is the first of three stages in the hair cycle. The hair develops and replaces the old hair during this period, and it continues to grow for several weeks to a few years.

Catagen is the second phase, which is the transition from active to resting hair and can take up to three weeks. Telogen is the third stage of hair growth in which hair remains in the scalp without developing and can be removed by pulling and combing the hair. Also, the hair may remain at this stage until the new hair grows and naturally pulls the old hair out and this phase might last up to three months.

Acharya Charaka classified Khalitya under Shiroroga and Acharya Vagbhata considered it under Kapalagata Roga,^[2]while Acharya Sushruta,^[3] Vrudda Vagbhata,^[4]Yoga Ratnakara and Madhavakara, has included Khalitya disease under Kshudra Roga. Which is due to mildness of the disease.^[5]

Treatment of Khalitya is Raktamokshana, it is the only Shodhana procedure where the vitiated Doshas are taken out from the Shakhas itself by creating an artificial route. Pracchana is one among the Shastrakrita Raktamokshana in which multiple small incisions are made in wide area to irrigate the impure blood. Here we have taken it as the pre therapy to Lepa to enhance the efficacy of Lepa.^[6]

Case Report

Patient information: A 26-year-old male patient presented to the Out Patient Department of Panchakarma, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, with complaints of hair loss and itching on the scalp for the past three years.

Clinical findings: The patient was asymptomatic for three years before experiencing gradual hair loss and scalp irritation. Before three years, there was an episode of hair donation and following that, he began to notice patchy hair loss. It was first noticed on the parietal part of the scalp and subsequently progressed day by day. These patches were approximately 2-3cm in size. It had spread throughout the entire scalp within three months. He has been on contemporary treatment for two years and has seen no progress. So, he approached Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, for improved management. First degree relatives had no family history of this condition. There had been no history of known endocrinological abnormalities.

Dashavidha Pariksha: The patients Prakriti (~body constitution) was Pitta Vataja, whereas the Vikriti (~ abnormal body constitutions) was Tridoshaja, Satva (~will power) was Avara, Samhanana (~compactness), Sara (~essence of tissues), Satyma (~homologation), Ahara Shakti (~ability to assimilate food), Vyayama Shakti (~ability to perform strenuous work), Vaya (~age) and Bala (~strength) was Madhyama.

Treatment timeline

Table 1: Different therapy procedures performed, their ingredients and the duration

Procedure	Ingredients	Duration
Udwartana (~Powder massage) to Shiras	Triphala Churna [12] Nimba Churna [12] Bhringaraja Churna [12]	1st -5th day, 7th- 9th day
Pracchana (~bloodletting therapy) followed by Lepa	Vana Dhanyaka,[15] Triphala, Icchabedi Rasa [17]	6th- 9th day
Mukhabhyanga (~Abhyanga to the face with oil) with Ksheerabala Taila Followed by Nasya (~medicated nasal drops)	Shadbindu Taila [18] (~7ml in each nostril)	1st to 9th day Once a day in the morning before food.

Table 2: Medications that are prescribed during discharge (10^th to 40^th day)

Medication	Dosage
Bhringarajasava[16]	30ml with equal quantity of water twice daily after food
Shadbindu Taila[18]	Pratimarsha Nasya in each nostril twice in the morning and evening before food
Bhringaraja Churna[12] Nimba Churna[11] Triphala Churna[12] Yashtimadhu Churna[13]	Mix 5 grams of each Churna with water to form a 3mm thickness It was used in the morning Allow it to dry for 20 minutes before rinsing with lukewarm water.

Assessment Criteria

Table 3: Keshabhumi

No hair fall	Grade 0
Hairfall once while washing hairs	Grade 1
Hairfall on combing	Grade 2
Hairfall even without combing and raised hairline in frontal region (severe hairfall without any manipulation)	Grade 3

Table 4: Darunaka

Absent	Grade 0
Mild	Grade 1
Moderate	Grade 2
Severe	Grade 3

Table 5: Kesha Bhoomi Rukshata

Smooth hair surface	Grade 0
Occasional rough hair surface	Grade 1
Slight rough hair surface	Grade 2
Rough hair surface	Grade 3

Table 6: Kesha Bhoomi Kandu

Absent	Grade 0
Mild itching	Grade 1
Moderate itching	Grade 2
Severe itching	Grade 3

Table 7: Pull Test

0-10	Grade 0
11-15	Grade 1
16-20	Grade 2
Above 20	Grade 3

Table 8: For Male Pattern Baldness: The Modified Norwood – Hamilton Scale

SN	Stages	Grading
1.	Full head of hair without any hair fall	0
2.	Minor recession at the front of the hairline.	1
3.	Further loss at the front of the hairline which is considered ''cosmetically significant”	2
4.	Progressively more loss along the front hairline and at the crown	3
5.	Hair loss extends toward the vertex	4
6.	Frontal and vertex balding areas marge into one and increase in size	5
7.	The last stage of male-pattern baldness in which all hair is lost along the front hairline	6

Table 9: Outcome

SN	Symptoms	Before treatment (1st day)	After treatment (40th day)
1.	Kesha Shatana	3	1
2.	Kesha Bhoomi Rukshata	3	2
3.	Kesha Bhoomi Kandu	2	1
4.	Darunaka	0	0
5.	Hair pull test	3	1
6.	The Modified Norwood – Hamilton Scale	4	3

Discussion

Khalitya is Pitta Pradhana Tridoshajanya Vyadhi along with Rakta. Vitiated Bhrajaka Pitta along with vitiated Vata leads to weakening of the hair from the hair roots. Vitiated Kapha along with Rakta obstruct the hair roots which prevent further hair growth.^[7]Pracchana Karma enables the damaged hair follicles to recover through their inherent regenerative capacity. It relieves the blockage at the root of hairs, “Pracchane Pinditehitam” & stimulates scalp metabolism by increasing blood circulation.^[8]

Pracchana increases the circulation in the scalp. It removes the vitiated Raktha and Kapha which obstructs the hair roots.^[9]Pracchana is done as the pre therapy to Lepa to enhance the efficacy of Lepa. Pracchana improves the perifollicular vascularisation and strengthens the hair follicle. Nasya is main line of treatment in Urdhwajatrugata Vikaras as drug administered through the nostrils reaches Uttamanga and expels the morbid Doshas residing there.

Udwartana opens the minute channels and improves blood as well as lymphatic circulation. It is Kapha, Vatahara and removes Aavarana or Srotorodha.^[10] The drugs used for Udwartana are Nimba, Triphala, Bhringaraja, Yastimahdu. The property of Nimba is having Krimihara, Pittahara, Vishahara, Kandughna and Kushtahara.^[11]Triphala is Kushtahara, Kaphapittaghni.^[11] Bhringaraja is having Keshya, Twachya, Vishaghna and Krimihara property.^[12] Yashtimadhu is Keshya, Vishapaha.^[13]Through drugs only Virya of Aushadhi will be absorbed ^[14] Fresh vanadhanyaka leaves (E. foetidum) have been assessed for anti-convulsant, anthelmintic, and its extract is a potential source of natural products with topical anti-inflammatory activity. Also analgesic, antimalarial and antibacterial properties were reported from traditional use.^[15]

Bhringarajasava ^[16] is a compound herbal formulation consisting of Bhringaraja as active ingredient along with Pippali, Jatiphala, Lavanga Ela, Tamalapatra, Tamala, Nagakesara and Gudam Its other properties include Balyam (~nutritive), Brimhanam (~tonic), Rasayanam (~Rejuvenative), Hridyam (~cardiotonic), Vishaharam (~anti-toxic) and Krimighnam (~anti-bacterial).

Phorbol esters present in Jayapala^[17] have skin irritant effect and it regulates cell growth and cell differentiation thus favours the regrowth of hair.

Ksheerabala Taila^[18] is Vatashamaka (~pacifies Vata) and is Balya (~strengthens muscles) in nature and was prescribed for Abhyanga. Shadbindu Taila^[19] has been mentioned as Pratimarsha Nasya. It has been indicated in all Shira Rogas, its helpful in Kesha Chalita (~hairfall).

Conclusion

In this generation, poor lifestyle choices have made a substantial contribution to premature hair loss. People have turned to Ayurveda because to the failure of conventional techniques.

The success of this case demonstrates how Ayurveda may perform work wonders in cases of Khalitya.

Reference

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2. Vagbhat, Astanga Hridaya, English translation, vol. III, Prof. K. R. Srikantha Murthy,Uttara sthana, shiroroga vigyaniya adhyaya (23;25,26). Varanasi: Chowkhambha Sanskrit Series Office; 1997. pg 222.

3. Shastri Ambika Dutta, Sushruta Samhita, Ayurveda Tattva Sandipika Hindi commentary, Chaukhamba Sanskrit Sansthan Varanasi reprint edition 2010, Part 1, pg 368

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5. Sharangadhara, Sharangdhara Samhita, Prof. K. R. Srikanta Murthy, Prathamakhand, kalaadikakhyana Adhyaya (5:15). Varanasi: Chaukhambha orientalia, 2001; 21

6. International Ayurvedic Medical Journal (December, 2016- January, 2017) 1(2) 166-174

7. Kaviraj Ambika Dutta Shastri (editor). Sushruta Samhita of Sushruta,Nidanastana chapter 13,verse no.33-35, 1st edi.Varanasi: Chaukamba Sanskrit Sansthana:2011:284

8. Sushruta. Sushruta Samhita with the Nibandhasangraha Commentary of Sri Dalhanacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on shareera sthana. Edited by Vaidya Jadavji Trikamji Acharya and Narayan Ram Acharya ‘Kavyatirtha’, 1st ed. Varanasi: Chaukambha Surbharati Prakashan; 2008 ch 8/26 pp382

9. Vagbhata. Astanga Hrdayam Uttarasthana with commentaries (sarvangasundara) of Arunadatta and (Ayurveda rasayana) of Hemadri, edited by Bhisagacharya Harisastriparadakaravaidya, Varanasi: Chaukhamba Orientalia; 2014. Ch 3/25 26 860pp

10. Jatinder Verma, Pravesh Srivastava, Mangal Gopesh et al, International Journal of Innovative Science and Research Technology, Volume 4, Issue 5, May 2019

11. Jaiswal Awantika, Ranajan Mridul, Mishra.H.S et al. Scholars Academic Journal of Pharmacy, 4(1): 48-50, May 2015

12. Shambharkar NL, Rakshapal Gupta et al. International Journal of Ayurveda Pharm Chem

13. Brahma Sankara Misra, editor. Bhavaprakasa of Sri Bhavamisra, Chikitsa Sthana. Ch.24, Ver.22.(th ed.Varanasi: Chaukhambha Sanskrit Sansthan: 2005.

14. Jadavji T. editor. Sushrutha Samhitha Of Sushrutha, Shareeera Sthana ch 9, ver 9 reprint edition, Varanasi; Chaukamba Orientalia 2011 p

15. Mohammad Amin Shavandi, Zahra Haddadian, Mohd Halim Shah Ismail. Journal of Asian scientific Research https://www.researchgate.net/publication/47729078_Eryngium_foetidum_L

16. Gada Nigraham of Sri Vaidyashodala with Vidyotini Hindi Commentary by Sri Indradev Tripathi. Varanasi: Choukhamba Sanskrit Series; 1968. [Google Scholar]

17. Weinstein IB, Lee LS, Fisher PB, Mufson A and Yamasaki H. Action of Probol esters in cell culture: mimicry of transformation, altered different action and effects on cell membrane. J Supramol. Struct 1979; 12: 95-208. http://dx.doi.org/10.1002/jss.400120206.2-8-2018

18. Charaka Samhita – by Agnivesh, Published by Chaukhambha Bharati Academy, Varanasi 14th edition, 1987, Chikitsa Sthan – 29/119-120.

19. Vangasena. Samhita (edited by Nirmala Saxena) of Vangasena, edition 1st, Volume II, Varanasi; Chaukhamba Sanskrita Samsthana: 2004,17/102

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-07-26	2022-07-28	2022-08-04	2022-08-11	2022-08-18
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	16%

Case Report

Khalitya

Journal of Ayurveda and Integrated Medical Sciences