E-ISSN:2456-3110

Research Article

Melasma

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

A randomised comparative clinical study to assess the efficacy of Arjuna Twak Churna Lepa and Yastimadhu Churna Lepa along with Khadira Churna in management of Vyanga with special reference to Melasma

Hunasagi K.1*, Patil U.2
DOI: http://dx.doi.org/10.21760/jaims.7.10.11

1* Kamala Hunasagi, Post Graduate Scholar, Department of P.G Studies in Kayachikitsa, BLDEA’s AVS Ayurveda Mahavidyalaya, Vijayapura, Karnataka, India.

2 Uma Patil, Professor, Department of P.G Studies in Kayachikitsa, BLDEA’s AVS Ayurveda Mahavidyalaya, Vijayapura, Karnataka, India.

Background: Vyanga is one of the skin disease and it is included under the heading of a Kshudra Rogas. Vyanga is pathological condition of the facial skin which is produced by the vitiation of the Vata, Pitta Doshas and Rakta Dhatu and Manasika Nidanas such as Bhaya, Krodha and Shoka are the main culprits characterized by the presence of Niruja, Tanu, and Shyava Mandalas over the face. Vyanga is correlated with facial Melasma, melasma is skin condition in which a hyperpigmented patches over the face of the individual showing the similarities in clinical features. Objectives: To assess the efficacy of Arjuna Twak Churna Lepa and Yastimadhu Churna Lepa along with Khadira Churna in the management of Vyanga with special reference to melasma. Methodology: A comparative clinical study was conducted on Vyanga Roga for the period of 21 days. The patients were divided into 2 groups. In Group A 20 patients were administered with Arjuna Twak Churna Lepa along with Khadira Sara Churna and in Group B 20 patients were administered with Yasthimadhu Churna Lepa along with Khadira Sara Churna. Results: Group A and Group B have shown statistically significant result. Group A treated with Arjuna Twak Churna Lepa along with Khadira Sara Churna shown better result compared with Group B treated with Yasthimadhu Churna Lepa along with Khadira Sara Churna.

Keywords: Vyanga, Melasma, Kshudra Rogas, Hyperpigmentation

Corresponding Author How to Cite this Article To Browse
Kamala Hunasagi, Post Graduate Scholar, Department of P.G Studies in Kayachikitsa, BLDEA’s AVS Ayurveda Mahavidyalaya, Vijayapura, Karnataka, India.
Email: 		Kamala Hunasagi, Uma Patil, A randomised comparative clinical study to assess the efficacy of Arjuna Twak Churna Lepa and Yastimadhu Churna Lepa along with Khadira Churna in management of Vyanga with special reference to Melasma. J Ayu Int Med Sci. 2022;7(10):86-93.
Available From
https://www.jaims.in/jaims/article/view/2122

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-09-24 2022-09-26 2022-10-03 2022-10-10 2022-10-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Kamala Hunasagi, Uma Patiland Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Ayurveda is the science of life. Aim of Ayurveda is to maintain health of healthy person and to eradicate the disease of the diseased person.[1] Skin is the largest and important organ of the body; face is the index of the mind. In day today life everyone is very much concerned about healthy skin beauty.

In Ayurveda number of skin diseases have been explained under the heading Kshudraroga.[2] Kshudrarogas are minor diseases having simple etiology and symptoms. Vyanga is one among them which effects the skin beauty characterized by presence of painless thin and bluish black patches on face occurs by of the vitiation of Vata and Pitta Dosha.[3] i.e., Brajak Pitta followed by Rakta Dhatu.

Charaka mentioned Vyanga is the Raktapradoshajvikar.[4] aggravated Pitta along with Rakta is the main culprit for the initiation of pathology, Etiological factors like Krodha, Shoka mainly Pitta vitiation takes place which inturn affects the Jatharagni and normal functioning of Ranjakpitta. Varnotpatti based on Ashrayaashrayee Bhavas derangement of Pitta Dosha leads to abnormality of Raktadhatu. Shrama, Shoka will lead to Udana Vata vitiation, thus vitiated Ranjak Pitta and Rakta Dhatu as well as Udanavata travel in the body through Dhamanis and gets Sthansamshraya in Mukhagatatwacha and causes the vitiation of Bhrajakapitta.

Vyanga is co-related with Melasma.[5] in modern science exact cause of melasma is unknown. However, some factors are explained as etiopathogenesis, those are sunlight, genetic predisposition and role of female hormonal activity, a form of hyperpigmentation associated with increased melanin, especially seen on cheeks, nose, forehead, chin and upperlip.

The reported prevalence of melasma ranges from 0.25 - 4.0% in several south east Asian population.[6] The age of onset is also unknown, with average age ranging being between 20 to 40 years. Melasma however effects women more than men.

In Ayurveda skin is the one of route of the administration of the drugs is considered equally important, as the other route of administration. many preparations are available in different forms in classics. Which are to be used topically.

The Lepa helps in removing the Doshas locally and gives rise to the normal colour of the skin.

There are many cosmetic products available, but their results are not satisfactory on spending lots of money. but in Ayurveda preparations are in greater demand in treatment of skin diseases with economically cheaper treating methods.

Hence, present study is intended to know the effect of Arjun Twak Churna Lepa[7] and Yasthimadhu Churna Lepa[8] along with Khadira Churna[9] as these preparations having properties like Twakprasadak, Varnyakar, Raktaprasadak, Kustagna,[10] can produce the cutaneous depigmentation and useful in the management of Vyanga.

Materials and Methods

Drug Source: Arjun Twak, Yasthimadhu root and Khadira Churna were collected from local market. They are authenticated by the Dept. of Dravyaguna BLDEA’S AVS Ayurveda Mahavidyalaya, Vijayapura. The formulations of present study will be prepared as per the classical reference in the BLDEA’S AVS Ayurveda Pharmacy attached to the Dept. of Rasashastra and Bhaishajya Kalpana.

Clinical Source: Vyanga cases which were attended to OPD in A.V.S Ayurveda Mahavidyalaya, Vijayapura. 40 patients diagnosed with Vyanga were taken for the study from OPD of BLDE’S AVS Ayurveda Mahavidyalaya, Vijayapura

Inclusion criteria

  • Patients with classical signs and symptoms of Vyanga
  • Patients of either sex between 20 to 50 years.

Exclusion criteria

  • Secondary to systemic diseases.
  • Women using oral contraceptives.
  • Pregnant women and lactating mothers.
  • Patients not willing to participate and not giving consent for the study.

Laboratory Investigations: Hb%

Study Design

40 patients of Vyanga were selected randomly and divided into two equal groups, Group- A and Group-B.


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Group-A

  • Lepa: Arjuna Twak Churna Lepa with Madhu, thickness of Lepa is 3-4mm and it should be washed before it dries up.
  • Time : Daily Morning Once
  • Shamana Yoga : Khadira Churna 1gm Twice Daily with lukewarm water (two Pala - 98ml)
  • Duration: 21days.

Group-B

  • Lepa: Yastimadhu Churna lepa, thickness of lepa is 3-4mm and it should be washed before it dries up.
  • Time : Daily morning once
  • Shamana Yoga : Khadira Churna 1gm Twice Daily with lukewarm water (two Pala - 98ml)
  • Duration : 21days

Assessment criteria: The effect of therapy was assessed on the basis of subjective and objective criteria.

Subjective criteria: Subjective criteria includes,

  • Itching.
  • Burning sensation.

Objective criteria: Objective criteria includes,

  • Skin/lesion colour.
  • Texture (dry/oily).
  • Number of lesions.
  • Size of lesions

Subjective Criteria

1. Kandu (Itching) - Score

  • No Itching - 0
  • Mild Itching (Occasional itching but does not disturb routine Activity) - 1
  • Moderate Itching (Frequent itching, disturbs routine activity but does not disturb sleep) - 2
  • Severe Itching (Frequent itching that disturbs routine activity as well as sleep) - 3

2. Daha (Burning sensation) - Score

  • No Burning sensation - 0
  • Mild Burning sensation (Occasional burning sensation mostly when patient undergoes to Sun exposure) - 1
  • Moderate Burning sensation (Frequent burning sensation which increases when patient undergoes to Sun exposure) - 2
  • Severe Burning sensation (Continuous burning sensation with or without sun exposure) - 3

Objective Criteria
1. Rukshata (Dry Skin) - Score

  • Normal - 0
  • Mild Dryness (Not seen but felt by touch) - 1
  • Moderate Dryness (Stretching of the skin that person feels) - 2
  • Severe Dryness Visible dryness (Chapping of the skin, hardness of the skin) - 3

2. Snigdhata (Oily Skin) - Score

  • Normal - 0
  • Mild Oiliness (Not seen with naked eye, Oiliness feel by touch, no need to wash face frequently, Wash face only 1-2 times a day) - 1
  • Moderate Oiliness (Oiliness is visible on skin Need to wash face frequently 3-4 times a day) - 2
  • Severe Oiliness (Excessive Oiliness, Formation of Acne, need to wash face more frequently > 4 times a day) - 3

3. Size - Score

  • <1 cm - 1
  • 1-3 cm - 2
  • 3-6 cm - 3
  • >6 cm - 4

When lesions or patches are multiple, the size of the largest lesion is taken into consideration

4. Color - Score

  • Light Brown - 1
  • Brown - 2
  • Dark brown - 3
  • Black - 4
  • Dark black - 5

5. Number of Lesions - Score

  • 1-2 - 1
  • 3-4 - 2
  • 5-6 - 3
  • 6 - 4

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Overall assessment

Good result: The color of the hyperpigmented lesion fading to 6-8 shades on the fairness meter is considered as good result.

Moderate result: The color of the hyperpigmented lesion fading to 4-6 shades on the fairness meter is considered as moderate result.

Mild result: The color of the hyperpigmented lesion fading above the 2-4 shade on the fairness meter is considered as mild result.

Observations

This comparative clinical trial was conducted on 40 Vyanga patients. The patients were selected randomly and divided into two groups namely Group A and Group B. Group A patients were given Arjuna Twak Churna along with Khadira Sara Churna and Group B patients were given Yasthimadhu Churna along with Khadira Sara Churna. For both the groups Chikitsa Kala was 21days. The one of the inclusion criteria for this study is selection of patients between age group of 20 to 50years. The observations of the present study in the age category reveals Out of 40 Subjects, There is a peak evidence (45%) of discolouration in the age group of 30-40 years and 10% were from age group of 20- 30 years and 35% were from the age group of 40 to 50years and 10% were from age group of 50 to 60 years in group A. And in group B 40% of the patients were of 30 to40 age group and 10% of subjects were of 20 to 30 age group and 35% of subjects were of 40 to 50 age group and 15% of subjects were of 50 to 60 age group, in the study majority of the subjects were female than males in both the groups 75% of the subjects were female and 25% of the subjects were males in group A. and 85% of subjects were females and 15% of subjects in group B. In this study majority of the subjects affected are housewives, Out of 40 Subjects 15% of the Subjects were in service, 5% Subjects were Farmer, 60% of Subjects were housewives, 15% of Subjects were labour, 5% of Subjects were students in Group A. And in Group B 25% of Subjects were in service, 65% of Subjects were housewives, 10% of Subjects were labour. In this study majority of the subjects were affected due excessive exposure to sun light as a Nidana, Out of 40 Subjects 60% of Subjects were excessive exposed sunlight in group

A and in Group B 65% of Subjects were showing presence of excessive exposure. Manasika Nidana wise study reveals that Out of 40 Subjects 25% of Subjects were having Krodha, 35% were having shoka, 50% of Subjects were having Ayasa in group A. And in Group B 35% of Subjects were having Krodha, 60% of Subjects were having Shoka, 5% of Subjects were having Bhaya and 10% of Subjects were having Ayasa.

Menustrual cycle wise distribution study reveals that Out of 40 Subjects 45% of Subjects were have regular cycle and 55% were have irregular cycle ingroup A, and Group B 65% of Subjects were have regular cycle and 45% of Subjects have irregular cycle.(not applicable for male Subjects), Menopause wise study reveals that Out of 40 Subjects 20% of Subjects were attained menopause and 80% of Subjects not attained in group A, in Group B 25% of Subjects were attained and 75% of Subjects not attained. (Not applicable for male pts and who have underwent hysterectomy).

Results

Table 1: Effect of therapy on group A and Group B on size of lesion.

Assessment Observations Recorded on Descriptives Paired test
N Mean ±SD Reduction (in %) Wilcoxan signed rank test P value
Arjuna Twak Churn Lepa along with Khadira Sara Churna (Group A)
BT 20 2.10 0.641   4.472 0.001
AT 20 1.10 0.641 1.0(48)
Yasthimadhu Churn Lepa along with Khadira Sara Churna (Group B)
BT 20 2.25 0.444   4.379 0.001  
AT 20 1.20 0.410 1.05(47)

HS - Highly significant

Table 2: Effect of therapy on Group A and Group B on colour of Lesion.

Assessment Observations Recorded on Descriptives Paired test
N Mean ±SD Reduction (in %) Wilcoxan signed rank test P value
Arjuna Twak Churn Lepa along with Khadira Sara Churna (Group A)
BT 20 2.70 1.031     3.782 0.001  
AT 20 1.15 0.671 1.15(57)
Yasthimadhu Churn Lepa along with Khadira Sara Churna (Group B)
BT 20 2.80 1.196   3.571 0.001  
AT 20 1.30 0.470 1.5(54)

HS - Highly significant


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jaims_2122_01.JPG

Graph 1: Showing effect of group A and Group B on Number of Lesion


jaims_2122_02.JPG

Graph 2: Effect of therapy in both the group on Snigdhata


jaims_2122_03.JPG

Graph 3: Effect of therapy in both groups on Rukshata.



Over all outcome of result

Table 4: Statistical outcome of the study Before Treatment & After Treatment

Parameter Mean Mean Difference SD± % p Remarks
BT AT BT AT
Size Of Lesion 2.10 1.10 1.0 0.641 0.641 48 0.001 H.S
Color Of Lesion 2.70 1.15 1.15 1.0331 0.671 57 0.001 H.S
Number Of Lesion 1.85 1.05 0.8 0.587 0.510 43 0.001 H.S
Fairness Scoring / Grading 14.30 9.80 4.5 3.686 2.726 32 0.001 H.S
Rukshata   0.60 0 0.6 0.503 0 100 0.001 H.S
Snigdhata 0.45 0 0.45 0.605 0 100 0.001 H.S

BT- Before Treatment; AF - After; H.S - Highly Significant

Table 5: Statistical outcome of the study Before Treatment & After Treatment

Parameter Mean Mean Difference SD± % p Remarks
BT AT BT AT
Size Of Lesion 2.25 1.20 1.05 0.444 0.410 47 0.001 H.S
Color of Lesion 2.80 1.30 1.5 1.196 0.470 54 0.001 H.S
Number of Lesion 1.90 1.05 0.85 0.447 0.224 45 0.001 H.S
Fairness Scoring / Grading 16.15 10.65 5.5 2.852 1.927 34 0.001 H.S
Rukshata   0.55 0 0.55 0.510 0 100 0.001 H.S
Snigdhata 0.45 0 0.45 0.510 0 100 0.001 H.S

BT- Before Treatment; AF - After; H.S - Highly Significant

Discussion

Vyanga is one of the hyperpigmentary disorder, which is noticed certain areas over the face. On the basis of the symptoms it is co-related with Melasma. Vyanga is one among the 44 Ksudra Rogas. Charaka mentioned it as Raktapradoshaja Vikara and Sushruta explained under Ksudraroga, Acharya Vagbhata described Vyanga in Ksudra Roga Adhyaya including types of Vyanga. Vyanga is skin pigmentary disorder specially affects to the facial skin.

Melasma is one of the Hyperpigmentary disorder that causes the great impact on the life of patients. In Ayurveda Vyanga comes under Ksudra Roga as it is having Alpa Nidhana, Alpa Lakshana and Alpa Chikitsa. In modern science also the information about pathogenesis of Melasma is still very limited.

Manasika Nidanas like Shoka, Krodha, Ayasa and Bhaya are the main Nidanas for


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the manifestation of Vyanga Roga, these Nidanas intern vitiates Vata Dosha along with Pitta Dosha. Mental stress is the main causative factor for the causation of Vyanga Roga. Sun exposure, use of cosmetics, use of Medications, are the main causes of for the causation of Melasma. Stress is one of the influencing factor for the development of Melasma. Profound emotional stress implicated the release of MSH by the hypothalamus as a cause.

Clinical features are based on the shape of Lesions (Mandala), Unelevated pigmentation of lesion (Tanuka), Colour of Lesion (Shyva), and pain (Neeruja).

Due to the Manasika Nidhanas like Shoka, Krodha, Ayasa, Bhaya vitiates Vata and Pitta Doshas, exposure to sunlight, hormonal imbalances are also the causative factors for Vyanga Roga, these Nidanas intern causes the Rasavaha, Raktavaha and Manovaha Sroto Dusti. And gets lodges in the facial skin by producing Shyava, Neeruja, Tanuka, Mandalas over the face.

Twacha is the Adhistana for Varna and also site of Rasadhatu, by Ashraya, Ashrayee Bhava, it can be concluded that Kapha is also involved, if the subjects presents the symptom Kandu (itching). This can be suggested that there is a involvement of Kaphadosha.

The pathogenesis of melasma is multifactorial and not entirely characterized. A direct relationship with female hormonal activity appears to present, because Melasma occurs more frequently in females than males and commonly develops or worsens with use of oral contraceptive pills, and one half melasma cases present initially during pregnancy, due to the increased level of progesterone and oestrogen. The most important factor in the development of melasma is due to exposure to sunlight. UV light induces production of oxygen species in the skin, which subsequently promotes melanogeness.

The treatment modalities for Vyanga are Bahirparimarjan and Sodhana Chikitsa basically aims to correct the vitiated Doshas, Dushyas, Agnivikriti, Srotodusti. The treatment modalities mentioned are applied to improve Vaivarnyata of the skin. Khadira Churna which is having the property of Raktashodha and Kustaghna. It is advised internally by Yogaratnakar.

Arjuna Twak Churna Lepa with Madhu over the hyperpigmented patches along with Khadira Churna given for 21 days for group A. Arjuna Twak is having Kashaya Rasa, Laghu, Ruksha Guna and Veerya is Sheeta and its having Pittashamaka and Rakta Prasadak properties. Kashya Rasa encounters the Pitta and Rakta Dosha and removes the Twak Vaivarnyata. Sheeta Veerya of the drug pacifies the Pitta Dosha. Prasadan property of Sheeta Veerya purify the accumulated Doshas. The Twak Prasadak and Raktaprasak properties encounters the locally accumulated Doshas.

Madhu with its Tridosha Prashamana property may affect Doshas which are vitiated in Vyanga (Vata, Pitta). Madhu with its Yogavahi Guna it enhances the property of Arjuna Twak Churna. The topical application of the medicine aims at providing the high concentrations locally. Madhu with its Prasadana property it improves the skin complexion as it is having the Varnyakar property. Madhu has not showed any skin reactions so it can be used safely.

Khadira Churna internally it is having Tikta Kashaya Rasa, Sheeta Veerya, Laghu Ruksha Guna, are the properties of Agneya Dravya, which are responsible for Prabha and Varna. It alleviates Pitta Kapha. Charak Acharya mentioned it as best Kustahara Dravya in Agraprakarana. The Churna has ingredients like catechin catechu tannic acid. There by Khadira helps for better absorption. it has properties like Kandugha, Kusthagna. Kakshya rasa of Khadira holds Twakprasadak and Raktaprasadka properties which ultimately leads to Raktaprasadana and reduction in Vaivarnyata of skin.

Yasthimadhuchurna Lepa with water over the hyperpigmented patches along with Khadira Churna. Yasthimadhu is having Madhura Rasa, Guru Snigdha Guna and Sheeta Veerya. And its Vatapitta Shamaka. its properties are Varnya Kandughna. Madhura Rasa pacifies the Vata Pitta and Snigdha and Guru Guna are responsible for Mardava and Varna Prasadana. Sheeta Veerya has property of Rakta Prasadana. By its properties like Kandughna and Varnya it reduces the Vaivarnyata of the facial skin.

Thus, it can be concluded that Arjuna Twak Churna Lepa and Yasthimadhu Churna Lepa along with Khadira Churna has moderately effect on Vynga Roga.


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Conclusion

Arjuna Twak Churna Lepa and Yastimadhu Churna Lepa along with Khadira Churna are found to be moderately effective treatment in melasma. Female patients are prone more than male patients may be due to hormonal changes post menopause and usage of oral contraceptives), stress and strain of day today life. Arjuna Twak Churna Lepa along with Khadira Churna with its Kashya Rasa and Sheeta Veerya, and properties like Twachya and Pittashamak and Raktaprasadak properties may reduce the Vaivarnyata of skin and found significant result. Yasthimadhu Churna Lepa along with Khadira Churna with its Madhura Rasa and Seeta Veerya and has the Varnyakar and Rakta Shodhak property reduces the Vaivarnyata of the skin and found significant results. Application of Lepa helps for micro absorption of the chemical constituents and improves discolouration of the lesion.

Reference

1. Agnivesh, Charak Samhita, By Acharya Vidyadhar Shukla and Prof. Ravidatta Tripati, Sutrasthana, 30/26, Vol 1, Chaukambha Krishnadas Sansthan, Delhi, Reprint 2009, page no.447.

2. Sushruta’s, Sushruta Samhita by Kaviraj Ambikadatta Shastri, Nidhansthana, Kshudra Roga, Nidhana Sthana, 13/46, Vol 1, Choukambha Sanskrit Sansthan, Varanasi, edition reprint 2018, pg.no.373.

3. Vaghbata, Astanga Sangrah, by Kaviraj Atridev Gupta, Uttar Sthana, Kshudra Roga, vol 2, Choukambha Krishnad Asacademy, Varanasi, sloka no 30, page no.325.

4. Agnivesh, Charaka Samhita by Acharya Vidhyadharshukla and prof. Ravidatta Tripati, Sutrasthana, Vividhasitapitiyaadhyaya 28/12, vol 1, Chowkambha Krishnadas Pratisthan, Delhi, reprint 2017, page no.498.

5. https://www.ncbi.nlm.nih.gov./pmc/articles/PMC55747Retrived on 2510/3/2020

6. Paul K. Taylorsc. Dermatology for skin color, New York, McGraw Hill Companies, 2009

7. Sharangadhara, Sharangadhara Samhita, by Prof. Dwarakaprasad Mishri Lepa Vidhi Adhyaya 11/71, Choukhamba Sanskrit Series Office, Varanasi, edition first, 2010, page no. 480.

8. Agnivesh, Charak Samhita by Acharya Vidhyadhar Shulka and prof. Ravidatta Tripati, Sutra Sthana, vol 1, Shadvirechanashatasritiya Adhyaya sloka no.4, Chaukambha Krisnadas Prathisthana, Delhi, reprint 2017, page no. 82.

9. Yogaratnakar By Lakshmipati Shastri, Uttarardha, Kusta Chikitsa Adhyaya, Chaukambha Prakashana, Edition: Reprint 2015, sloka no.1 page no.219.

10. Dravyaguna Vignan of Nighantu Adarsh By Bapalal G Vaidya, vol. 1 Choukambha Bharti Academy, edition third, 200


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