An open labelled clinical study to evaluate the effect of Manjistha Lepa on Savarnikarana of Vrana Vastu w.s.r. to scar

Sushma Sv; Rakesh RN; Sahana Kamath

doi:10.21760/jaims.8.10.2

An open labelled clinical study to evaluate the effect of Manjistha Lepa on Savarnikarana of Vrana Vastu w.s.r. to scar

Sushma Sv^1*, Rakesh RN², Kamath S³

DOI:10.21760/jaims.8.10.2

^1* Sushma Sv, Third Year Post Graduate Scholar, Dept Of Pg Studies In Shalya Tantra, Sri Dharmasthala Manjunatheshwara College Of Ayurveda, Udupi, Karnataka, India.

² Rakesh RN, Associate Professor, Dept of PG Studies in Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

³ Sahana Kamath, Assistant Professor, Dept of PG Studies in Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

Vranavastu is the scar formed on the skin after the Vrana is healed. It remains for the rest of life even after the healing of Vrana is completed.[1] This Vranavastu forms discoloration of skin, to treat this discoloration of skin various procedures are explained in Vaikrutapaha Chikitsa[2] of Vrana, which helps to restore the normal skin color after healing. Cosmetology[3] was given utmost importance even in the Vedic period. It emphasizes not only on physical beauty but also on psyche beauty for the purpose of attaining an admirable personality. Reference of Manjishta[4] used in skin disorders is mentioned in Charaka Samhitha under Varnya Gana. This study is carried out in a single group of 30 diagnosed cases of Vrana vasthu. This study is based on clinical evaluation of effect of Manjishta Lepa in Vrana Vasthu. Obtained observations and results have been analyzed in terms of Ayurveda and Contemporary science.

Keywords: Manjistha, Savarnikarana, Vrana, Scar

Corresponding Author	How to Cite this Article	To Browse
Sushma Sv, Third Year Post Graduate Scholar, Dept Of Pg Studies In Shalya Tantra, Sri Dharmasthala Manjunatheshwara College Of Ayurveda, Udupi, Karnataka, India. Email:	Sushma Sv, Rakesh RN, Kamath S, An open labelled clinical study to evaluate the effect of Manjistha Lepa on Savarnikarana of Vrana Vastu w.s.r. to scar. J Ayu Int Med Sci. 2023;8(9):14-20. Available From https://jaims.in/jaims/article/view/2682

Introduction

Ayurveda includes every aspect of a living thing's over all physical and mental wellbeing. The definition of Ayu includes the body, sense organs, mind, and soul.

Shalya Tantra is one among eight branches of Ayurveda, sheds light on various Surgical and Para surgical interventions for the treatment of various diseases. Acharya Sushrutha gave much more importance to the treatment of Vrana.

Vrana Vastu is the scar formed on the skin after the Vrana is healed. It remains for the rest of life even after the healing of Vrana is completed. This Vrana Vastu forms discoloration of skin, to treat this discoloration of skin various procedures are explained in Vaikrutapaha Chikitsa of Vrana, which helps to restore the normal skin color after healing. Cosmetology was given utmost importance even in the Vedic period. It emphasizes not only on physical beauty but also on psyche beauty for the purpose of attaining an admirable personality.

Skin being largest organ of the body not only attracts attention directly. But also acts like first line of body defense.^[5] Which is also prone to wounds and injuries commonly leading to scar or post inflammatory pigmentation, this acquired skin disorder can also be a complication of laser therapy. The prevalence rate of scar is >70%.^[6]

Wound healing^[7] is a series of mechanism which may lead to altered skin pigmentation causing unpleasant appearance and cosmetic concern by formation of scar hence management of scars and pigmentations are important. Mismanaged scar can develop into a hypertrophied scar or a keloid. As we know the cosmetic procedures in the present era are mostly invasive, costlier with considerable side effect and are not so feasible to common man.^[8] So there is need of Ayurvedic remedies in cosmetology which will be easily available with good outcomes and devoid of side effects.

Scar are a natural and normal part of healing following an injury to the skin. Vranavastu^[9] was mentioned by Sushruta which is formed after wound healing. The context of Vaikrutapaha Chikitsa of Shasti Upakrama like Pandu Karma and Krishna Karma^[10] was found in Sushrutha Samhitha and the concept of Savarnikarana was mentioned by Acharya Charaka^[11] and Vagbhata.^[12]

Manjishta^[13] used in skin disorders is mentioned in Charaka Samhitha under Varnya Gana. It also has Vranahara, Varnya and Raktha Shodhaka^[14] properties.

Aims and Objectives

To assess the efficacy of Manjistha Lepa in Savarnikarana of scars

Materials and Methods

Literary Source

The Literary data of Vrana Vastu and Manjishta Churna was collected from Ayurvedic texts, contemporary reputed published journals and retrorespective studies.

Sample Source

30 patients diagnosed with Scar or Pigmentation on skin resulted due to ulcers or wounds are selected from the IPD and OPD of S.D.M Ayurveda Hospital, Udupi.

Drug Source

Manjishta in dry form was identified and Churna was prepared in SDM Pharmacy Udupi.

Method of collection of data

30 subjects fulfilling diagnostic and inclusion criteria was selected and taken for the clinical trial with consent.

Study Design

Single group open labelled clinical study with pretest and posttest design.

Sample Size

30 patients fulfilling inclusion criteria was selected.

Diagnostic Criteria

Patients were investigated according to the proforma prepared for the study.
Patients diagnosed with scar or pigmentation of skin after wound healing.
The age group of 18-60 years was selected.
Size of the scar measuring upto 25sqcm.

Inclusion Criteria

Patients are selected in the age group of 18-60 years.

Patients with scar or pigmentation of skin after wound healing.
Post-operative scar
Size of the scar measuring up to 25sqcm.

Exclusion Criteria

Malignancy.
Keloid.
Patients suffering from skin disease like leucoderma, leprosy was excluded.

Method of preparation of Lepa

Dry Manjishta roots was collected and pounded into fine powder. This powder was mixed with sufficient quantity of water to make into the form of Lepa.

Intervention

Method of Application

The area of scar selected was cleaned with normal saline and dried with a sterile gauze. The freshly prepared Manjishta Lepa was applied over the scar, with thickness of ½ Angula (0.75cm)^[15] in opposite to the direction of hair follicles and was kept until it dries up.

Duration of treatment

The Lepa was applied once daily for a duration of 28 days.

Manjistha Roots

Manjistha Churna

Observation period

The patients were observed on 0^th, 7^th, 14^th and 28^th
Follow-up of the patient was done after 2weeks.

Study Period				Follow Up
Day 0	Day 7	Day 14	Day 28	Day 42
BT	AT-1	AT-2	AT-3	AT-4

Assessment Criteria

Subjective parameters

Pain	Vancouver Scar Scale[16]
None	0
Occasional	1
Requires medication	2
Itching
None	0
Occasional	1
Requires medication	2

Objective parameters

Pigmentation	Vancouver Scar Scale[16]
Normal	0
Hypo pigmentation	1
Mixed pigmentation	2
Hyperpigmentation	3
Colour of skin	Visual analog scale[17]
Perfect	1
Slight mismatch	2
Obvious mismatch	3
Gross mismatch	4

To compare the color of the scar with normal skin color by using the above parameters with the help of Fitzpatrick scale^[18]

Shape of scar	Grading
Remains unchanged	Grade 3
Reduction in shape/ size from 25 % - 50%	Grade 2
Reduction in shape/ size from 50% - 75%	Grade 1
Reduction in shape/ size > 75%	Grade 0

Subjective parameter within the group

Itching on the scar - Wilcoxan sign rank

Table 1: Comparison of Mean of Itching of the Scar

Parameter	Mean Score	P Value
Itching of scar 0-7th day	0.23	1.0
Itching of scar 14th day	0.20	0.31
Itching of scar 28th day	0.03	0.06
Itching of scar 42nd day	0.0	0.03

Objective parameter within the group

Colour of the scar - Wilcoxan sign rank

Table 2: Comparison of Mean of Colour of the Scar

Parameter	Mean Score	P Value
Colour of scar 0 - 7th day	3.03.	1.0
Colour of scar 7- 14th day	2.26	0.00
Colour of scar 14 - 28th day	1.93	0.0
Colour of scar 28 - 42nd day	1.03	0.0

Shape of the scar - Wilcoxan sign rank

Table 3: Comparison of Mean of shape of the Scar

Parameter	Mean Score	P Value
Shape of scar 0- 7th day	3.0	1.0
Shape of scar 7- 14th day	2.1	0.0
Shape of scar 14- 28th day	1.7	0.0
Shape of scar 28-42nd day	0.9	0.0

Comparing the results before and after the intervention using Wilcoxon signed rank test, reveals that it is statistically highly significant with the p value being 0.00

Paired T Test

Objective Parameter - Within the group

Size of the scar - Paired t test

Table 4: Observations on Area of the Scar after Application of the Lepa

Size of the scar	Mean Score	P Value
Size of the scar BT	7.55	0.20
Size of the scar 0-7th day	7.49	0.20
Size of the scar7-14th day	4.50	0.00
Size of the scar 14-28th day	2.98	0.00
Size of the scar 28- 42nd day	1.64	0.00

Comparing the results before and after the intervention using Paired T test, reveals that it is statistically highly significant with the p value being 0.00

Observations on Size of the Scar after Application of the Lepa

In present study out of 30 patients, after comparing before and after treatment. The p value for color of scar after treatment on 7^th day for the variable size of scar using Wilcoxon signed rank test, results obtained was found statistically was not significant as the p value was 0.20.

The mean color of the scar was reduced after the treatment on 14^th, 28^thand 42^nd day was found statistically highly significant with p value 0.00.

There was Gradual reduced in size of the scar during the course of treatment with the help of Manjishta Lepa.

Lepa

Observations on color of the Scar after Application of the Lepa

The mean color of the scar was reduced after the treatment on 14^th, 28^thand 42^nd day was found statistically highly significant with p value 0.0.

Manjistha is included under Varnya Dashemani. Ushna Veerya accelerates the action of Bhrajak Pitta (Agni), which is responsible for skin color and luster. Due to Tikta Rasa and Katu Vipaka have Kushthaghna property and Kashaya Rasa has Varnya action.

Observations on itching of the Scar after Application of the Lepa

In present study out of 30 patients, after comparing before and after treatment. The p value for color of scar after treatment on 7^th, 14^th and 28^th day for the variable size of scar using Wilcoxon signed rank test z value is results obtained was found statistically was not significant as the p value was 1.0, 0.31, 0.06

The itching of the scar was reduced after the treatment on 42^nd day was found statistically highly significant with p value 0.03.

Kandu is the symptom of Kapha mainly but it is due to dryness of skin and Vata dosha is the main reason behind it. Madhura Rasa of Manjistha pacifies the Vata dosha relieving Kandu. Kandughana action is performed by Tikta Rasa.

Observations on shape of the Scar after Application of the Lepa

In present study out of 30 patients, after comparing before and after treatment. The p value for shape of scar after treatment on 7^th day for the variable size of scar using Wilcoxon signed rank test and the results obtained was found statistically not significant as the p value was 1.00.

The mean shape of scar was reduced after the treatment on 14^th, 28^th and 42^nd day and was found statistically highly significant with p value 0.000.

The shape of scar during treatment was found to improve gradually and found to be statistically highly significant after 42^nd day with p value 0.00.

Rakta Prasadana by Tikta Rasa of Manjistha along with other factors contributes to nature the skin and maintain its proper luster and texture and prevent the Vairupya / shape caused due to tearing of skin.

Conclusion

Cosmetology was given utmost importance even in the Vedic period. It emphasizes not only on physical beauty but also on psyche beauty for the purpose of attaining an admirable personality. Wound healing is a series of mechanism which may lead to altered skin pigmentation causing unpleasant appearance and cosmetic concern by formation of scar, hence management of scars and pigmentations are important. So, there is need of Ayurvedic remedies in cosmetology which will be easily available with good outcomes and devoid of side effects. Using Manjishta Lepa in scar has proven effective both clinically and statistically by reducing itching, shape, size and colour of the scar. It also has properties like Vranahara, Varnya and Raktha Shodhaka. The treatment is effective in reducing the size of the scar in almost patients and 78% of patients had reduced in size of the scar. Hence this less interventional, economical method which helps to bring back normal colour associated with least adverse effect.

Before Treatment

After Treatment

Before Treatment

After Treatment

References

1. Trikamji VJ, editor. Commentary Nibanda Sangraha of Dalhana of Sushrutha Samhita of Sushrutha, Sutra Sthana; Vranasrava Vigyaniyam Adhyaya: Chapter 22, Verse 3. Varanasi: Chaukambha Surbharati Prakashan; 2014;107.

2. Trikamji VJ, editor. Commentary Nibanda Sangraha of Dalhana of Sushrutha Samhita of Sushrutha, Chikitsa Sthana; Dvivraniya Chikitsitam Adhyaya: Chapter 1, Verse 8. Varanasi: Chaukambha Surbharati Prakashan; 2014;397.

3. Trikamji VJ, editor. Commentary Nibanda Sangraha of Dalhana of Sushrutha Samhita of Sushrutha, Chikitsa Sthana; Dvivraniya Chikitsitam Adhyaya: Chapter 1, Verse 94. Varanasi: Chaukambha Surbharati Prakashan; 2014;405.

4. Kaur M. Care in Ayurveda. Ayoham Journal 2010-2011;14.

5. Behl PH, Agarwal A, Srivastav G. Practice of dermatology, 10th ed. New Delhi: CBS publishers & distributors; 2007;29.

6. Nouveau S, Agarwal D, Kohli M, Bernerd F, Misra N, Nayak CS. Skin Hyperpigmentation in Indian Population; Insights and Best Practice, Indian J Dermatol, 2016;61(5):487-95.

7. Shenoy KR, Shenoy A. Manipal manual of surgery, 4th edition. New Delhi: CBS publishers & distributers Pvt. Ltd; 2014;5.

8. Williams NS, Bulstrode CJK, O Connell PR, editors. RCG Russell Bailey & Loves short practice of surgery, 24th ed. London: Holder Arnold; 2004;258.

9. Trikamji VJ, editor. Commentary Nibanda Sangraha of Dalhana of Sushrutha Samhita of Sushrutha, Sutra Sthana; Vranaprashnam Adhyaya: Chapter 21, Verse 40. Varanasi: Chaukambha Surbharati Prakashan; 2014;107.

10. Trikamji VJ, editor. Commentary Nibanda Sangraha of Dalhana of Sushrutha Samhita of Sushrutha, Chikitsa Sthana; Dvivraniya Chikitsitam Adhyaya: Chapter 1, Verse 94. Varanasi: Chaukambha Surbharati Prakashan; 2014;405.

11. Trikamji AJ, editor. Commentary Ayurveda Dipika of Chakrapanidatta of Charaka Samhitha of Charaka, Chikista Sthana; Dvivraniya Chikistam Adayaya: Chapter 25, Verse 116. Varanasi: Chaukambha Surbharati Prakashan; 2019;596.

12. Paradakara BHS, editor. Commentary Sarvangasundara of Arunadatta and Ayurveda Rasayna of Hemadri of Ashtanga Hrudaya of Vagbhata, uttara sthana; vrana pratisheda adhyaya: chapter 25 verse 61, Varanasi: Chaukamba Surabharati Prakashana; 2020;868.

13. Trikamji AJ, editor. Commentary Ayurveda Dipika of Chakrapanidatta of Charaka Samhitha of Charaka, Sutra Sthana; Shadvirechana Shatasriteeya Adayaya: Chapter 4, Verse 8. Varanasi: Chaukhambha Surbharati Prakashan; 2019;32.

14. Hegde PL, Harini. Text Book of Dravya Guna Vijnana. Chaukhambha publications Volume 2, 2014;184.

15. Trikamji VJ, editor. Commentary Nibanda Sangraha of Dalhana of Sushrutha Samhita of Sushrutha, Chikitsa Sthana; Dvivraniya Chikitsitam Adhyaya: Chapter 1, Verse 6. Varanasi: Chaukhambha Surbharati Prakashan; 2014;397 Pp.824.

16. Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehability. 1995;16(5):535-8.

17. Micomonaco DC, Fung K, Mount G, et al. Development of new visual analog scale for the assessment of area of scar. J Otolaryngol head neck Surg 2009;38(1):77–89.

18. Fitzpatrick TB. The validity and practically of sun reactive skin types I through vi. Archives of Dermatology. 1988;124(6):869-871.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2023-08-11	2023-08-21	2023-09-08	2023-09-18	2023-09-23
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None declared	Nil	Yes	20.25

Research Article

Effect of Manjistha Lepa

Journal of Ayurveda and Integrated Medical Sciences

An open labelled clinical study to evaluate the effect of Manjistha Lepa on Savarnikarana of Vrana Vastu w.s.r. to scar

Sushma Sv^1*, Rakesh RN², Kamath S³

Introduction

Aims and Objectives

Materials and Methods

Conclusion

References

Research Article

Effect of Manjistha Lepa

Journal of Ayurveda and Integrated Medical Sciences

An open labelled clinical study to evaluate the effect of Manjistha Lepa on Savarnikarana of Vrana Vastu w.s.r. to scar

Sushma Sv1*, Rakesh RN2, Kamath S3

Introduction

Aims and Objectives

Materials and Methods

Conclusion

References

Sushma Sv^1*, Rakesh RN², Kamath S³